QUICK REVIEW SERIES for •

4th Year
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 QUICK REVIEW SERIES for II

PROSTHODONTICS
4th Year

J J yotsna Rao
BDS, MDS, PGCOI (MAHE), F ISOI
Director, SRS Dental Exams Academy, Bengaluru
Ex-Professor, Department of Oral and Maxillofacial Surgery
The Oxford Dental College, Hospital and Research Centre
Bengaluru, INDIA

ELSEVIER
ELSEVIER
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Quick Review Series for BDS 4th Year: Prosthodontics, Rao J Jyotsna

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 Dedicated
to
SRI GURU RAGHAVENDRA SWAMI
(The eternal power who has showered his blessings on me to successfully
complete the entire range of Quick Review Series for BDS)
This page intentionally left blank
---------------------- -,( Foreword )

I am extremely happy to pen a few words about this conscientiously written book. It is common knowledge that books
play a major complementary and contributing role in any educational process, where they are envisioned to facilitate
self-learning beyond classroom exercises.
This book of Quick Review Series for BDS 4th Year: Prosthodontics authored by Dr J JYOTSNA RAO is presented
with such a systemic approach that it demonstrates her consummate skill in preparing students for examinations. It is good
to see that she has shared her vast experience in academics with the students through this book.
When going through the pages of this book, I found that the author has made sincere attempt to present the subject of
Prosthodontics as per the syllabus of DCI to fulfill the long-term need of a concise quick review book with best standards,
simple language and required depth of explanation of the subject, through questions and answers of various university
examinations.
Designing such a book is a challenging task, especially if it is to be concise and comprehensive in scope. Such a
version demands wise sifting, prudent pruning and meaningful condensing of the enormous and variegated knowledge
base of BDS 4th year subjects.
This outstanding resource is perfect for those studying in final BDS. The easy to understand text material, serves as
both preparatory tool at the start of study course providing roadmap of the subject to be learnt, and at the end of the course
it helps in rapid review and recapitulation of what is learnt.
I am confident that this book is undeniably appropriate for exam-going UG students who are craving for thorough
review of subjects in a short period.

Regards

Dr MS Gowd
MDS (Born), FICD, FACD, FPFA, MICP (USA)
Hon' Dental Surgeon, Governor of Telangana
Past President, Indian Prosthodontic Society
Former Principal, Prof and Head, Dept of Prosthodontics
Army College of Dental Sciences, Secunderabad, Telangana

vii
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 Preface J
This book is a result of my close interaction with the students. There is a lot of information available to students in various
textbooks, which is not only voluminous but also time consuming and daunting to read. This book is not only a replacement
of any Prosthetic Dentistry, but is written keeping in mind the needs of students and their expectations from a book for the
purpose of excelling in the exams.
To excel in a subject one has to not only understand the same but also remember and present it in a systematic way in
the examinations. Keeping all these needs in view the subject has been condensed into a simple and comprehensible text.
The book is planned in a meticulous manner and I have endeavoured comprehensively to refer and include relevant
information from the standard textbooks. Though written in a question- and- answer format, this book is arranged in a
logical sequence for the purpose of better recapitulation. This makes it easy for the students to rapidly review the entire
subject and also recollect whatever they had studied during the entire final year of BDS.
This book is primarily intended for undergraduate students, but can also be used as a quick reference book by
postgraduate students also to recollect and review the subject quickly.
J Jyotsna Rao
drjjrao@gmail.com

ix
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-------------------- <(Acknowledgements)

First of all I thank almighty for his blessings without which this work would not have been possible.
I would like to first thank my father Mr J Sudharshan Rao who is the key person behind all my successful endeavours.
I am thankful to my mother Mrs S Sujatha Laxmi for her unforgettable sacrifices and choicest blessings. My warmest
regards to my husband Mr K Vinayak Rao for his constant support to enhance my software skills.
My thanks and love to my son Master K Raghasai without whose cooperation this work would not have been possible.
I am thankful to my brother Mr J Jayakrishna for his valuable constructive suggestions.
My sincere thanks is to Dr P Balreddy Principal, Professor and Head, Department of Oral and Maxillofacial Surgery,
Government Dental College and Hospital, Hyderabad, for his blessings. I wish to thank Dr BK Reddy, Ex-Principal,
Government Dental College , Hyderabad and Meghana Dental College, Nizamabad for his blessings and advice.
My sincere thanks to Dr Bhaskar Y, Dr P Chidambar, Dr Laxmikanth, and Mr Kiran (Librarian, Oxford Dental College,
Bangalore) and Narayana Swami for their invaluable support in collecting previous years' question papers from various
universities.
I would like to specially thank Dr Parmar Adithi Kiritikumar and Dr Priyanka Das, Dr Saniyara Khanam and
Dr Mardidiam Lanong for their valuable contribution in preparing manuscript. I would like to extend my regards to
Dr Rajini and P Nethravathi for their help in correction of manuscripts.
Thanks to Elsevier India, especially Dr Lalit Singh, Mrs Nimisha Goswami, Mr Anand K Iha and all other team
members for their active contribution in publishing this book.
I would like to take this opportunity to thank all those people who, directly or indirectly were instrumental in successfully
bringing out this book. Last but not the least, I acknowledge all my friends and colleagues for their best wishes to boost my
morale.

xi
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--------------------- - <( Contents )

Foreword vii
Preface ix
Acknowledgements xi

Section I TOPIC WISE SOLVED QUESTIONS OF PREVIOUS YEARS 1

PART I: COMPLETE DENTURES
Topic 1 Introduction to Complete Dentures 3
Topic 2 Diagnosis and Treatment Planning 13
Topic 3 Diagnostic Impressions in CD and Mouth Preparation for
CD and Objective of Impression Making 30
Topic 4 Primary Impression in Complete Dentures and Lab
Procedures Prior to Master Impression Making 41
Topic 5 Secondary Impression in Complete Dentures and
Lab Procedures Prior to jaw Relation 50
Topic 6 Maxillomandibular Relations 56
Topic 7 Lab Procedures Prior to Try-in 74
Topic 8 Lab Procedures Prior to Insertion and Complete
Denture Insertion 101
Topic 9 Relining and Rebasing in Complete Dentures 123
Topic 10 Special Complete Dentures and Miscellaneous 128

PART 11: FIXED PARTIAL DENTURES

Topic 1 Introduction to Fixed Partial Dentures 141
Topic 2 Parts and Design of Fixed Partial Dentures 147
Topic 3 Occlusion in Fixed Partial Dentures 161
Topic 4 Types of Abutments 171
Topic 5 Tooth Preparation 177
Topic 6 Types of Fixed Partial Dentures 194
Topic 7 Impression Making in Fixed Partial Dentures 196
Topic 8 Temporization or Provisional Restorations and Lab Procedures
Involved in Fabrication of FPO 204
Topic 9 Cementation of Fixed Partial Dentures and Miscellaneous 210
Topic 10 Maxillofacial Prosthetics and Implant Dentistry 225

xiii
 Contents

PART 111: REMOVABLE PARTIAL DENTURES

Topic 1 Introduction, Treatment Planning, and Mouth Preparation 233
Topic 2 Diagnosis Planning and Mouth Preparation 239
Topic 3 Major and Minor Connectors 244
Topic 4 Rests and Rest Seats 257
Topic 5 Direct and Indirect Retainers 260
Topic 6 Denture Base Considerations 274
Topic 7 Principles of RPO Design 276
Topic 8 Surveying and Preparation of Mouth for RPO 281
Topic 9 Impression Materials and Procedures for RPO 289
Topic 10 Support for the Distal Extension Denture Base, Occlusal
Relationship for RPO, and Laboratory Procedures and
Work Authorization for RPO 293
Topic 11 Correction of RPDs, Repairs and Additions to RPO,
Relining and Rebasing the RPO and Miscellaneous 296

Section 11 MULTIPLE CHOICE QUESTIONS 299

Section 111 PREVIOUS YEARS' QUESTION BANK 311

---------------------- -<( Section I )

Topic Wise Solved Questions

of Previous Years

PART I: COMPLETE DENTURES

Topic 1 Introduction to Complete Dentures 3
Topic 2 Diagnosis and Treatment Planning 13
Topic 3 Diagnostic Impressions in CD and Mouth Preparation for
CD and Objective of Impression Making 30
Topic 4 Primary Impression in Complete Dentures and Lab
Procedures Prior to Master Impression Making 41
Topic 5 Secondary Impression in Complete Dentures and
Lab Procedures Prior to Jaw Relation 50
Topic 6 Maxillomandibular Relations 56
Topic 7 Lab Procedures Prior to Try-in 74
Topic 8 Lab Procedures Prior to Insertion and Complete
Denture Insertion 101
Topic 9 Relining and Rebasing in Complete Dentures 123
Topic 10 Special Complete Dentures and Miscellaneous 128

PART 11: FIXED PARTIAL DENTURES

Topic 1 Introduction to Fixed Partial Dentures 141
Topic 2 Parts and Design of Fixed Partial Dentures 147
Topic 3 Occlusion in Fixed Partial Dentures 161
Topic 4 Types of Abutments 1 71
Topic 5 Tooth Preparation 177
Topic 6 Types of Fixed Partial Dentures 194
Topic 7 Impression Making in Fixed Partial Dentures 196
Topic 8 Temporization or Provisional Restorations and Lab Procedures
Involved in Fabrication of FPO 204
Topic 9 Cementation of Fixed Partial Dentures and Miscellaneous 210
Topic 10 Maxillofacial Prosthetics and Implant Dentistry 225

PART Ill: REMOVABLE PARTIAL DENTURES

Topic 1 Introduction, Treatment Planning, and Mouth Preparation 233
Topic 2 Diagnosis Planning and Mouth Preparation 239
Topic 3 Major and Minor Connectors 244
Topic 4 Rests and Rest Seats 257
Topic 5 Direct and Indirect Retainers 260
Topic 6 Denture Base Considerations 274
Topic 7 Principles of RPO Design 276
Topic 8 Surveying and Preparation of Mouth for RPO 281
Topic 9 Impression Materials and Procedures for RPO 289
Topic 10 Support for the Distal Extension Denture Base, Occlusal
Relationship for RPO, and Laboratory Procedures and
Work Authorization for RPO 293
Topic 11 Correction of RPDs, Repairs and Additions to RPO,
Relining and Rebasing the RPO and Miscellaneous 296
---------------------- -<( Section I )
Topic Wise Solved Questions
of Previous Years
Part I
Complete Dentures
------------------ - <( Topic
Introduction to Complete Dentures
LONG ESSAYS
Q. 1. Define edentulism and explain briefly the mecha-
nism of complete denture support in edentulous state.
Or
Enumerate the reasons for loss of teeth. What are the
consequences of loss of teeth? What are the methods of
prosthodontic replacements?
Ans.
Edentulism
Edentulism is the state of being edentulous, i.e., without
natural teeth.
Edentulous state represents a compromise in mastica-
tory system integrity along with adverse functional and
aesthetic sequelae.
Causes of Edentulism/Reasons for Loss of Teeth
• Traumatic injuries resulting from accidents, sports, etc.
• Loss of teeth due to dental diseases like caries, periodontal
disease, and failed endodontic treatment.
1 )
• Pathosis like cysts and tumours cause destruction of
alveolus and tooth loss.
• Prophylactic tooth extraction done for tumour radiation
therapy.
• Extraction of grossly malaligned teeth.
• Congenitally missing and failure of eruption of teeth.
• Iatrogenic extractions.
Mechanism of Complete Denture Support
in Edentulous State
A. Masticatory loads
Natural dentition: 44 lb (20 kg).
Complete denture: 13-16 lb (6-8 kg).
• Depends on consistency of food chewed. Edentulous
patients are instructed to chew softfood, which places
lesser load on supporting tissues within the tolerance
limit of tissues.
B. Area of support
• Less area of mucosa] support available as compared to
natural dentition.
3

Edentulous maxillae: 22.96 cm2
Edentulous mandible: 12.25 cm2
Natural dentition of both jaws: 45 cm2
• As the residual ridge resorbs, the denture-bearing area
progressively decreases alongwith its tolerance for denture
wearing, which further decreases if any systemic disease
such as anaemia, diabetes, and hypertension is present.
C. Residual ridge
• The residual ridge is a portion of the residual bone and
its soft tissue covering remains after the removal of teeth.
• It comprises of denture-bearing mucosa, submucosa,
periosteum, and underlying residual alveolar bone. This
serves as foundation for dentures.
• Dentulous state-bone receives tensile loads with large
supporting surface area.
• Edentulous state-residual ridge receives vertical, di-
agonal, and horizontal loads with small support area and
there is very less adaptation of supporting tissues to
functional requirements resulting in bone resorption.
• Further, the complete dentures move over their underly-
ing mucosa and bone during function, which causes
tissue damage.
Factors which increase denture retention and prevent
ridge resorption (Brill 1967)
• Maximal extension of denture bases.
• Maximal area of contact between the denture base and
mucous membrane.
• Intimate contact of denture base and its basal seat.
• Oral musculature-buccinator, orbicularis oris, and
intrinsic and extrinsic muscles of tongue (balancing of
forces between that of tongue and perioral muscula-
ture).
• Proper impression technique and design of labial, buc-
cal, and lingual polished surface of denture and dental
arch form.
D. Psychological effect of edentulous state on
retention
• Edentulous state leads to adverse psychological effect
on patients, which may decrease salivary secretion and
thus decrease retention.
• Further, due to residual ridge reduction and diminished-
neuromuscular skills and dental reflex adaptation, and
pain and initial discomfort in wearing new dentures in
edentulous state, there is increase in parafunctional
movements placing more loads on supporting tissues
and more destruction.
• Patient complains of sore tongue and develops a habit of
thrusting the tongue forward against the denture.
• Electromyography shows strong response of mentalis
and lower lip in complete denture-wearers with im-
paired retention and stability of lower denture.
Quick Review Series for BOS 4th Year: Prosthodontics
• Stress also increases the activity of temporalis and mas-
seter muscles, which causes tooth contact and pressure
and soreness of underlying mucosa due to diminished
blood supply.
• Complete dentures should be designed, so that the oc-
clusal surface allow both functional and parafunctional
movements of mandible. Teeth should instead be ar-
ranged in 'neutral zone' balancing the force between
tongue and perioral musculature and not necessarily
directly on the residual ridge.
E. Effect on mastication and swallowing
• Masticatory movement of tongue and cheek plays a vi-
tal role in keeping the food bolus between the occlusal
surfaces of teeth. This aids in appreciating the flavour of
food and is indirectly involved in salivary and gastric
secretions, swallowing, and digestion of carbohydrates.
• Maximal bite force in dentulous individuals is 5-6 times
more as compared to in denture wearers. Thus, loss of
teeth leads to diminished masticatory efficiency and
impaired swallowing and digestion.
• There are more tooth contacts on the nonchewing side
as compared to chewing side, because of displacement
and tilting of denture during mastication. The presence
of dentures (foreign object) in mouth elicits a different
stimulus to sensorimotor system and influences the cy-
clic masticatory stroke pattern.
• During swallowing, there is greater transfer of loads to
denture bases and then to underlying mucosa placing
stress on them and causing their destruction. So, the
complete denture occlusion should be compatible with
the forces generated by mandibular movements during
deglutition.
• Artificial teeth must be placed within the confines of the
functional balances of oral musculature involved in
mastication and deglutition.
F. Distribution of stress in denture-supporting tissues
• During function, dentures are displaced against their
supporting tissues by placing pressure on them, which
occludes its blood supply and tissue damage.
Viscoelastic character of denture-supporting tissues
• On placing the load, there is initial instantaneous
elastic compression of soft tissues followed by de-
layed elastic deformation that occurs slowly and
continuously to diminish the rate as duration of load
is extended.
• Once the load is removed, instant elastic decompres-
sion occurs followed by continued delayed elastic
recovery.
• Histologically, altered morphology of stressed oral mu-
cosa is seen, such as decrease in the depth of epithelial
ridges and obliteration of connective tissue papilla.
Section I I Topic Wise Solved Questions of Previous Years

Further, in elderly people, longer time is required in Treatment Options for Edentulous State
recovery of displaced mucosa.
• Preservation and prevention of what are remaining-
Pressure changes are subjected to force-time threshold and oral prophylaxis, and periodontal and endodontic
thus dentist must try to minimize either or both by following treatment.
measures: • Post and core/crown.
• Maximizing denture base coverage within the morpho- • Implants.
logical and functional limits of oral tissues decreases • Fixed partial dentures.
force per unit area. • Cast removable partial dentures.
• Developing an optimal denture occlusion, decreasing • Overdentures.
the occlusal table and educating the patient about de- • Immediate dentures.
creasing parafunctional habits. • Complete dentures.
• Use of resilient denture base lining materials, which • Implant retained dentures.
permit a wider distribution of occlusal forces and in-
creases the thickness of oral tissue by serving as an ana-
logue of mucoperiosteum with its relatively low elastic Q. 2. Discuss in detail how you will manage mandibular
modulus. Most frequently used are silicone rubbers/ poor foundation case for complete denture fabrication.
acrylic resins. Or
• By keeping the dentures out of mouth during night will
give rest to supporting tissues and control the time dur- Discuss mouth preparation of compete dentures.
ing which load is applied to them. And, also tissues will Ans.
get exposed to saliva and get stimulated by tongue, lip,
and cheek activity.
Mandibular Poor Foundation
G. Changes in morphological facial height and • Good and healthy supporting tissue as well as soft and
temporomandibular joints bony tissue foundation is prerequisite to success of
• Residual ridge reduction causes a decrease in total facial complete denture treatment. Several preexisting con-
height and increase in mandibular prognathism. ditions in mouth can interfere with fabrication and use
• In complete denture-wearers, the anterior mandible of complete denture, which need to be corrected.
height reduction is 6.6 mm which is about four times • Management of poor mandibular foundation case for
more than that in maxillary process. complete denture fabrication can be categorized into
• Any change in morphological facial height/jawbones is following:
transferred to temporomandibular joints. Tooth loss and I. Non-surgical methods.
incorrect or absence of prosthetic treatment results in II. Surgical methods.
pain, dysfunction, and degenerative changes in TMJ. III. Combination method.
• Centric relation is the most posterior relation of man-
dible to the maxilla at established vertical relation. It I. Non-surgical Methods
coincides with the reproducible posterior hinge position
A. Rest for denture-supporting tissues.
of mandible and unconscious swallowing with mandible
occurs at this position. B. Occlusal correction of old prosthesis.
C. Good nutrition.
• In edentulous patients, it is difficult to accurately record
the centric relation and it is subjected to change, as the D. Conditioning of patient's musculature.
vertical relation at which, it is established keeps on chang-
ing due to reduction in ridge height, alterations in morpho- II. Surgical Methods
logical facial height, and morphological changes in TMJ.
A. Procedures to improve bony foundation
i. Retained dentition.
H. Cosmetic changes in edentulous state
ii. Removal of pathologic bony conditions.
• Deepening of nasolabial groove. iii. Techniques to deal with mandibular alveolar excess.
• Loss of labiodental angle. iv. Techniques to deal with excessive alveolar bone
• Decrease in horizontal labial angle. resorption
• Narrowing of lips. a. Techniques to reduce alveolar atrophy.
• Increase in columella-philtral angle. b. Techniques to correct alveolar atrophy.
• Prognathic appearance. c. Techniques to compensate for alveolar atrophy.

B. Procedures to improve soft tissue foundation
i. Hypermobile tissue correction.
ii. Excision of fibrous hyperplasia of the retromolar pad
and epulis fissuratum.
iii. Hyperplastic maxillary tuberosity excision.
iv. Hyperplastic palatal mucosal correction.
v. Frenectomy for hyperplastic lingual frenum.
C. Procedures to improve ridge relationships
i. Maxillary advancement procedures.
ii. Maxillary retrusion procedures.
iii. Mandibular advancement procedures.
iv. Mandibular retrusion procedures
• Subcondylar osteotomy.
• Sagittal (ramus) osteotomy.
• Vertical osteotomy of ramus.
D. Implants
• Subperiosteal.
• Transosteal.
• Endosteal.
• Mucosal inserts.
• Ramus inserts.
• Endodontic implants.
Non-surgical methods
These include as follows:
A. Rest for denture-supporting tissues
It can be achieved by the following:
a. Leaving the dentures out of mouth for a period of time.
b. Use of tissue conditioners-temporary soft liners.
c. Finger massage of the oedematous and enlarged denture-
bearing mucosa.
• These procedures promote recovery of deformed and
damaged tissues due to old dentures back to their nor-
mal form. Before taking impression for new denture
fabrication, old dentures should be left out of mouth
for 48-72 h to allow soft-tissue recovery. When recov-
ery time is prolonged, keeping dentures out of mouth
is not feasible. Tissue conditioners are used in such
situations.
These are made of a polymer powder and an aromatic
ester-ethanol mixture (Braden I 970). They remain soft for
several days while the tissues are recovering. Their uses
include as follows:
• Recovery of deformed tissues.
• Liners for surgical splint.
• Stabilization of trial denture base.
• Determination of optimal arch form and neutral zone.
• As functional impression materials in refitting complete
dentures.
Quick Review Series for BOS 4th Year: Prosthodontics
B. Occlusal correction of old prosthesis
• With use, occlusal surface of denture wears down lead-
ing to decrease in vertical dimension and overclosure.
This places more stress on supporting tissues and causes
their damage.
Restoration of vertical facial height can be done using
resilient lining materials. Their uses include:
• Recovery of tissues of temporomandibular joint.
• To estimate the amount of vertical facial height that can
be tolerated by patient.
• To permit some movement of denture base, so that its
position becomes compatible with existing occlusion.
C. Good nutrition
• Good nutrition is mandatory mainly for elderly patients,
who are malnourished because of which extra stress is
placed on tissues leading to denture failure. Taking
proper diet history and emphasizing on good nutritional
programme is what is required.
D. Conditioning of patient's musculature
• Some patients are unable to follow instructions and co-
ordinate jaw movements, which create problems during
denture fabrication, e.g., during impression making and
recording jaw relations.
• For such patients, mandibular jaw exercises programme
should be done which allow relaxation of muscles of
mastication, improve their coordination, and prepare the
patient psychologically for prosthetic treatment.
II. Surgical Methods
• Pre-prosthodontic surgical procedures are designed to
facilitate fabrication of prosthesis or to improve the
prognosis of prosthodontic care.
• Some conditions of patient's mouth, such as atrophy of
alveolar ridges, hyperplasia of soft tissues, etc., require
surgical correction in order to establish good denture
base foundation.
A. Surgical procedures to improve mandibular
denture base foundation
a. Procedures to improve bony foundation
i. Retained dentition
• Retained dentition can be seen in radiographs. They are
of two types:
a. Unerupted teeth.
b. Retained roots.
• Above, if present, should be removed prior to prosthetic
treatment in order to prevent their possible transforma-
tion into pathosis such as cyst or tumour. They are left
as such, if it is asymptomatic for several years and
removal can cause lot of bone loss.
Section I I Topic Wise Solved Questions of Previous Years
ii. Removal of pathologic bony conditions
• If any odontogenic cyst present, then it can transform
into tumour and cause bone destruction.
• It should be explored surgically and examined
microscopically. Treatment includes small cyst-
enucleation.
• Large cyst-marsupialization for shrinkage, bone fill-in,
and to prevent surgical fracture and damage to adjacent
vital structures.
• In case of tumour, radiographic and histological exami-
nation should be done followed by immediate surgical
treatment during which maximum amount of residual
ridge should be preserved.
iii. Techniques to deal with mandibular alveolar excess
a. Alveoloplasty
The surgical smoothening and shaping of the alveolar ridge
is done prior to denture placement. During alveoloplasty,
minimum amount of bone should be removed.
Types of alveoloplasty include the following:
i. Simple compression
• It is simple and effective and done after routine extrac-
tions.
• Following extraction, there is expansion of buccal and
lingual cortical plate. Compression of bone reduces the
size of wound, promotes healing, and allows favourable
remodelling of bone.
ii. Cortical alveoloplasty
• It is done when urgent denture fabrication is re-
quired.
• It aims at primary closure of extraction socket for bone
remodelling.
• Following extraction, crestal incison is made and any
bony projections removed and smoothened.
• If multiple extractions are done, then soft tissues on
mesial and distal side of socket are trimmed and the
wound is then closed by sutures.
iii. lntercortical alveoloplasty
• Also known as Dean's alveoloplasty, crush technique,
and interseptal alveoloplasty.
• Done in case of prominent anterior ridged, which
causes undercut thereby causing problems during
denture fabrication and use.
• lnterradicular septa are removed with a rongeur till the
base of socket and then vertical bone cuts are made bi-
laterally in the canine region.
• Then, using finger pressure, labial cortical plate is frac-
tured inward and bone step distal to canine is rounded
off. Wound suturing is done to prevent labial bone from
springing back.
b. Reduction of knife edge/irregular/sharp
mylohyoid ridge
• Following extreme alveolar atrophy, the mandibular
ridge becomes sharp causing pain while wearing den-
ture. In this case, an incision is made slightly below the
crest, flap is reflected, and sharp edges are removed with
side-cutting ronguer and smoothened with bone file.
In case of sharp mylohyoid ridge, it should be removed if
• Overlying mucoperiosteum is thin and prone to denture
irritation.
• Creates undercuts.
• Mylohyoid muscle hyperactivity causes denture dis-
placement.
Procedure
Cresta! incision is made and flap is reflected to the lingual
side. At its point of attachment, mylohyoid muscle is de-
tached. Exposed mylohyoid ridge is trimmed and smooth-
ened. During healing, muscle reattaches. Vital structures
should be preserved.
c. Genial tubercle reduction or reattachment
Prominent genial tubercle after ridge resorption causes
problem in denture construction.
Procedure
• Removal of tubercle and allowing genioglossus muscle
to reattach.
• Removal of tubercle and repositioning of genioglossus
muscle with percutaneous sutures held with cotton roll
under the chin.
• Detachment of tubercles using osteotome and bur cut as
guide, along with its attached muscle and repositioning to
inferior border of mandible held in place by wire ligature.
Sometimes, the tubercles can serve as shelf on which
dentures can rest and increase the area for denture support
and thus not requiring removal.
d. Removal of mandibular torus
Indications
• Interfere with denture fabrication.
• Mucosa overlying torus is ulcerated and healing is slow.
• They are large and interfere with speech and deglutition.
Procedure
• Cresta) incision is made and envelope flap is reflected
without tearing the thin mucosa.
• Torus is cleaved carefully from mandible using osteo-
tome malleted at its junction.
• In case of unclear junction, slot can be made using bur
for ostoetome positioning or the torus can be removed
entirely using bur.
• At the end, stent is placed over the surgical area to pre-
vent haematoma formation.

e. Alveolar repositioning
• For better retention and stability, alveolar bone should
be aligned over basal bone. Mandibular subapical oste-
otomy is done for the above purposes.
• The repositioned segments are stabilized using splints or
treatment dentures held in place by perialveolar wires.
iv. Techniques to deal with excessive alveolar bone
resorption
A. Techniques to reduce alveolar atrophy
• If root forms of teeth without periodontal disease are
left in alveolus, then bone resorption is greatly reduced.
Based on this, following techniques can be used:
a. Overlay dentures
Dentures are fabricated over modified endodonti-
cally treated teeth.
b. Submucous vital root retention
• Roots are reduced to 2 mm below the alveolar crest and
primary water tight closure of overlying mucosa is done
which causes the root to remain vital.
• A layer of bone with periodontal ligament forms and
covers the reduced root.
Dentures are placed after six weeks of above proce-
dure achieving balanced occlusion.
c. Root cone implants
• Hydroxyapatite root cone implants are placed in fresh
sockets to reduce ridge resorption to a great extent. Im-
plant is placed 2 mm below the bone crest.
B. Techniques to Correct Alveolar Atrophy
• Either by replacing lost bone (augmentation) using
natural/synthetic graft or regenerating the lost bone.
Various graft materials used are:
i. Rib graft-from fifth to ninth rib.
ii. Iliac crest graft-material of choice.
iii. Particulate bone and marrow.
iv. Hydroxyapatite-biocompatible, non-resorbable,
non-osteogenic mineral similar to bone and tooth.
Favours normal bone healing around the material
and promotes direct chemical bonding to particles
without an intervening fibrous capsule.
v. Tricalcium phosphate-resorbable and has osteo-
genie potential.
Techniques
a. Direct augmentation of mandibular ridge with rib graft
• In addition to ridge augmentation, this procedure
reinforces severely atrophic mandible in danger of
fracture.
Procedure
• Two 15 cm length segments are obtained from fifth to
ninth ribs. First segment is contoured by vertical scoring
(kerfing) on its inner aspect to increase flexibility.
Quick Review Series for BOS 4th Year: Prosthodontics
Second segment is cut into 4-6 mm size pieces for
packing.
b. Augmentation of the inferior border
Submandibular incision is made to place the rib graft.
Vestibuloplasty is done after 3-6 months.
Advantage: Extraoral surgery, so that interim denture
can be placed immediately.
Disadvantage: Extraoral scar, chances of facial shape
alteration, and damage to sensory or motor nerve caus-
ing lip biting.
c. Augmentation with pedicle and interpositional bone grafts
It is graft placed between two segments and bone is at-
tached to its own blood supply leading to less resorption.
Three techniques:
i. Horizontal osteotomy with interpositional bone graft
• Vertical height of the bone should be sufficient
to cut the bone horizontally. Incision is placed
lower to ridge crest. Lingual tissues are not
disturbed to maintain the blood supply.
• Bone is cut horizontally and the graft material is
sandwiched between the two segments and stabi-
lized using transosteal wires. Horizontal cut is either
placed above or below the inferior alveolar canal.
ii. Vertical or visor osteotomy
• Indicated when insufficient bone height is
present for horizontal cut, but bone width is
adequate (approximately 10 mm).
• Mandible is split vertically and buccolingually
and the lingual section is raised to increase the
height.
• Particulate bone marrow graft is placed facially
to raise the lingual segment to fill the gap and
to correct contour and is secured with transos-
teal wires.
• There may be chance of damage to nerve re-
sulting in paraesthesia, so utmost care must be
taken.
m. Combined vertical and horizontal osteotomies.
d. Ridge augmentation with synthetic grafts, i.e., hydroxy-
apatite and tricalcium phosphate (subperiosteal tunnel)
• Bilateral vertical incisions are made just anterior to
mental foramen.
• Subperiosteal tunnelling is done on ridge crest fol-
lowed by filling the material using syringe.
• Incision is closed and material is moulded to shape
of ridge using finger pressure. After 10 weeks, ves-
tibuloplasty is done.
e. Labial augmentation of undercut anterior ridge
• Materials used: Gelatin sponge, oxidized cellulose,
tantalum mesh, cartilage, bone, and hydroxyapatite
(preferred).
• Midline vertical incision is made, bilateral subperi-
osteal tunnelling is done till the canine region, and
graft is placed into the tunnel to fill the undercut.
Section I I Topic Wise Solved Questions of Previous Years
v. Techniques to compensate for alveolar atrophy
a. Vestibuloplasty
Vestibuloplasty is defined as a surgical procedure de-
signed to restore alveolar ridge height by lowering mus-
cles attaching to the facial, labial, and lingual aspects of
the jaws.
Objectives
• To extend the denture-bearing surface for additional
support and retention.
• To reposition muscle attachments from the crest of the
ridge.
• To provide a better foundation for the fabrication of
better functional prosthesis.
Three basic techniques
i. Mucosa] advancement
It involves dissection and advancement of subepi-
thelial connective tissue and placement of an over-
extended surgical stent.
ii. Secondary epithelialization
It involves use of an apically repositioned flap, which
is sutured to periosteum to desired depth. Healing
occurs by granulation and secondary intention.
It can be done in presence of hyperplastic and hy-
permobile ridge tissue. In order to counteract re-
lapse, overcorrection should be done beyond the
required sulcus depth.
iii. Epithelial graft vestibuloplasty
It is a secondary epithelialization procedure, which
uses skin or oral mucous membrane graft to cover
the exposed tissue.
Indications
• To increase support, stability, and retention of denture in
case of severe resorption of mandibular ridge.
• When high muscle attachment interferes with develop-
ment of adequate border seal, sufficient bone height of
1.5 cm should be present for this procedure. It is the
most favourable and predictable of all vestibuloplasties.
Contraindications
• Patients who can be treated using conventional complete
denture techniques.
• Should not be done for neurotic, psychotic, and de-
pressed patients.
• For patients with neuromuscular disorders, patients with
poor health, geriatric patients, and for those having un-
favourable surgical risk.
• Insufficient vertical height and severe prognathism
cases.
b. Lowering the Mental Forarnen
• In case of severe mandibular resorption, mental foramen
shifts close to ridge crest which causes in discomfort
during denture wearing.
Procedure
Cresta] incision is made to expose the mental foramen.
Neurovascular bundle is lifted with the help of nerve hook
and a vertical groove extending 5-10 mm inferiorly is made
with fissure bur. Freed nerve is placed in new position and
held there with haemostatic gauze.
B. Procedures to Improve Soft Tissue Foundation
i. Hyperrnobile tissue correction
It is pendulous rim of tissue, which forms on the crest of
mandibular alveolar ridge.
Techniques to reduce it include the following:
a. Nonsurgical
Modified impression technique is used to record the
hypermobile tissue without pressure.
b. Surgical
• Two oblique incisions are made parallel to alveolar
crest. Resultant wedge of tissue is dissected using
periosteal elevator. In presence of sharp, thin under-
lying alveolar ridge, minor alveoloplasty can be
done. The wound is then closed using sutures.
• Thin band of tissue present on mandibular alveolar
crest ridge can be excised using scissors and healing
occurs by secondary intention.
c. Sclerosing technique
In this technique, the soft hyperplastic tissue is con-
verted into firm fibrous tissue by injecting sclerosing
solution into it.
Procedure
• 2-4 mL of sodium morrhuate 5% is injected into hyper-
plastic tissue under local anaesthesia.
• The needle is inserted at midline of labial aspect of
ridge and directed posterolaterally at ridge base just
below the periosteum. Simultaneously while withdraw-
ing needle, solution is deposited. Next injection can be
made more posteriorly.
• Similarly, it is repeated on the other side and finally
solution is infiltrated directly into the hyperplastic tis-
sue. Patient is instructed not to wear the denture for
4-6 weeks.
ii. Excision of fibrous hyperplasia of the retrornolar pad
• It interferes with closure of maxillary denture and limits
the complete posterior extent of lower denture.
• An elliptic/wedge excision with thinning of flap is done.
• Lingual flap thinning should be done carefully to pre-
vent damage to lingual nerve.
iii. Frenectorny for hyperplastic lingual frenurn
• Short lingual frenum-ankyloglossia/tongue-tie creates
difficulty in speech and causes denture instability. It can

be diagnosed by asking the patient to touch the incisive
papilla with the tip of tongue and notice the tension and
amount of displacement of lower denture.
Procedure
• Bilateral lingual nerve block along with local infiltra-
tion is given to achieve haemostasis.
• Tongue is protruded out and a transverse incision is
made in middle of ventral aspect of tongue and the car-
buncles of the submandibular ducts.
• For extra length of tongue, some fibres of genioglos-
sus can be sectioned. The resulting diamond-shaped
defect is closed as linear incision with interrupted
sutures.
• Denture should be made before performing the proce-
dure, so that it can serve as a stent to prevent relapse in
future.
C. Procedures to Improve the Ridge Relationship
• Ideally, there should be class I relationship between up-
per and lower arch for normal function and aesthetics. If
any jaw discrepancy is present, such as mandibular
prognathism, then there will be extra stress placed on
upper arch causing its faster resorption and also poses
difficulty in denture construction, speech, mastication,
and affects patient's appearance.
Pre-surgical procedures
i. Model surgery is performed on casts of patient jaws.
ii. Fabrication of gunning splints on preoperatively
altered casts.
iii. Psychological evaluation of patient's ability to cope
up with the stress of surgery.
Surgical techniques to improve ridge relationship
(for mandible)
a. Mandibular advancement procedures
• Sagittal osteotomy or its variations, such as vertical
L, modified C, or sliding osteotomy is performed
through intraoral approach for mandibular advance-
ment.
• For advancements greater than 8 mm, bone grafting
is done. Skeletal fixation for six to eight weeks is
required.
b. Mandibular retrusion procedures
Mandibular setback is done by following techniques:
• Subcondylar osteotomy: In this, ramus is sectioned from
sigmoid notch obliquely to posterior aspect of ramus
either through an extraoral or intraoral approach.
• Sagittal (ramus) osteotomy: lntraoral approach. Hori-
zontal bony cut is made half way through ramus thick-
ness on its medial aspect. Vertical cut is then made on
the lateral aspect at the junction of ramus and body. This
Quick Review Series for BOS 4th Year: Prosthodontics
technique is indicated when extreme (10 mm) setback
of mandible is required and symmetry is present.
• Vertical osteotomy of ramus: Ramus is sectioned verti-
cally from the mandibular notch down over the man-
dibular foramen to the lower border of mandible.
At the end of all the above procedures, skeletal inter-
maxillary fixation is required forapproximately one month.
Surgical splints should be worn until definitive complete
dentures can be given.
Q. 3. Enumerate the reasons for loss of teeth. What are
the consequences of loss of teeth? What are the methods
of prosthodontic replacements?
Ans.
Edentulism is the state of being edentulous, that is without
natural teeth. Edentulous state represents a compromise in
masticatory system integrity along with adverse functional
and aesthetic sequelae.
Reasons for Loss of Teeth
Teeth are lost due to various reasons which are as follows:
i. Traumatic injuries resulting from accidents, falls, vio-
lent sports, etc.
ii. Dental diseases like caries which destroy the tooth.
iii. Diseases of gingiva such as periodontal disease, which
destroys the encircling bone and leads to loosening of
teeth.
iv. Extraction of teeth due to infections resulting from
caries, periodontal diseases, and failed endodontic
treatment.
v. Destruction of bone and eventual loosening and loss of
teeth due to pathosis such as cysts, malignancies, and
tumours.
vi. Prophylactic tooth extraction done for tumour radia-
tion therapy.
vii. Extraction of grossly malaligned teeth, if orthodontic
treatment cannot be done to realign it correctly.
viii. Congenitally missing teeth as in partial anodontia
(some teeth are missing) or total anodontia (all teeth
are missing).
ix. Failure of eruption of teeth-impacted teeth.
x. Iatrogenic extractions-rarely wrongly removed by
the dentist due to wrong diagnosis.
Consequences of Loss of Teeth
It refers to changes that occur when teeth are lost. They
vary from tooth to tooth and from patient to patient. Some-
times changes are rapid within a short period of time while
sometimes very slow.
Section I I Topic Wise Solved Questions of Previous Years
These are as follows:
i. Resorption: It is the first change to occur. Remodelling
of bony socket takes place until it converts into
rounded edentulous ridge. It can range from little re-
modelling to extreme resorption of ridge.
ii. Tilting: Empty space present can cause the adjacent
teeth to tilt/trip, which can be extreme in some cases.
iii. Drifting: It refers to bodily migration of teeth into
edentulous space and its closure. If loss of teeth occurs
at very young age, the drifted tooth permanently
occupies the place of missing tooth.
iv. Occlusal disharmony: It is due to tilting and drifting.
Occlusal contacts between maxillary and mandibular
teeth get disrupted resulting in occlusal interferences,
which causes pain/discomfort/occlusal wear and in
extreme cases, cause damage to TMJ.
Methods of Prosthodontic Replacements
in Case of Tooth Loss
It should be done in a logical and conservative sequence.
i. Preservation and prevention:Preservation of what is
remaining is of utmost importance and should be prac-
ticed first before replacement. It includes oral hygiene
instructions, scaling and root planning, restorations,
periodontal therapy, endodontic treatment, etc.
ii. Post and core/crowns:Viable roots may be pre-
served and restored with post and core and can be
used for support in overlay dentures, root cone
implants, etc.
iii. Implants: These are used for replacement of single/
multiple teeth, provided adequate bone and no contra-
indications are present and patient can afford it.
iv. Fixed partial dentures: Single/multiple (limited) teeth
can be replaced by fixed bridge. It is not a favourable
treatment in case of long-span edentulousness, due to
more stress application on the prosthesis abutment.
Success depends upon the size, location, number, and
health of abutment teeth.
v. Cast removable partial denture: It is useful in case of
long edentulous span. It consists of clasps, rests, and
SHORT ESSAYS
Q. 1. Metallic denture base.
Ans.
Metallic Denture Base
Metallic denture bases are fabricated using gold, gold alloys,
cobalt-chromium, or nickel-chromium alloys.
guiding planes which together provide adequate reten-
tion, stability, and support to partial denture. Initially,
temporary/treatment partial denture (TPD) made of
acrylic/plastic is given prior to construction of perma-
nent one. In some places, people use TPD as definitive
prosthesis, which can lead to damage of residual ridge
if used for prolonged periods.
vi. Overdenture: It is a good alternative to total extrac-
tion, when few healthy teeth, such as canines and
premolars are remaining. After their appropriate treat-
ment, they are reduced in height and denture is
fabricated and placed over these teeth.
vii. Immediate denture: It is a type of complete denture,
which is placed in patient's mouth immediately after
extraction of all his teeth. These prevent the patient
to bear the embarrassing period of being without
teeth.
viii. Complete denture (Full denture): It is the traditional
prosthodontic treatment.
ix. Denture relies on residual ridge for support and retention.
x. Ease in fabrication, but it leads to gradual reduction in
ridge over years, which is fast in some patients and
slow in some.
xi. Implant retained denture: Full implant supported/
partial implant and partial ridge supported. Require
surgery for placement and are expensive. But, pro-
vides better retention and functional dentures.
xii. Maxillofacial prosthesis: This branch deals with pros-
thetic replacement of other areas of mouth and face
lost due to trauma/disease along with teeth. It includes
obturators, prosthetic eyes, ears, nose, and other parts
of the maxillofacial region. Materials used range from
hard acrylic-like materials to soft latex, which can be
characterized and coloured to resemble natural and
life-like as possible.
xiii. Splints and stents: These are adjuncts to certain treat-
ment, but not actually prostheses. Splint is a rigid/
flexible device that maintains in position a displaced/
movable part, and also used to keep in place and pro-
tect an injured part. Stent is used to hold a graft in place
and provide support for an anastomosed structure.
Advantages
• Heavy mandibular dentures leading to improved reten-
tion and stability.
• Good sensory interpretation due to high thermal con-
ductivity.
• Strong even in thin sections and are very comfortable
for the patient.
• Easy maintenance.

Disadvantages
• Expensive as compared to acrylic resin denture bases.
• More time is required for fabrication.
• Requires refractory cast material.
• Difficult fabrication.
• Rebasing cannot be done.
Q. 2. Pre-prosthetic surgery.
Or
Pre-prosthetic surgical managements in complete denture.
Ans.
Pre-prosthetic Surgery
• Pre-prosthodontic surgery is defined as surgical proce-
dure designed to facilitate fabrication of prosthesis or to
improve the prognosis of prosthodontic care.
• It includes following procedures:
A. Procedures to Improve Bony Foundation
i. Retained dentition: Above, if present, should be re-
moved prior to prosthetic treatment in order to prevent
their possible transformation into pathosis such as cyst
or tumour.
ii. Removal of pathologic bony conditions: If any odon-
togenic cyst is present, then it can transform into tu-
mour and cause bone destruction. It should be explored
surgically and examined microscopically.
iii. Techniques to deal with mandibular alveolar excess
Alveoloplasty
Alveoloplasty is the surgical smoothening and shaping of
the alveolar ridge prior to denture placement. During al-
veoloplasty, minimum amount of bone should be removed.
Types include:
a. Simple compression.
b. Cortical alveoloplasty.
c. Intercortical alveoloplasty.
iv. Techniques to deal with excessive alevolar bone
resorption
a. Techniques to reduce alveolar atrophy: If root forms of
teeth (without periodontal disease) are left in alveolus,
then bone resorption is greatly reduced. Based on this,
following techniques can be used:
i. Overlay dentures.
ii. Submucous vital root retention.
iii. Root cone implants.
b. Techniques to correct alveolar atrophy: Either by re-
placing lost bone (augmentation) using natural/synthetic
graft or by regenerating the lost bone.
Quick Review Series for BOS 4th Year: Prosthodontics
v. Techniques to compensate for alveolar atrophy
Vestibuloplasty
It is a surgical procedure designed to restore alveolar ridge
height by lowering muscles attaching to the facial, labial,
and lingual aspects of the jaws.
Three basic techniques are:
Mucosa! advancement.
Secondary epithelialization.
Epithelial graft vestibuloplasty.
B. Procedures to Improve Soft Tissue Foundation
i. Hypermobile tissue correction.
ii. Excision of fibrous hyperplasia of the retromolar pad
and epulis fissuratum.
iii. Hyperplastic maxillary tuberosity excision.
iv. Hyperplastic palatal mucosa! correction.
v. Frenectomy for hyperplastic lingual frenum.
Q. 3. Vestibuloplasty.
Ans.
Vestibuloplasty
Vestibuloplasty is defined as a surgical procedure designed
to restore alveolar ridge height by lowering muscles attach-
ing to the facial, labial, and lingual aspects of the jaws.
Objectives
• To extend the denture-bearing surface for additional
support and retention.
• To reposition muscle attachments from the crest of the
ridge.
• To provide a better foundation for the fabrication of
better functional prosthesis.
Three Basic Techniques
i. Mucosal advancement
• Dissection and advancement of subepithelial connective
tissue and placement of an overextended surgical stent.
ii. Secondary epithelialization
• Use of an apically repositioned flap which is sutured to
periosteum to desired depth. Healing occurs by granula-
tion and secondary intention.
• It can be done in presence of hyperplastic and hypermo-
bile ridge tissue. In order to counteract relapse, overcor-
rection should be done beyond the required sulcus depth.
iii. Epithelial graft vestibuloplasty
It is a secondary epithelialization procedure, which uses skin
or oral mucous membrane graft to cover the exposed tissue.
Section I I Topic Wise Solved Questions of Previous Years
Indications
• To increase support, stability, and retention of denture in
case of severe resorption of mandibular ridge.
• When high muscle attachment interferes with the devel-
opment of adequate border seal.
• Sufficient bone height of 1.5 cm should be present for
this procedure.
• It is the most favourable and predictable of all vestibu-
loplasties.
GD
Contraindications
• Patients who can be treated using conventional complete
denture techniques.
• Should not be done for neurotic, psychotic, and depressed
patients.
• For patients with neuromuscular disorders, patients with
poor health, geriatric patients, and for those having un-
favourable surgical risk.
• Insufficient vertical height and severe prognathism cases.

SHORT NOTES
Q. 1. Metallic denture base. Polished surface of complete denture.

Or Ans.

Advantages of metal bases.

Ans. Polished Surface

Fabrication using gold, gold alloys, cobalt-chromium or Polished surface is also called CAMEO surface. It is that
nickel-chromium alloys. portion of a surface of denture that extends in an occlusal
direction from the border of the denture and includes the
palatal surfaces. It is part of the denture base, which is usu-
Advantages of Metal Bases ally polished and it includes the buccal and the lingual
• Heavy mandibular dentures leading to improved retention surfaces of the teeth.
and stability. It should be well polished to prevent accumulation of
• Good sensory interpretation due to high thermal con- food debris.
ductivity. The polished surface is divided into:
• Strong even in thin sections and are very comfortable • Facial surface (both maxillary and mandibular denture).
for the patient. • Palatal surface (maxillary denture).
• Easy maintenance. • Lingual surface (mandibular denture).
Q. 2. Polished surface.

Or

------------------<( Topic 2)
Diagnosis and Treatment Planning

LONG ESSAYS
Q. 1. Discuss in detail the clinical significance of the follow-
ing for ensuring success of complete denture treatment.
a. Pre-extraction records.
b. Examination, diagnosis, and treatment planning.
Or
Discuss the significance of case history recording, diag-
nosis, and treatment planning in the fabrication of com-
plete dentures prosthesis.
Or
Diabetic patient aged 65 years with few teeth remain-
ing comes to your dental college/hospital for dental
prosthesis. Discuss the treatment planning and special
steps to be taken by you for the management of the
patient.
Ans.
 Quick Review Series for BOS 4th Year: Prosthodontics

Complete Denture Treatment Following steps in sequential manner should be carried out
for examination and diagnosis:
For ensuring success of complete denture treatment, the
i. Recording the general information.
clinical significance of the following
ii. Recording the chief complaint and assessing the
a. Pre-extraction records, and
patient's expectations.
b. Examination, diagnosis, and treatment planning
iii. Recording the relevant medical history.
are described.
iv. Recording current medication.
v. Recording the relevant dental history.
Pre-extraction Records vi. Performing thorough visual and manual examination
of the mouth, the head, and the neck regions.
Following are the pre-extraction records which provide
vii. Performing radiographic examination.
valuable information about the patient dentition and facial
viii. Referring for additional tests, if required, e.g., blood,
profile before extraction:
sugar, and urine tests.
i. Profile radiographs: These are made with teeth in
ix. Referring for medical consultation (when indicated).
occlusion and compared with those made with occlusal
x. Referring for second opinion and opinion from other
rims in position. It has the following disadvantages:
dental specialists (when required).
• Distorted image.
xi. Making alginate impressions and preparing mounted
• Time-consuming.
study models (when indicated).
• Radiation hazards.
xii. Discussingthe diagnosis, treatment planning, and
ii. Profile photographs: These can be compared before
prognosis with the patient.
and after treatment, but profile angles can change with
xiii. Finalizing the fees and obtaining the informed
change in patient's posture.
consent.
iii. Articulated casts: With teeth in occlusion, measure-
ments are made between stable landmarks, i.e., be- i. Recording the general information
tween upper and lower frena.
The first step in patient evaluation can be done by the
iv. Lead wire silhouettes: These are adapted to patients,
dentist itself, reception staff, or by asking the patient to fill
before extraction and outline is transferred to card-
the form.
board and cut out, after extraction cut out is placed
a. Name: To add personal touch and to build confidence
against patient's profile to check vertical relation. It is
with patient, he/she should be addressed by his/her
not commonly used now.
name.
v. Acrylic facemasks (Swenson's technique): It is not a
b. File/record number: It is necessary for maintaining
practical method. Before extraction, it is made using
records.
facial impression and cast.
c. Age: It is important to note age, because:
vi. Facial measurements:
• As age advances, capacity of tissues to withstand
• Dakometer: Instrument is positioned on the bridge
stress reduces.
of the nose with impression compound and chin
• Healing capacity of denture-bearing and other tissues
piece is screwed, until it touches the chin front. A
of body decrease with age.
spring pressure gauge controls pressure. An incisor
• In elderly patient, diseases like diabetes and hyper-
attachment records position of central incisors. Re-
tension are prevalent.
cords are noted and compound nosepiece is pre-
d. Race: Some diseases are present only in certain race and
served for reassembly after extraction.
also selection to denture teeth and denture base colour
• Willis gauge: One arm contacts the base of the nose and
varies with race of patient, e.g., dark-skinned individu-
the other arm is moved along the side, until it touches
als have more pigmentation of gingiva.
the base of the chin. It is not an accurate method.
e. Sex: Women and young men are more concerned about
• Sorensen's profile guide: It is one of the devices for
aesthetics and appearance.
recording facial measurement.
f. Older individuals are mainly concerned with comfort
and function.
g. Occupation: Person's job also determines the aesthetic
Examination, Diagnosis, and Treatment Planning
requirements of prosthesis.
• For success of prosthetic treatment, a careful, correct, h. Address and telephone number: It should be noted to
and complete examination along with diagnosis is contact the patient during the treatment and in case of
important followed by providing the patient with best emergency.
possible treatment plan in accordance with his/her age, i. Previous dentist (if any): Recording this, serves as
physical, mental, and financial status. dental record in case of forensic evidence or in
Section I I Topic Wise Solved Questions of Previous Years
medicolegal cases. Also, pretreatment records can be
obtained.
Psychological evaluation
The 'House classification' of mental attitude of patient by
MM House classifies denture patients into different groups,
based on their personality as follows:
a. Philosophical
• Patient has best mental attitude required for denture
treatment.
• Patient is well motivated and realizes his part in treatment.
• Patient cooperates with the dentist and learns to adjust.
• Patient is rational, sensible, calm, and composed in
difficult situations.
b. Exacting (critical)
• Patient is methodical and precise.
• There is need to explain each step of the procedure in
detail to the patient.
• He sometimes proposes treatment plan to the dentist
and makes severe demands.
• Patient should be managed with extracare, effort, and
patience. Dentist must listen to the demands of the
patient, but must not consider, if unreasonable.
c. Indifferent
• Patient has a questionable prognosis.
• Patient lacks motivation and is not very interested in
treatment.
• Patient tries to find mistakes in treatment and blames
dentist for any mishap.
• Patient does not cooperate and follow instructions and is
forced by his relatives, spouse, etc., for dental treatment.
• Such patient is difficult to manage. Patient should be
well educated about the treatment and motivated to
develop interest in the treatment. If no improvement is
observed, then it is better to postpone or refuse the
treatment.
d. Hysterical
• Patient is easily excited, highly apprehensive, and
emotionally unstable.
• Patient rarely cooperates with the dentist.
• Patient has unfounded complaints and unrealistic
expectations.
• Lot of time and patience is required to manage such
patient.
• Medical consultation might be required for the systemic
problems, if present.
e. Sceptical
• Patient has had bad results from previous treatment and
is doubtful whether his problems can be solved.
• Patient has unfavourable conditions like resorbed ridges
and poor health.
• Patient may be in psychological stress due to recent
death of a close relative, etc.
• First, psychological management is required for such
patient before dental treatment. Kindness, care, and
sympathy should be offered and condition should be
dealt with patience and good attention, in order to
restore his confidence.
ii. Recording the chief complaint and assessment of
patient's expectations
• Chief complaint should be recorded in patient's own
words.
• Reason for seeking prosthodontics treatment should be
evaluated. Some need it for aesthetics, while some for
better function.
• Expectations of the patient from the treatment should be
asked and if not realistic, patient should be explained
and motivated for the treatment.
iii. Recording the medical history
Aim
• To diagnose any systemic problem that might affect the
treatment.
• To deal with any medical emergency during the pro-
cedure.
• In case of presence of transmissible disease, suitable
disinfection steps can be taken.
• Medical consultation is required for patients with serious
systemic problems before starting the treatment.
Certain medical conditions that can be present are:
I. Diabetes: If affects the wound healing capacity of the
tissues and chances of infection increase. It should be
dealt properly if any preprosthetic surgery is planned.
II. Cardiovascular disorders: Management includes the
following:
• Short appointments with premedication in patients
with history of angina and cardiac arrest. Adrenaline-
free local anaesthetic is injected, if required.
In case of elective surgery, medical consultation is
done first.
• Antibiotic prophylaxis in conditions like rheumatic
heart disease, congenital heart disorder, etc., and in
case of any surgery or tooth extraction that needs to
be done.
• In case of increased blood pressure, first, medical
consultation should be done.
III. Joint diseases: Osteoarthritis of TMJ may pose prob-
lems during denture construction and special trays for
impression recording may be required in case of inad-
equate mouth opening. Jaw relations may be difficult
to record.

IV. Skin diseases: Painful mucosa may be present in case
of certain skin disorders like pemphigus. So, rest
should be given to tissues in-between while using
dentures.
V. Neurological disorders: Example Bell's palsy and
parkinsonism. Patient is unable to cooperate with
dentist's instructions and finds difficulty in maintain-
ing denture and oral hygiene and assistance may be
required for that.
VI. Oral malignancies: If present, require surgical re-
moval of the affected part and construction of denture
with added obturator or maxillofacial prosthetics.
VII. Radiation therapy might be required. Treatment must
be postponed, until tissues regain health after radia-
tion and after denture fabrication. Tissues must be
closely monitored for any signs of radiation necrosis.
VIII. Transmissible diseases: For example, TB, AIDS,
SARS, hepatitis, herpes, etc., might be present.
IX. They should be carefully diagnosed and appropriate
precautions must be taken by dentist for himself as
well as for laboratory personnel and for other patients.
iv. Recording current medication
The patient might be taking medication for any systemic
disease present which may affect the dental treatment.
i. Insulin: It is taken to treat diabetes mellitus. When in-
jected local anaesthetic during treatment, patient may
go into hypoglycaemic shock due to decrease in blood
glucose levels. It should be assured that patient has
eaten meal before treatment and in case of shock he
should be given glucose immediately.
ii. Anticoagulants: Aspirin anddicoumarol are prescribed
in stroke and cardiovascular diseases. Consulting the
physician is mandatory, in case if preprosthetic sur-
gery or deep scaling is required.
iii. Antihypertensives: They cause dryness of mouth and
postural hypotension (fainting or dizziness on stand-
ing up).
iv. Antiparkinsonism agents: Artane and norflex can cause
dryness of skin and mucosa. Behavioural changes and
confusions may be seen.
v. Corticosteroids: These are given in case of allergies
and arthritis.
v. Recording the dental history
i. History of tooth loss
• Teeth lost due to periodontal reason-poor ridges.
• Teeth lost at different time intervals-uneven ridge
levels.
• Loss of lower posterior teeth-supraeruption of upper
posterior teeth with overhanging tuberosity and ridge.
ii. Experience with old dentures
• Information on old dentures should be recorded, so
that if any problem is present then it can be avoided
Quick Review Series for BOS 4 th Year: Prosthodontics
in new dentures. Patient should be informed that due
to continued resorption, retention of new denture
may decrease and relining and rebasing is required
in the first six months when rate of bone loss is at
the maximum.
iii. Performing oral examination
Extraoral examination
i. General appearance of face is noted for healthy or for
any signs of malnourishment seen.
ii. Facial symmetry, form, and profile: Ooutline of face is
important to select tooth shape.
Classification of frontal face form by House, Frush, and
Fisher
a. Square.
b. Square-tapering.
c. Tapering.
d. Ovoid.
Classification of lateral face form by Angle
a. Class 1- normal.
b. Class 2 - retrognathic.
c. Class 3 - prognathic.
i. Skin: Shade selection of teeth is done in accordance
with skin colour.
• Pale skin-signs of anaemia.
• Indians-darker skin ranging from dark brown to
white.
ii. Palpation of head and neck regions: It is done to check
for any enlarged lymph node/mass.
• Enlarged tender nodes-infections.
• Hard attached nodes-tumour (primary or second-
ary through metastasis).
iii. Lip
• Lip length classification: Long, medium, or short.
Short lips-more denture base seen while smiling
and talking, so longer teeth need to be selected.
Long lips-vice versa. Tooth visibility cannot be
used as a guide to anterior tooth positioning.
• Lip thickness
Thin lips-sensitive to small changes in anterior
tooth position.
Thick lips-give dentist more flexibility in anterior
tooth positioning.
Indians-have fuller lips with maxilla being slightly
prognathic.
• Lip mobility: It is classified as:
a. Class 1 - normal.
b. Class 2 - reduced mobility and less display of
front teeth.
c. Class 3 - paralysis.
Mobility of lip may be affected in stroke victims.
Section I I Topic Wise Solved Questions of Previous Years
Paralysis of one half of lip will cause drooping of mouth
and facial asymmetry on affected side.
• Lip support: It is classified as:
a. Adequately supported.
b. Inadequately supported.
Lip is supported by teeth. So, when teeth are lost there
is collapse of lip.
• Smile line or lip line: Based on the extent of lips
displaced on smiling, a patient is said to have
a. A high lip line (patients have gummy smile due to
more display of gums and teeth).
b. Low lip line.
c. Normal or medium lip line.
iv. Neuromuscular evaluation: Various mandibular move-
ments are done to determine neuromuscular coordination.
It is classified as:
a. Class 1 - excellent.
b. Class 2 - fair.
c. Class 3 - poor. In cases of stroke, paralysis, and
parkinsonism, patients find difficulty in adapting to
new dentures.
v. Speech evaluation: It is classified as normal and affected.
Patients with speech impediments require special atten-
tion while placing the front teeth and forming the palatal
portions of upper denture.
vi. Temporomandibular joint evaluation: Patient is exam-
ined for temporomandibular joint disorders like pain or
difficulty in opening the mouth.
Jaw movements such as opening it wide and closing, moving
from left to right and then finally forwards and backwards are
performed and if any uncoordinated jerky movements are
present, it indicates difficulty in recording jaw relations.
lntraoral examination
Examination of mouth and ridge is done for any condition
that might affect, compromise, or even enhance the out-
come of the treatment.
I. Cheeks
Importance
• Forms peripheral seal of the denture. The draping or
placement of the cheek tissues over the buccal flanges
of the dentures.
• Opening of Stenson's ducts (parotid gland) present as
a raised papilla on the cheek opposite the maxillary
second molar in edentulous individuals.
• It is also the location for many lesions like
a. Lichen planus.
b. Submucosal fibrosis: It is found in paan chewers.
Here, the mucosa appears pale and feels leathery to
touch. Mouth opening is limited.
c. White lesions of the buccal mucosa: Differential di-
agnosis includes lichen planus, Ieukoplakia, or fungal
lesions.
d. Malignancies: Squamous cell carcinoma is most com-
mon. Premalignant changes like leukoplakia and
erythroplakia are seen. Palatal changes due to reverse
smoking are seen in people of Andhra Pradesh.
II. Tongue
• Favourable tongue-average-sized, freely moves, and
covered by healthy mucosa.
• Importance: It helps in denture stability by controlling
the dentures during functions like speech, mastication,
and swallowing.
• Examination is done using a gauze pad to grasp and
hold the tongue.
a. Tongue size
Classification
i. Normal: With normal function.
ii. Large: After the loss of teeth (especially lower posteri-
ors) the tongue may spread out and enlarge, which may
make denture construction difficult. Tongue biting can
occur. It may slowly regain its normal size after a period
of wearing complete dentures.
Management of large tongue can be done as follows:
• The occlusal plane may be lowered.
• Narrower teeth may be used.
• The intermolar distance may be increased (within
limits).
• The lingual cusps may be grinded off.
• Setting of a second molar may be avoided.
b. Tongue position
Classification (Wright's classification)
Normal: Normal size and function. Favourable prognosis. It
fills the floor of the mouth and is confined by the mandibu-
lar teeth. The lateral borders rest at the level of the man-
dibular occlusal plane, while the dorsum is raised above it.
The apex rests at or slightly below the incisal edges of the
mandibular anterior teeth.
Class 1: Retracted (not too favourable). It is retracted ex-
posing the floor of the mouth till the molar area. The lateral
borders are raised above the mandibular occlusal plane. The
apex is pulled down into the floor of the mouth which is
also pulled downwards.
Class 2: Retracted (not too favourable). The tongue is
tense and retruded backward and upward. The lateral bor-
ders rest above the mandibular occlusal plane. The tip is
pulled into the body of the tongue and is almost invisible.
The floor of the mouth is raised and tense.
c. Tongue mucosa
Normal tongue mucosa shows filiform and fungiform
papillae on dorsal surface and the colour is a healthy
pink.

Variations that may be seen are:
i. Bald or smooth tongue-due to atrophy of the filiform
papilla. Seen occasionally in the elderly and in pa-
tients with iron or vitamin deficiency.
ii. Geographic tongue.
iii. Hairy tongue.
iv. Red and inflamed tongue-may be indicative of vitamin
B12 deficiency.
v. Caviar tongue: This is a nodular enlargement of the
veins on the under surface of the tongue (lingual
varicosities). It is seen in elderly. Occasionally, vari-
cosities may indicate a cardiovascular or pulmonary
problem.
vi. Coated tongue-indicative of patient's poor oral hy-
giene. Heavy white or stained deposits may be seen on
unhygienic tongue, often seen in the elderly due to
reduced salivary flow.
vii. Candida albicans: Chronically ill or severely debili-
tated geriatric patients may have candida infections,
characterized by curdy white patches which come off
when wiped with gauze.
Ill. Frenal attachments
Frenum is defined as a fold of mucosa at different locations
in the sulcus region of the maxillary and mandibular ridge.
Labial frenum: It runs from lip portion of the sulcus and is
attached to the residual alveolar ridge.
Buccal frenum (right and left): It appears as a single fold or
multiple folds.
Classification
a. Class 1 - sulcal/low attachment (favourable).
b. Class 2 - attaches midway between sulcus and crest of
the ridge.
c. Class 3 - crestal or near crestal attachment (high) -
unfavorable.
It affects the prognosis of the denture by causing a deep
notching of denture affecting its seal and retention, and
denture borders may cause irritation and ulceration of the
frenum. A surgical correction (frenectomy) is indicated.
IV. Floor of the mouth
It affects the prognosis of mandibular denture, if:
• It is near ridge crest/hyperactive, denture retention and
stability is less.
• Sometimes, the floor of the mouth is near/on the ridge
when the resorption in sublingual and mylohyoid region
is extreme.
V. Maxillary tuberosity
If enlarged and undercuts present, then it can pose problems
like:
• Back end of occlusal place needs to be placed low.
• Less space for all molars arrangement
Quick Review Series for BOS 4th Year: Prosthodontics
• Undercut present can make denture removal and inser-
tion difficult.
Management
Radiographic examination to determine whether enlarge-
ment is bony/fibrous/combination followed by surgical re-
moval.
VI. Hard palate
Classification based on shape of palatal vault:
a. Class 1: U-shaped. Most favourable for retention and
stability.
b. Class 2: V-shaped. Not very favourable. Slight move-
ment of the denture can break the seal and reduce reten-
tion. May be associated with a tapered arch.
c. Class 3: Flat or shallow vault. Not very favourable.
Usually accompanied by resorbed ridges and poor
resistance to lateral forces.
VII. Palatal torus
It is a large, hard bony rounded projection on the hard palate.
It is located posterior to rugae region in midline. If lo-
cated more posteriorly, then it may interfere with peripheral
seal placement so should be removed surgically. Size can
be small to very large.
Classification
a. Class 1: Absent/minimal.
b. Class 2: Moderate.
c. Class 3: Large.
VIII. Mandibular tori
Small, pea-sized bony prominences are seen on the lingual
side of mandibular ridge in the bicuspid region. If large,
surgical removal is required.
IX. Smoker's palate (Stomatitis nicotina)
Palatal (hard and soft) changes seen in heavy tobacco
smokers present as gray patches with nodular centre and
red inflamed openings of mucous glands may be seen dis-
tributed on the lesion.
X. Soft palate
Anatomy of soft palate determines the extra area available
for retention and the width of posterior palatal seal area.
Classification
Based on angulation between soft and hard palate, it is
classified as:
a. Class 1: Soft palate is horizontal curving gently down-
wards.
b. Most favourable with more surface area for retention
and provides wider seal and muscular
c. activity is minimal.
d. Class 2: Soft palate turns downwards at 45° angulation to
the hard palate. It has features between class 1 and class 3.
Section I I Topic Wise Solved Questions of Previous Years
e. Class 3: Soft palate turns sharply downwards at 70°
angulation to the hard palate, deep-shaped palate. Less
favourable due to greater movement of soft palate
during function and has narrow seal area.
XI. Residual alveolar ridge
Studying of anatomy and quality of residual ridge is important.
a. Arch size
Classification by Engelmeier is based on length and width
of the edentulous arch.
a. Class 1: Large, greater support and retention due to
large surface area.
b. Class 2: Average.
c. Class 3: Small, less support and retention.
b. Arch form
Classification by House:
a. Class 1: Square - favourably-shaped and more sur-
face area. Most common.
b. Class 2: Tapered/v-shaped associated with high
arched palate. Less retention and stability.
c. Class 3: Ovoid - less common.
Variation in above occur due to difference in resorption
pattern.
d. Arch size discrepancy
This causes difficulty in stability and arrangement of teeth.
Causes
• Congenital.
• Trauma: Trauma to TMJ during growth phase, e.g., for-
ceps delivery, fall, etc., can retard mandibular growth.
• Severe class 2 and class 3 malocclusion.
• Severe resorption; Maxilla becomes small and mandible
becomes wide with resorption leading to arch size dis-
crepancy.
e. Arch relationship
Classification
i. Anterior arch relationship
Class 1: There is a normal anterior horizontal overlap
(overjet) of around2 to 8 mm, when the teeth are set.
Class 2: Excessive horizontal overlap. Lower anterior
teeth are located posterior to the upper anterior teeth in
excess of 8 mm.
Class 3: The lower incisors may be in an edge to edge
incisal relationship or may be anterior to the maxillary
incisors.
Cl II and III relationships are usually seen in relation to
arch size discrepancies. Teeth arrangement would result
in a more buccal location of the mandibular functional
cusps in relation (cusp to cusp or cross bite) to the maxil-
lary cusps, and may be associated with large mandible/an
underdeveloped maxilla/both. Occasionally cases with
combinations, e.g., a class I anterior ridge relationship
and a unilateral or bilateral posterior class III relationship
are encountered anterior to the maxillary incisors.
ii. Posterior arch relationships
Class 1: Posteriorly, normal functional and non-
functional cusp relationship present.
Class 2: Routine teeth arrangement would result in
more lingually located mandibular cusps (scissor bite),
unilateral or bilateral, and associated with an underde-
veloped mandible.
iii. Interarch space
The amount of space available to set teeth depends on
the amount of space present between the upper and the
lower ridges.
The interarch space is classified as:
A. Normal.
B. Excessive.
C. Reduced.
iv. Residual ridge size
It is based on height and bulk. There are three types:
a. Average ridge: It offers adequate support to dentures.
b. Large/bulky ridge: It is seen in freshly extracted but
healed sites. Enough space might not be present to
set the teeth.
c. Small, flat, or resorbed ridge: It is due to extreme
resorption and offers poor retention and support to
the denture.
v. Residual ridge (Cross-sectional contour)
Ideal ridge: Well developed high ridge with broad crest
and parallel sides.
Types: Based on shape (cross-sectional contour), it is
classified as follows:
a. U-shaped: Good prognosis. Favourable for retention
and support.
b. V-shaped or tapered: Favourable prognosis. Com-
monly seen in the mandibular arch.
c. Knife-edged: Poor prognosis. The resorptive process
often leaves sharpknife-edged ridges, usually seen
in the mandibular arch and is unfavourable for den-
tures. Crest has to be relieved to avoid soreness.
d. Flat: Poor prognosis. The resorptive process contin-
ues until there is little or no ridge remaining.
e. Inverted: Poor prognosis. Caused by extreme
resorption, especially in the mandible. The resorp-
tive process extends into the body of the mandible.
f. Undercut: Potential for difficulties. The undercut
ridge (if severe) can present problems during denture
construction and for subsequent use. Insertion and
removal of the denture may be difficult or can cause
damage to the tissues in its path.
Other configurations seen are as follows:
i. Irregular knife-edged ridges (due to bony spicules).
ii. Bulky irregular ridges with undercut sides are seen in
the freshly extracted.

iii. ridges.
iv. Soft tissue support for the ridge
This can be examined by palpation.
It should be firm and resilient and covering mucosa
should be firmly attached and keratinized.
Types: Based on nature of supporting soft tissue, it is clas-
sified as follows:
1. Firm and resilient.
2. Flabby and hypermobile: This offers poor support,
because the denture bases shiftduring masticatory
function.
Management: Wide variety of methods ranging from
modified impression techniques to surgery are available.
vii. Bony prominences
Manual palpation of sulcus areas, ridge crest and
slopes, and the palatal areas is done to identify any bony
prominences/sharp areas present which can make denture
wearing uncomfortable/painful.
Common bony prominences seen are:
a. Midpalatine raphe: These are present along the mid-
line of the palate, may be very prominent in some
individuals and needs relief.
b. Bony spicules and sharp ridge crest: The resorption
process can result in a knife-edged or spiny ridge
crest, either relieved or removed surgically.
c. Sharp mylohyoid ridge: Resorption of the lower
ridge can result in a prominent mylohyoid ridge
which can cause pain, if not relieved.
d. Palatal foramen: Borders are sometimes raised and
sharp.
e. Prominent genial tubercle: Extreme resorption can
also result in the genial tubercles becoming prominent.
f. Bony fragments: Bone fragments which might have
fractured during extraction may be found occasion-
ally extruding through the mucosa.
g. Fractured root pieces: Fractured root fragments may
be occasionally felt just below the mucosa.
h. Tori: Small maxillary tori may be included in the
denture with relief provided.
i. Larger tori require surgical removal. The same is
true for mandibular tori. Large tori might interfere
with the mandibular denture retention, whereas
smaller tori may be included in the denture with ad-
equate relief.
viii. Undercuts
Undercuts present on ridge can cause difficulty in
denture removal.
Common location may be present in any part of the
ridge. Some common locations are:
• Occasionally labial or lingual slopes of the man-
dibular anterior ridge.
• Labial portion of the maxillary anterior ridge.
• Buccal to the maxillary tuberosity region.
• Retromylohyoid area of the lower ridge.
Quick Review Series for BOS 4th Year: Prosthodontics
Management
If isolated, anterior undercut poses no problem.
Some undercuts may be managed by relieving the inside
portion of the denture.
A unilateral posterior undercut does not pose much
problem, as the path of insertion can be varied.
A bilateral severe undercut poses a problem. Surgical
elimination of one of the undercut (usually the more severe
one) is indicatedand insertion and frequent abrasion of the
mucosa can lead to ulceration and pain.
Classification
Undercuts may be:
a. Unilateral or bilateral.
b. Labial or lingual.
c. Mild, moderate, or severe.
Saliva
Saliva is important for tissue health and denture retention.
Consistency and amount of saliva is recorded.
Consistency
a. Thin serous: Favourable for denture retention.
b. Thick mucus: Difficult to work with and displaces the
denture.
c. Mixed: Equal mixture of the above two.
Amount
a. Normal: Ideal for denture retention.
b. Excessive: Makes denture construction difficult.
c. Reduced: Results in dry mouth/xerostomia and de-
creased denture retention.
Leads to soreness of tissues and coated tongue. It is seen
after radiation therapy, usage of certain drugs, etc. Sali-
vary substitutes are used for treatment.
XII. Radiographic examination
It is done to rule out any bony conditions that could affect the
treatment. A panoramic radiograph (also known as orthopan-
tomograph or OPG) is routinely done. It serves as a useful
conjunct in addition to history and physical examination.
Diagnosis offollowing can be done using radiograph:
• Bone pathosis.
• Cysts.
• Tumours.
• Retained roots or teeth.
• To study the periodontal condition of the remaining
teeth when present.
• Bony fractures.
• To study soft tissue thickness.
• To study the extent of bone resorption.
• To determine thickness of the body of the mandible.
• To locate the mandibular canal and its proximity to the
ridge crest.
• To locate the maxillary sinuses.
• To plan surgeries.
Section I I Topic Wise Solved Questions of Previous Years
• To see remaining bone density and quality.
• As treatment records.
• For patient education.
Fractured roots or teeth lying close to the surface may
be removed surgically, if the patient is fit for surgery.
However, deep seated retained teeth or root fragments
may be left alone, if they are asymptomatic as it could
result in undue bone destruction, reduce the height of the
residual alveolar ridge, and cause undue trauma to the
patient.
Additional supplemental radiographs are:
i. Periapical radiographs.
ii. Occlusal view radiographs.
iii. Lateral cephalometric radiograph (cephalogram).
Additional tests and medical consultation
• Additional tests like a routine blood test, blood and
urine sugar levels, and medical consultation with a phy-
sician may be required when indicated.
• When writing to the physician, a proper referral is pre-
pared outlining the signs and symptoms of the case.
• Any doubts or suspicions the dentist has requiring clari-
fication and the nature of the proposed dental treatment,
as to whether it involves surgical or nonsurgical proce-
dures are also clearly mentioned.
Diagnosis
• The determination of the nature of a disease.
• Diagnosis involves thorough analysis of all the factors,
which can affect the success of treatment. This includes
both systemic and local factors and mental condition of
the patient. Certain conditions could make the outcome
of treatment less satisfactory.
• A well made denture can fail, because the dentist did
not diagnose a complicating factor at the time of the
initial examination. The prosthodontic diagnostic index
is a useful tool to determine the diagnosis and prognosis
of denture treatment.
Prosthodontic Diagnostic Index (PDI)
for Complete Edentulism
It is developed by the American College of Prosthodontists.
The system classifies edentulous patient treatment com-
plexity using four diagnostic criteria:
a. Mandibular bone height,
b. Maxillomandibular relationship,
c. Maxillary residual ridge morphology, and
d. Muscle attachments.
These four criteria identify patients as:
a. Class 1 (Ideal or minimally compromised).
b. Class 2 (Moderately compromised).
c. Class 3 (Substantially compromised), or
d. Class 4 (Severely compromised).
PDI for the Edentulous Class 1 Patient
A patient who presents with ideal or minimally compro-
mised complete edentulism can be treated successfully by
conventional prosthodontic techniques.
Class I patient exhibits the following:
a. A residual mandibular bone height of at least 2 I mm
measured at the area of least vertical bone height.
b. A maxillomandibular relationship permitting normal
tooth articulation and an ideal ridge relationship.
c. A maxillary ridge morphology that resists horizontal
and vertical movement of the denture base, and
d. Muscle attachment locations conducive to denture base
stability and retention.
PDI for the Edentulous Class 2 Patient
A patient who presents with moderately compromised
complete edentulism and continued physical degradation of
the denture-supporting anatomy.
Class 2 patient exhibits the following:
a. A residual mandibular bone height of I 6-20 mm mea-
sured at the area of least vertical bone height.
b. A maxillomandibular relationship permitting normal
tooth articulation and an appropriate ridge relationship.
c. A maxillary residual ridge morphology that resists hori-
zontal and vertical movement of the denture base, and
d. Muscle attachments that exert limited compromise on
denture-base stability and retention.
PDI for the Edentulous Class 3 Patient
A patient who presents with substantially compromised
complete edentulism and who exhibits the following:
a. Limited interarch space of I 8-20 mm and/or temporo-
mandibular disorders.
b. A residual mandibular bone height of I I- I 5 mm mea-
sured at the area of least vertical bone height. An angle
class I, II, or III maxillomandibular relationship.
c. Muscle attachments that exert a moderate compromise
on denture-base stability and retention, and
d. A maxillary residual ridge morphology providing mini-
mal resistance movement of the denture base.
PD/ for the Edentulous Class 4 Patient
A patient who presents with the most debilitated form of
complete edentulism, where surgical reconstruction is usu-
ally indicated and specialized prosthodontic techniques are
required to achieve an acceptable outcome and exhibits the
following:
a. A residual mandibular bone height of 10 mm or less,
b. An angle class I, II, or III maxillomandibular relationship.
c. A maxillary residual ridge morphology providing no
resistance to movement of the denture base, and
d. Muscle attachments that exert a significant compromise
on denture-base stability and retention.
 Quick Review Series for BOS 4th Year: Prosthodontics

Treatment plan Or
The sequence of procedures planned for the treatment of a
With the help of diagram, discuss the denture-bearing
patient after diagnosis is as follows:
area of edentulous mouth. Give the clinical importance
• Diagnosis and treatment planning should be done be-
of posterior palatal seal and retromolar pad.
fore initiation of treatment. All the findings of the case
are analysed and the most suitable treatment plan is Ans.
determined which includes premedication, consultation,
Diagrams are as follows:
and treatment involving other specialists.
• It is explained to the patient in a simple and straight
forward manner including all the factors that might
complicate the treatment (if any). The patient is encour-
aged to speak and clear any doubts that he/she might
Alveolar ridge
have about the treatment. Mldpalaune raphe----,,._--+----1 Soft palate

Alternate Treatment Plan Maxillary tuberos,ty

Patient might not agree to the suggested treatment plan, due Hamular notch
Pterygomand,bular raphe
to various reasons: Uvula f "/ / ,' \

• The patient is not prepared to undergo surgery or other Retromolar pad

dental procedures due to personal reasons.
Pear shaped pad
• The patient does not have time to complete the sug- ~estdual alveolandge---t-
gested treatment plan.
• If the suggested treatment plan is too expensive, cheaper
Buccalfrenum
alternative needs to be consideredand the recommended
treatment plan has to be altered accordingly (within
limits). --Labial frenum

• The alternative treatment plan may be less than ideal, Fig. 1 Maxillary denture foundation showing functions of various areas
but if it is necessary due to above reasons, then we
should try to achieve best possible result. Valve seal area

Refusal of Treatment
• It is the duty of the dentist to respect the patient's 11..'"'~ Primary stress
wishes and include it in the treatment plan whenever bearing area
possible. Secondary stress
• But, if patient's demands are unreasonable or against bearing area

professional judgements or ethics, then the dentist may Relief area

refuse treatment or refer him to another dentist for a
second opinion. i • / I Secondary
retentive area
Prognosis
It is a forecast to the probable result of a disease or a course
of therapy. Pterygomaxillary and posterior palatal seai srea
Special points to be remembered in management of diabe- Fig. 2 Mandibular denture foundation showing functions of various areas
tes patient are:
• Diabetes affects the wound-healing capacity of the tis- secondary stress bearing
sues and chances of infection increase. Should be dealt area (slopes of the ridges)

properly if any preprosthetic surgery is planned.

• Insulin used to treat diabetes mellitus, when injected
along with local anaesthetic during treatment, patient
may go into hypoglycaemic shock due to decrease in
blood glucose levels. It should be assured that patient Secondary stress
bearing area (buccal
has taken meal before treatment and in case of shock, shelf area)
glucose should be given immediately. Secondary relief area
(ridge crest)
Q. 2. What do you understand by the term 'Examina-
tion of the patient'? Name the objectives of examination
of a patient. Discuss in detail the clinical significance of Valve seal area Secondary stress bearing area
anatomical landmarks of edentulous maxilla and (sulcus area)
mandible. Fig. 3 Anatomical landmarks of edentulous mouth
Section I I Topic Wise Solved Questions of Previous Years
Examination of Patient
Following are the objectives of examination of patient:
i. Recording the general information.
ii. Recoding the chief complaint and assessing patient's
expectations.
iii. Recording the relevant medical history.
iv. Recording current medication.
v. Recording the relevant dental history.
vi. Performing thorough visual and manual examination
of the mouth and head and neck regions.
vii. Performing radiographic examination.
viii. Referring for additional tests, if required, e.g., blood,
sugar, and urine.
ix. Referring for medical consultation (when indicated).
x. Referring for second opinion and opinion from other
dental specialists (when required).
xi. Making alginate impressions and preparing mounted
study models (when indicated).
xii. Discussing the diagnosis, treatment planning, and
prognosis with the patient.
xiii. Finalizing the fees and obtaining the informed consent.
Clinical Significance of Anatomical
Landmarks of Maxilla and Mandible
A. Maxilla
I. Supporting structures
i. Residual alveolar ridge
• The crest and part of the slope has compact type of
bone, covered with a layer of fibrous connective tis-
sue which is attached firmly and therefore best able
to support a denture. With resorption, this area
gradually reduces in size thus reducing the support.
• Function
It is the primary stress-bearing area. Extra stress may be
placed on the crest during impression procedures.
ii. Rugae area
• It is series of ridges in the anterior part of hard palate
and made up of keratinized fibrous connective tissue.
Function: It is the secondary stress-bearing area, because it
resists the forward movement. It should be recorded with-
out pressure. If the tissue distorts while making the impres-
sion, then it can rebound and the denture unseated.
iii. Median palatine raphe
• It is present as a slightly raised bony ridge along the
midline of the hard palate.
Significance
It is the relief area for two reasons. They are:
a. The mucosa covering it, is thin and nonresilient, pres-
sure on which can lead to soreness and severe pain.
b. If not adequately relieved, then it can act as a ful-
crum point and cause rocking of the
c. Dentures.
iv. Hard palate
• Soft tissues serve as cushion between the hard denture
surface and the bone. It varies in thickness in different
parts of the oral cavity.
• Over hard palate, keratinized epithelium is present. Soft
tissue consists of mucosa and submucosa.
• Mucosa of hard palate is masticatory type and firmly
attached, which is best suited for denture support.
• Hard palate is divided into two parts:
a. Anterolateral: Submucosa contains adipose tissue.
Significance: It forms part of the secondary retentive area.
b. Posterolateral region (glandular region): It is located
on either side of the midline of the posterior region
of the hard palate. Mucous glands are thick and
cover the blood vessels and nerves come from the
greater palatine foramen.
Significance: It is the secondary retentive area. It
should not be compressed. Otherwise, it can
interfere with the function of mucous glands
leading to their excessive secretion and inaccuracy
in recording of impression details.
v. Incisive papilla
• A small tissue projection located immediately behind
and between the central incisors in dentulous mouth.
• Its location varies in the edentulous mouth. It may be on
the crest of the ridge after resorption has occurred.
• It covers the incisive foramen through which the naso
palatine nerves and vessels pass.
Significance: Relief area: Relief is provided in the
final impression to prevent pressure on the emerging
naso palatine nerves and vessels. Denture pressure
on the papilla can cause paraesthesia, pain, burning
sensation, and other vague complaints.
vi. Zygomatic process (Malar process)
• It is located buccal to the first molar region. It is a hard
area that may become prominent in mouth that has been
edentulous for a long time, covered by thin, loosely
attached mucosa.
• Function relieved when prominent, to prevent soreness.
vii. Maxillary tuberosity
• It is the posterior most part of the maxillary edentulous
ridge. When the maxillary teeth extrude, (when oppos
ing mandibular teeth are lost), it becomes very large and
hangs down with the extruding teeth. This region may
be covered with excess hypermobile tissue.
Significance:
a. It should be covered in the impression.
b. An overhanging tuberosity can interfere with the
location of the occlusal plane and reduce the space
available for the denture and should be surgically
reduced.
c. A hypermobile tuberosity can interfere with denture
stability.
d. Teeth are not set on the tuberosity region.

II. Limiting structures (Valve seal areas)
These are the tissues which define the boundary of dentures.
• Provide retention to denture by providing a seal against
entry of air, e.g., the facial sulcus, the posterior palatal
seal area, the alveololingual sulcus, etc.
• Prevents the entry of food.
• Histology: The vestibule is lined by nonkeratinized epi-
thelium. The submucosa is thick and contains loose
areolar tissue and elastic fibres.
The limiting structures are as follows:
i. Labial frenum
• Fold of mucous membrane in the midline.
• Starts superiorly from lip's inner surface as fan-shaped
structure and converges near its attachment on labial
side of ridge. It has no action of its own.
Significance: Relief area
• Recorded as narrow notch labial notch in the impres-
sion. If not relieved, then it causes irritation.
• If present close to ridge crest, then it affects denture seal
and retention and thus frenectomy needs be done.
ii. Buccal frenum
• Fold of mucous membrane on buccal side.
• May be present as single fold/double fold/broad- and
fan-shaped.
• Related to three muscles:
a. Caninus (levator anguli oris): It is attached beneath
the frenum and affects its position.
b. Orbicularis oris: It pulls it forward.
c. Bucciantor: It pulls it backward.
Significance: Relief area.
• Recorded as buccal notch in the impression, in its functional
form (e.g., during chewing and smiling), failure to do so can
lead to denture dislodgement during mouth functions.
iii. Labial vestibule
• Sulcus area between labial and buccal frenum and forms
part of valve seal area.
Significance:
• Accommodates labial flange of denture.
• Provides valve seal.
• Affects patient appearance:
• If flange is thick, then lips bulge out.
• If flange is thin, then one can see unsupported lips.
iv. Buccal vestibule
• Extends from buccal frenum to hamular notch and
forms part of vale seal area.
Significance:
• Provides peripheral seal.
• Accommodates buccal flange of denture.
• It is affected by the action of masseter and coronoid process.
v. Coronoid process
• Located buccally in the maxillary tuberosity region.
Quick Review Series for BOS 4th Year: Prosthodontics
Significance:
• It affects the buccal flange of denture as the mandible
moves forward, side to side or opens wide.
• When distal flange is too thick, it dislodges the
denture.
vi. Masseter muscle
• It reduces the space when contracted under heavy biting
pressure.
vii. Pterygomaxillary notch
• Located distal to maxillary tuberosity, between the tu-
berosity and hamular process of pterygoid plate.
Significance:
• Forms the posterior limit of denture.
• Pterygomaxillary seal can be obtained by placing extra
pressure in this region.
viii. Pterygomandibular raphe
• Extends from hamulus to distolingual corner of retro-
molar pad. Buccinators attach to its distal part.
Significance:
• If denture is overextended beyond the hamular notch,
and mouth opened wide, then raphe pulls forward in-
juring the tissues.
ix. Palatine fovea
• These are two small indentations in the posterior palate
in midline.
• Formed by joining together of several mucous gland
ducts. May be prominent or barely visible.
Significance:
• Close to vibrating line and present in soft tissue.
• Serves as guideline for posterior border of denture
(posterior vibrating lineis 2 mm anterior to foveae).
x. Posterior palatal seal area
• It is the area between anterior and posterior vibrating lines.
• It is in the shape of Cupid's bow.
• Along with pterygomaxillary seal, it forms the posterior
part of valve seal.
Function:
• To attain seal, extra pressure can be applied here.
• Marks the posterior limit of denture.
B. Mandible
I. Supporting structures
i. Residual alveolar ridge
• It is covered by keratinized layer and firmly attached
to periosteum.
• It is sometimes loosely attached and movable.
• Bone is cancellous, spongy, and trabeculated in nature.
Functions:
• Secondary relief area: Due to presence of cancellous
bone, it does not provide good support.
Section I I Topic Wise Solved Questions of Previous Years
• If it is sharp, spongy, and full of nutrient canals, then it
should be relieved during impression.
ii. Slopes of the residual alveolar ridge
• Covered by a thin plate of cortical bone and functions as
secondary stress-bearing area.
iii. Buccal shelf area
• It is supporting structure of mandible.
• Boundaries:
• Anteriorly: Buccal frenum.
• Posteriorly: Retromolar pad.
• Medially: Crest of the ridge.
• Laterally: External oblique line.
• Inferior part of buccinator is attached to this area, but as
the fibres run horizontally, it does not interfere with
denture.
• Histology: Mucosa is less keratinized and loosely
attached.
Functions:
• It serves as the primary stress-bearing area, because it is
at right angles to vertical
• occlusal loads and is covered with dense smooth corti-
cal bone.
iv. Mylohyoid ridge
• Bony ridge found on lingual side of mandible.
• Begins from third molar region, sloping downwards and
forwards.
• Provides attachment to mylohyoid muscle.
• Covered by soft tissue and examined by palpation
method.
Functions:
• Determines the height of lingual flange.
• In case of severely undercut ridge, it is difficult to inset
and remove denture.
• Bulbous irregular ridge/thin, sharp ridge can cause soft
tissue irritation and needs to be corrected surgically.
v. Mental foramen
In case of extremely resorbed ridge, it comes to level of ridge
crest near the premolar region and needs to be relieved. Pres-
sure on mental nerve can lead to numbness of lip.
vi. Torus mandibularis
• Cause is unknown.
• Present as rounded bony prominences in premolar re-
gion in some individuals.
• Located midway between soft tissue of the floor of
mouth and ridge crest.
• Size varies from pea to hazelnut.
Functions:
• Relief area: It is covered by thin layer of mucous mem-
brane which may get irritated by the denture.
• Surgical removal of large tori is required, as it interferes
with peripheral seal.
II. Buccal limiting structures of mandible
i. Labial frenum
• Band of fibrous connective tissue to which orbicu-
laris oris is attached.
• Sensitive and active and should be relieved to prevent
soreness and to maintain the peripheral seal.
ii. Buccal frenum
• Connected to maxillary buccal frenum as a continuous
band via modiolus at the corner of the mouth.
• Denture borders should not be overextended in this re-
gion, as fibres and muscular tissues actively pull in this
region which can cause denture displacement.
iii. Labial sulcus/vestibule
• Extends between labial and buccal frenum.
Significance:
• Accommodates the labial flange of denture which is shal-
low in extension because of the fibres of orbicularis oris
and incisivus labii inferioris running close to ridge crest.
• Forms part of valve seal area.
iv. Buccal vestibule
• Extends from buccal frenum to outside back corner of
reteromolar pad.
• Lower part of bucciantor is attached to it in molar re-
gion, but as the fibres are horizontal it do not displace
the lower denture.
Significance:
• Forms part of valve seal.
• Accommodates the buccal flange of denture.
v. External oblique ridge
• Its palpation helps to know the amount of resistance of-
fered by the border tissues in this region.
vi. Masseter muscle influence area
• Its contraction pushes inward against the buccina-
tors muscle and affects the distobuccal corner of the
denture which should converge rapidly to avoid
displacement.
vii. Distal border of denture
It is limited by:
• Ramus of mandible.
• Buccinator is at its attachment to pterygomandibular raphe.
• Internal and external oblique ridge as it ascends the ramus.
Significance:
• If denture border is overextended here, then it causes
soreness and limits thebuccinator muscle function.
viii. Retromolar pad
• It is triangular pad of soft tissue at the distal end of
mandibular ridge.
• It is covered with nonkeratinized epithelium.

Contents:
• Glandular tissue.
• Temporalis tendon.
• Buccinator fibres enter it from buccal side.
• Superior pharyngeal constrictor enters it from lingual
side.
• Pterygomandibular raphe enters it from back inside comer.
Significance:
• Forms part of valve seal area.
• Provides border seal.
• Extra pressure on the pad to be avoided, to not to injure
the muscle fibres.
ix. Pear-shaped pad
• Retromolar papilla is present in the region of third mo-
lar distally, after whose loss it remains fused to scar.
• It is pear-shaped unlike retromolar pad, which is soft
and readily displaced.
Lingual limiting structures of mandible
i. Retromylohyoid curtain
• Wall of mucous membrane which limits the distolingual
part of denture flange.
• Supported superiorly by superior constrictor and lin-
gually by anterior tonsillar pillar.
Significance:
• Accommodates the distolingual part of denture.
• It should be carefully border moulded to avoid soreness
and displacement of denture, as it pulls forward when
the tongue thrust out.
ii. Alveololingual sulcus (lingual vestibule)
• Also called as lingual vestibule-limiting structure of mandible.
• It extends from lingual frenum anteriorly to retromylo-
hyoid curtain posteriorly.
• It is divided into three parts:
a. Anterior part
• It extends from lingual frenum to premylohyoid
fossa.
• It is the shallowest portion of the lingual flange.
b. Middle part
• It extends from premylohyoid fossa to distal end
of mylohyoid ridge.
• It slopes towards the tongue.
• It allows room for action of mylohyoid muscle.
• Increased flange height, as it can be extended
beyond the muscle attachment.
• It allows floor of mouth to rise without displacing
the denture.
• It provides room for tongue rest on flange leading
to retention.
• It avoids impingement of sublingual gland and
submaxillary duct.
Quick Review Series for BOS 4th Year: Prosthodontics
c. Posterior region (retromylohyoid fossa region)
• It extends from the end of mylohyoid ridge to
retromylohyoid curtain.
• Posterior region slopes away from tongue and
towards the ridge.
• It guides the tongue on top of the lingual flange.
iii. Lingual frenum
• It is attached to the tongue anteriorly.
• It is active and resistant.
Significance:
• If not relieved, it causes soreness and dislodgement of
denture.
iv. Mylohyoid muscle
• It originates from mylohyoid line.
• It is most active muscle of the floor of the mouth.
Extensions:
• Posteriorly - 1 cm distal to mylohyoid ridge end.
• Anteriorly - up to midline.
• Medially - both sides of mylohyoid join to form the
floor of the mouth.
• In anterior region, it lies deep to sublingual gland.
Significance:
• It influences the lingual flange of denture.
• When it is relaxed, a space exists between the flange and
the mucus membrane and contact occurs only when the
tongue is raised out.
v. Mylohyoid ridge
• It provides attachment to mylohyoid muscle.
Significance:
• Denture border should extend below this ridge otherwise
there will be soreness, denture displacement, and loss of seal.
• In extreme resorption, ridge becomes prominent and
should be surgically corrected/relieved by impression.
vi. Genial tubercles
• It is present as a hard projection in the midline on
lingual side of mandible.
• It becomes prominent in severe resorption cases.
• It is either visible or felt on palpation.
Significance:
• If prominent, then it should be relieved to avoid pain
and soreness.
• Denture border should rest on soft tissues around the
periphery of tubercles.
• They can be surgically relocated.
vii. Sublingual gland region
• It rests anteriorly on the mylohyoid muscle.
Section I I Topic Wise Solved Questions of Previous Years
• It comes close to ridge crest, when the floor of
mouth is raised limiting the height of lingual flange
in this region.
SHORT ESSAYS
Q. 1. Importance of preprosthetic evaluation of the
edentulous area before making impression.
Ans.
Importance of preprosthetic evaluation of edentulous area
before making impression is as follows:
• To determine that no mental or physical condition exists
which would contraindicate the wearing and use of the
denture itself.
• A review of past and current medical history with par-
ticular attention to any condition that might increase the
surgical risk.
• To assess the nutritional status.
• To conduct an intraoral examination and assess the need
for surgery, as well as to rule out nonsurgical alternatives.
• To evaluate the TMJ and jaw relationship.
• To carry out additional diagnostic procedures like radio-
graphic studies, and blood and urine analyses, etc.
• Dental model evaluation and mock surgery on the diag-
nostic casts to get an idea about the actual surgery
results.
Preprosthetic evaluation should be carried out in the fol-
lowing sequential manner:
• Recording the general information.
• Recoding the chief complaint and assessing patient's
expectations.
• Recording the relevant medical history.
• Recording current medication.
• Recording the relevant dental history.
• Performing thorough visual and manual examination of
the mouth and head and neck regions.
• Performing radiographic examination.
• Referring for additional tests, if required, e.g., blood,
sugar, and urine.
• Referring for medical consultation (when indicated).
• Referring for second opinion and opinion from other
dental specialists (when required).
• Making alginate impressions and preparing mounted
study models (when indicated).
• Discussingthe diagnosis, treatment planning, and prog-
nosis with the patient.
• Finalizing the fees and obtaining the informed consent.
Q. 2. Why complete radiographic examination should
be made for an endentulous mouth?
• S-shape of the lingual flange is due to activity of my-
lohyoid muscle, which when contracted raises the area
between premylohyoid and retromylohyoid fossa re-
sulting in characteristic 's' curve.
Ans.
• Radiographic examination is done to rule out any bony
conditions that could affect the treatment. A panoramic
radiograph (also known as orthopantomograph or OPG)
is routinely done. It serves as a useful conjunct in addi-
tion to history and physical examination.
Diagnosis of the following can be done using radiograph:
• Bone pathosis.
• Cysts.
• Tumours.
• Retained roots or teeth.
• To study the periodontal condition of the remaining
teeth, when present.
• Bony fractures.
• To study soft tissue thickness.
• To study the extent of bone resorption.
• To determine thickness of the body of the mandible.
• To locate the mandibular canal and its proximity to the
ridge crest.
• To locate the maxillary sinuses.
• To plan surgeries.
• To see remaining bone density and quality.
• As treatment records.
• For patient education.
• Fractured roots or teeth lying close to the surface may be
removed surgically, if the patient is fit for surgery. How-
ever, deep-seated retained teeth or root fragments may be
left alone, if they are asymptomatic as it could result in
undue bone destruction, reduce the height of the residual
alveolar ridge, and cause undue trauma to the patient.
Additional supplemental radiographs are:
a. Periapical radiographs.
b. Occlusal view radiographs.
c. Lateral cephalometric radiographs (cephalogram).
Q. 3. Discuss the examination, diagnosis, and treatment
planning in complete denture patients.
Ans.
Examination, Diagnosis, and Treatment
Planning in Complete Denture Patients
• For success of prosthetic treatment, a careful, correct,
and complete examination, and diagnosis is important
followed by providing the patient with the best possible

treatment plan in accordance with his age, physical,
mental, and financial status.
Examination and diagnosis should be carried out in the
following sequential manner:
i. Recording the general information.
ii. Recoding the chief complaint and assessing patient's
expectations.
iii. Recording the relevant medical history.
iv. Recording current medication.
v. Recording the relevant dental history.
vi. Performing thorough visual and manual examina-
tion of the mouth and head and neck regions.
vii. Performing radiographic examination.
viii. Referring for additional tests, if required, e.g.,
blood, sugar, and urine.
ix. Referring for medical consultation (when indicated).
x. Referring for second opinion and opinion from
other dental specialists (when required)
xi. Making alginate impressions and preparing
mounted study models (when indicated).
xii. Discussing the diagnosis, treatment planning, and
prognosis with the patient.
xiii. Finalizing the fees and obtaining the informed
consent.
Diagnosis
• The determination of the nature of a disease is known as
diagnosis.
• Diagnosis involves thorough analysis of all the factors
which can affect the success of treatment. This includes
both systemic and local factors and mental condition of
the patient. Certain conditions could make the outcome
of treatment less satisfactory.
• A well made denture can fail, if the dentist cannot di-
agnose a complicating factor at the time of the initial
examination.
• The prosthodontic diagnostic index is a useful tool to de-
termine the diagnosis and prognosis of denture treatment.
Prosthodontic Diagnostic Index (POI) for
Complete Edentulism
It was developed by the American College of Prosthodon-
tists. The system classifies edentulous patient treatment
complexity using four diagnostic criteria:
a. Mandibular bone height.
b. Maxillomandibular relationship.
c. Maxillary residual ridge morphology, and
d. Muscle attachments.
These four criteria identify patients, as:
Class 1 (ideal or minimally compromised).
Class 2 (moderately compromised).
Class 3 (substantially compromised), or
Class 4 (severely compromised).
Quick Review Series for BOS 4th Year: Prosthodontics
Treatment Plan
The sequence of procedures planned for the treatment of a
patient after diagnosis is as follows:
• Diagnosis and treatment planning should be done before
initiation of treatment. All the findings of the case are
analyzed and the most suitable treatment plan is deter-
mined, which includes premedication, consultation, and
treatment, involving other specialists.
• It is explained to the patient in a simple and straight
forward manner, including all the factors that might
complicate the treatment (if any). The patient is encour-
aged to speak and clear any doubts that he/she might
have about the treatment.
Q. 4. Mental attitude of patients.
Ans.
The House Classification of Mental Attitude of Patient by
MM House classifies denture patients into different groups
based on their personality as:
a. Philosophical
• Patient has best mental attitude required for denture
treatment.
• Patient is well motivated and realizes his part m
treatment.
• Patient cooperates with the dentist and learns to
adjust.
• Patient is rational, sensible, calm, and composed in
difficult situations.
b. Exacting (critical)
• Patient is methodical and precise.
• Need to explain each step of the procedure in detail
to the patient.
• Patient sometimes proposes treatment plan to the
dentist and makes severe demands.
• Patient should be managed with extra care, effort, and
patience. Dentist must listen to the demands of the
patient, but must not consider them, if unreasonable.
c. Indifferent
• Patient has a questionable prognosis.
• Patient lacks motivation and is not very interested in
treatment.
• Patient tries to find mistakes in treatment and blames
dentist for any mishap.
• Patient does not cooperate and follow instructions
and is forced by his relatives, spouse, etc., for dental
treatment.
• Such patient is difficult to manage. Patient should be well
educated about the treatment and motivated to develop
interest in treatment. If no improvement is observed,
then it is better to postpone or refuse the treatment.
d. Hysterical
• Patient is easily excited, highly apprehensive, and
emotionally unstable.
• Patient rarely cooperates with the dentist.
Section I I Topic Wise Solved Questions of Previous Years

• Patient has unfounded complaints and unrealistic
expectations.
• Lot of time and patience is required to manage such
patient.
• Medical consultation might be required for the
systemic problems, if present.
e. Sceptical
• Patient has had bad results from previous treatment
and is doubtful whether their problems can be solved.
• Patient has unfavourable conditions like resorbed
ridges and poor health.
• Patient may be in psychological stress, due to recent
death of close relative etc.
• First, psychological management is required for such
patient before dental treatment. Kindness, care, and
sympathy should be offered and condition should be
dealt with patience and good attention, in order to
restore his confidence.

SHORT NOTES
Q. 1. House classification of mental attitudes. Classification:
Undercuts may be:
Or
• Unilateral or bilateral.
Mental attitudes of patients. • Labial or lingual.
• Mild, moderate, or severe.
Ans.
Q. 3. Importance of full mouth intraoral radiographs in
The House Classification of Mental Attitude of Patient
edentulous patients.
MM House classifies denture patients into different groups,
based on their personality as: Ans.
a. Philosophical
• Patient has best mental attitude required for denture
Importance of lntraoral Radiographic
treatment.
• Patient is rational, sensible, calm, and composed in Examination
difficult situations and is well motivated. Diagnosis of following can be done using radiograph:
b. Exacting (critical) • Bone pathosis.
• Patient is methodical and precise. • Cysts.
• Patient sometimes proposes treatment plan to the • Tumours.
dentist and makes severe demands. • Retained roots or teeth.
c. Indifferent • To study the periodontal condition of the remaining
• Patient has a questionable prognosis. teeth, when present.
• Patient lacks motivation and is not very interested in • Bony fractures.
treatment. • To study soft tissue thickness.
• Such patient is difficult to manage. • To study the extent of bone resorption.
d. Hysterical • To determine thickness of the body of the mandible.
• Patient is easily excited, highly apprehensive, and • To locate the mandibular canal and its proximity to the
emotionally unstable. ridge crest.
• Patient rarely cooperates with the dentist. • To locate the maxillary sinuses.
• Medical consultation might be required for the sys- • To plan surgeries.
temic problems, if present. • To see remaining bone density and quality.
e. Sceptical • As treatment records.
• Pateint has had bad results from previous treatment • For patient education.
and is doubtful whether his problems can be solved.
• Patient has unfavourable conditions like resorbed Q. 4. What are the soft tissues covering the hard palate
ridges and poor health. and their relevance to complete dentures?
• Kindness, care, and sympathy should be offered and Ans.
condition should be dealt withpatience and good
attention, in order to restore his confidence.
Soft Tissues and their Relevance to Complete
Q. 2. Undercuts in complete denture.
Dentures
Ans.
• Soft tissues serve as cushion between the hard denture
Undercuts present on ridge can cause difficulty in denture surface and the bone. It varies in thickness in different parts
removal and insertion and frequent abrasion of the mucosa of the oral cavity. Over hard palate, keratinized epithelium
can lead to ulceration and pain. is present. Soft tissue consists of mucosa and submucosa.
 Quick Review Series for BOS 4th Year: Prosthodontics

• Mucosa of hard palate is masticatory type and firmly
attached, which is best suited for denture support.
• Hard palate is divided into two parts:
I. Anterolateral
• Submucosa contains adipose tissue.
• Significance: It forms part of the secondary re-
tentive area.
II. Posterolateral region (glandular region)
• It is located on either side of midline of the poste-
rior region of the hard palate. Mucous glands are
thick and cover the blood vessels and nerves com-
ing from the greater palatine foramen.
Significance:
It serves as secondary retentive area. It should not be com-
pressed otherwise it can interfere with the function of mu-
cous glands leading to their excessive secretion and inac-
curacy in recording of impression details.
Q. 5. Soft palate.
Or
Muscles of the soft palate.
Ans.
Soft Palate
Soft palate is a fold of mucous membrane consisting of
following parts:
Palatine aponeurosis-flattened tendon of the tensor veli
palatini, which forms the fibrous basis of the palate.
• Near the median plane, aponeurosis splits to enclose the
musculus uvulae.
• Superior surface of the palatine aponeurosis-levator
veli palatini and the palatopharyngeus.
• Inferior surface of the palatine aponeurosis-palatoglossus.
• Numerous mucous glands and some taste buds are
present.
Muscles of the Soft Palate
i. Tensor palati (tensor veli palatini)-thin, triangular muscle.
Functions:
a. It tightens the soft palate, chiefly the anterior part.
b. It opens the auditory tube to equalize air pressure
between the middle ear and the nasopharynx.
ii. Levator palati (levator veli palatini)-cylindrical mus-
cle that lies deep to the tensor veli palatine.
Functions
a. It elevates soft palate and closes the pharyngeal
isthmus.
b. It opens the auditory tube, like the tensor veli
palatini.
iii. Musculus uvulae-longitudinal strip placed on one
side of the median plane, within the palatine aponeu-
rosis, which pulls up the uvula.
iv. Palatoglossus-pulls up the root of the tongue, ap-
proximates the palatoglossal arches, and thus closes
the oropharyngeal isthmus.
v. Palatopharyngeous-pulls up the wall of pharynx and
shortens it, during swallowing.

------------------ - <( Topic 3)

Diagnostic Impressions in CD and Mouth Preparation
for CD and Objective of Impression Making

LONG ESSAYS
Q. 1. Define complete denture retention. Enumerate It is the ability of the denture to withstand displacement
various factors of retention. against its path of insertion.
Ans. Factors affecting retention are:
A. Anatomical factors.
B. Physiological factors.
Retention C. Physical factors.
Retention is defined as that quality inherent in the prosthesis, D. Mechanical factors.
which resists the force of gravity, adhesiveness of foods, and E. Muscular factors.
the forces associated with the opening of the jaws (GPT).
Section I I Topic Wise Solved Questions of Previous Years
Anatomical Factors
Anatomical factors which affect retention are:
i. Size of the denture-bearing area: It increases with in-
crease in size of the denture-bearing area.
• Maxillary denture-bearing area: 24 cm2.
• Mandible denture-bearing area: 14 cm2.
Hence, maxillary dentures have more retention than
mandibular dentures.
ii. Quality of the denture-bearing area: The displacability
of the tissues influences the retention of the denture.
Tissues displaced during impression-making will lead
to tissue rebound during denture use, leading to loss of
retention.
Physiological Factors
• Saliva retention depends upon viscosity of saliva.
• Thick and ropy saliva accumulates between the tissue
surface of the denture and the palate, leading to loss of
retention.
• Thin and watery saliva is ideal.
• Ptyalism leads to gagging.
• Xerostomia produce soreness and irritation.
Physical Factors
Physical factors which control retention are as follows:
i. Adhesion
It is defined as physical attraction of two unlike molecules
to each other (GPT).
• Saliva plays an important role in adhesion. It wets the
tissue surface of denture and the mucosa forming a thin
film between them, which helps to hold the denture to
the mucosa. In patients with xerostomia, adhesion does
not play a major role.
• Amount of adhesion present is proportional to the
denture base area.
ii. Cohesion
• It is defined as the physical attraction of like molecules
to each other (GPT).
• Cohesive forces act within the thin film of saliva.
Watery serous saliva forms a thinner film and is more
cohesive than thick mucous saliva.
• Cohesive forces increase with increase in denture-
bearing area.
iii. lnterfacial surface tension
It is the tension or resistance to separation possessed
by the film of liquid between two well adapted surfaces -
GPT.
To obtain maximum interfacial surface tension:
• Saliva should be thin and even.
• Perfect adaptation should be present between the tissues
and the denture base.
• The denture base should cover a large area.
• There should be good adhesive and cohesive forces,
which aid to enhance interfacial surface tension.
• It plays a major role in retention of maxillary denture
and is dependent on the presence of air at the margins of
liquid and solid contact (liquid air interface).
• If there is no liquid-air interface, then there will be no sur-
face tension. This phenomenon is seen in mandibular den-
tures where there is excess saliva along the denture borders
with minimal interfacial surface tension and no retention.
• Stefan's formula to calculate interfacial surface tension:
F= (3/2*3.14*Kr4 I H3) * v, where:
F - interfacial surface tension.
k - viscosity of the interposed liquid (saliva).
r - denture surface area.
h - width of the space between the denture base and the
mucosa.
V - velocity of the displacing force.
F decreases with the increase in h.
Increase in r increases the F.
A slow and steady increase in V will have least resis-
tance from interfacial surface tension than a rapid V.
iv. Capillarity or capillary attraction
It is defined as that quality or state, wherein surface tension
causes elevation or depression of the surface of a liquid that
is in contact with a solid (GPT).
Factors which improve capillary attraction and thus
retention are as follows:
• Closeness of adaptation of denture base to soft
tissue.
• Greater surface of the denture-bearing area.
• Thin film of saliva should be present.
v. Atmospheric pressure and peripheral seal
• Peripheral seal is the area of contact between the periph-
eral borders of the denture and the resilient-limiting
structures.
• It prevents air entry between the denture surface and the
soft tissue maintaining a low pressure in space between
the above two.
• To achieve good peripheral seal, the denture borders
should rest on soft and resilient tissues which allow
movement of mucosa along with the denture base dur-
ing function.
• When displacing forces act on denture, a partial vacuum
is produced between the denture and the soft tissues,
which aids in retention.

• This property is called the natural suction ofa denture.
Hence, atmospheric pressure is referred to as emer-
gency retentive force or temporary restraining force.
• Retention produced by an atmospheric pressure is di-
rectly proportional to the denture base area.
Mechanical Factors
Mechanical factors which control retention are as follows:
• Undercuts
• Unilateral undercuts aid in retention.
• Bilateral undercuts interfere with denture insertion and
require surgical correction.
• Retentive springs.
• Magnetic forces: lntramucosal magnets aid in increas-
ing retention of highly-resorbed ridges.
• Denture adhesives: These are available as creams/gels/
powders. They are coated on tissue surface before wearing.
• Suction chambers and suction discs: These are_used in
maxillary dentures to aid in retention by creating an area
of negative pressure, but avoided nowadays due to their
potency of causing palatal hyperplasia.
Muscular Factors
• Muscles exercise supplements retentive force on the denture.
• There is a balance between the forces acting from the
buccal musculature and the tongue which is obtained in
the neutral zone and thus, the artificial teeth should be
arranged in neutral zone to achieve better retention.
• Occlusal plane should be parallel to residual ridge and
divide the interarch space equally.
Q. 2. Define impression. Discuss biological consider-
ations for a maxillary impression.
Ans.
Impression
Impression is a negative likeness or copy in reverse of the
surface of an object, which is an imprint of the teeth and
adjacent structures used in dentistry (GPT).
Biological Considerations of Maxillary
Impression
Supporting Structures
i. Residual alveolar ridge
• The crest and part of the slope has compact type of
bone, covered with a layer of fibrous connective tissue
which is attached firmly and therefore best able to sup-
port a denture. With resorption, this area gradually re-
duces in size thus reducing the support.
Quick Review Series for BOS 4th Year: Prosthodontics
• Function
It serves as the primary stress-bearing area. Extra-stress
may be placed on the crest during impression procedures.
ii. Rugae area
• It is a series of ridges in the anterior part of hard palate,
made up of keratinized fibrous connective tissue.
• Function
It serves as secondary stress-bearing area, because it
resists the forward movement. It should be recorded
without pressure. If the tissue distorts while making
the impression, then it can rebound and unseat the
denture.
iii. Median palatine raphe
• Present as a slightly raised bony ridge along the midline
of the hard palate.
• Significance
It is the relief area for two reasons:
• The mucosa covering it, is thin and nonresilient, pressure
on which can lead to soreness and severe pain.
• If not adequately relieved, then it can act as a fulcrum
point and cause rocking of the dentures.
iv. Hard palate
• Soft tissues serve as cushion between the hard denture
surface and the bone. It varies in thickness in different
parts of the oral cavity. Over hard palate, keratinized
epithelium is present. Soft tissue consists of mucosa and
submucosa.
• Mucosa of hard palate is masticatory type and firmly
attached, which is best suited for denture support.
Hard palate is divided into two parts:
a. Anterolateral: Submucosa contains adipose tissue.
Significance
• It forms part of the secondary retentive area.
b. Posterolateral region (glandular region)
• Located on either side of midline of the posterior
region of the hard palate. Mucous glands are thick
and cover the blood vessels and nerves, coming from
the greater palatine foramen.
Significance
• It serves as the secondary retentive area. It should not
be compressed otherwise it can interfere with the
function of mucous glands leading to their excessive
secretion and inaccuracy in recording of impression
details.
v. Incisive papilla
• A small tissue projection located immediately be-
hind and between the central incisors in dentulous
mouths.
Section I I Topic Wise Solved Questions of Previous Years
• Its location varies in the edentulous mouth. It may be on
the crest of the ridge after resorption has occurred.
• It covers the incisive foramen through which the naso-
palatine nerves and vessels pass.
Significance
• Relief area: Relief is provided in the final impression
to prevent pressure on the emerging nasopalatine
nerves and vessels. Denture pressure on the papilla
can cause paraesthesia, pain, burning sensation, and
other vague complaints.
vi. Zygornatic process (Malar process)
• It is located buccal to the first molar region. It is a hard
area that may become prominent in mouths that have
been edentulous for a long time, covered by thin,
loosely attached mucosa.
• Function: Is relieved when prominent, to prevent soreness.
vii. Maxillary tuberosity
• It is the posterior most part of the maxillary edentulous
ridge. When the maxillary teeth extrude (when oppos-
ing mandibular teeth are lost), it becomes very large and
hangs down with the extruding teeth. This region may
be covered with excess hypermobile tissue.
Significance
a. It should be covered in the impression.
b. An overhanging tuberosity can interfere with the
location of the occlusal plane and reduce the space
available for the denture and should be surgically
reduced.
c. A hypermobile tuberosity can interfere with den-
ture stability.
d. Teeth are not set on the tuberosity region.
Limiting Structures (Valve Seal Areas)
• These are the tissues which define the boundary of
dentures.
• They provide retention to denture by providing a seal
against entry of air, e.g., the facial sulcus, the posterior
palatal seal area, and the alveololingual sulcus.
• They prevent the entry of food.
• Histologically, the vestibule is lined by nonkeratinized
epithelium. The submucosa is thick and contains loose
areolar tissue and elastic fibres.
i. Labial frenurn
• Fold of mucous membrane in the midline.
• Starts superiorly from lip's inner surface as fan-shaped
structure and converges near its attachment on labial
side of ridge. It has no action of its own.
Significance: It serves as relief area.
• It is recorded as narrow notch or labial notch in the
impression. If not relieved, causes irritation.
• If present close to ridge crest, then it affects denture seal
and retention and thus frenectomy should be done.
ii. Buccal frenurn
• Fold of mucous membrane on buccal side.
• May be present as single fold/double fold/broad- and
fan-shaped.
• Related to three muscles:
a. Caninus (levator anguli oris): It is attached beneath
the frenum and affects its position.
b. Orbicularis oris pulls it forward.
c. Bucciantor pulls it backward.
Significance: It serves as relief area.
• It is recorded as buccal notch in the impression in its func-
tional form (e.g., during chewing and smiling), failure to
do so can lead to denture dislodgement during mouth
functions.
iii. Labial vestibule
• It is the sulcus area between labial and buccal frenum
and forms part of valve seal area.
Significance
• It accommodates labial flange of denture.
• It provides valve seal.
• It affects patient's appearance:
If flange is thick, then lips bulge out.
If flange is thin, then one can see unsupported lips.
iv. Buccal vestibule
• It extends from buccal frenum to hamular notch and
forms part of valve seal area.
Significance
• It provides peripheral seal.
• It accommodates buccal flange of denture.
• It is affected by the action of masseter and coronoid
process.
v. Coronoid process
• It is located buccally in the maxillary tuberosity region.
Significance
• It affects the buccal flange of denture as the mandible
moves forward, side to side, or opens wide.
• When distal flange is too thick, it dislodges the denture.
vi. Masseter muscle
• It reduces the space when contracted under heavy biting
pressure.
vii. Pterygornaxillary notch
• It is located distal to maxillary tuberosity, between the
tuberosity and the hamular process of pterygoid plate.

Significance
• It forms the posterior limit of denture.
• Pterygomaxillary seal can be obtained by placing extra
pressure in this region.
viii. Pterygomandibular raphe
• It extends from hamulus to distolingual comer of retro-
molar pad.
• Buccinators attaches to its distal part.
Significance
• If denture is overextended beyond the hamular notch,
and mouth opened wide, then raphe pulls forward, injur-
ing the tissues.
ix. Palatine fovea
• These are two small indentations in the posterior palate
in midline.
• These are formed by joining together of several mucous
gland ducts.
• These may be prominent or barely visible.
Significance
• These are close to vibrating line and present in soft tissue.
• They serve as guideline for posterior border of
denture (posterior vibrating line 2 mm anterior to
foveae).
x. Posterior palatal seal area
• It is an area between anterior and posterior vibrating lines.
• It is in the shape of Cupid's bow.
• Along with pterygomaxillary seal, it forms the posterior
part of valve seal.
Function
• To attain seal, extrapressure can be applied here.
• It marks the posterior limit of denture.
Q. 3. Define impressions in prosthodontics. Why is it
called as biological? Discuss the principles and objectives
of impression making in complete denture prosthesis.
Or
Describe in brief the principles and objectives of maxil-
lary final impression for complete edentulous patients.
Ans.
Impression
Impression may be defined as a negative likeness or copy
in reverse of the surface of an object, which is an imprint
of the teeth and adjacent structures for use in dentistry
(OPT).
Quick Review Series for BOS 4th Year: Prosthodontics
It is called as biological, because it records the living
tissues of the oral cavity some in functional form and some
in relaxed state.
Principles of Impression Making
i. Oral tissues must be healthy.
ii. It should include all the basal seat areas within the
limits of health and function of the supporting and
limiting tissues.
iii. The borders must be in harmony with the anatomical
and the physiological limitations of the oral structures.
iv. Physiological type of border moulding should be per-
formed.
v. Sufficient space should be provided within the impres-
sion tray for the selected impression material.
vi. Impression must be removed from the mouth without
damaging the mucosa.
vii. Selective pressure should be applied on the basal seat
during impression making.
viii. guiding mechanism should be provided for correct
positioning of the tray within the mouth.
ix. The tray and impression material should be made of
dimensionally stable materials.
x. The external shape of the impression should be similar
to the external form of complete denture.
Objectives of Impression Making
Five objectives of impression making in complete denture
prosthodontics as stated by Carl 0. Boucher in 1944 are as
follows:
Preservation of alveolar ridge
Muller De Van's (1952) statement: 'The preservation of that
which remains is of utmost importance and not the meticu-
lous replacement of that which has been lost'.
This can be achieved by:
• using techniques that reduce alveolar resorption, i.e.,
wider coverage so that force per unit area is less.
• placing more load on stress-bearing areas and less load
on nonstress-bearing areas.
Retention
It is defined as that quality inherent in the prosthesis, which
resists the force of gravity, adhesiveness of foods, and the
forces associated with the opening of the jaws (OPT).
It is the ability of the denture to withstand displacement
against its path of insertion.
Section I I Topic Wise Solved Questions of Previous Years
Factors affecting retention are as follows:
A. Anatomical factors.
B. Physiological factors.
C. Physical factors.
D. Mechanical factors.
E. Muscular factors.
A. Anatomical factors
Anatomical factors which affect retention are:
• Size of the denture-bearing area: It increases with in-
crease in size of the denture-bearing area.
• Maxillary denture-bearing area-24 cm2.
• Mandible denture-bearing area-14 cm2•
• Hence, maxillary dentures have more retention than
mandibular dentures.
• Quality of the denture-bearing area: The displaceability
of the tissues influences the retention of the denture.
Tissues displaced during impression making will lead to
tissue rebound during denture use, leading to loss of
retention.
B. Physiological factors
• Saliva retention depends upon viscosity of saliva.
• Thick and ropy saliva accumulates between the tissue
surface of the denture and the palate leading to loss of
retention.
• Thin and watery saliva is ideal.
• Ptyalism leads to gagging.
• Xerostomia produces soreness and irritation.
C. Physical factors
Physical factors which control retention are:
a. Adhesion
Physical attraction of unlike molecules to each other is
known as Adhesion (GPT).
• Saliva plays an important role in adhesion.
• It wets the tissue surface of denture and the mucosa
forming a thin film between them which helps
hold the denture to the mucosa. In patients with
xerostomia, adhesion does not play a major role.
• Amount of adhesion present is proportional to the
denture base area.
b. Cohesion
It is the physical attraction of like molecules for each other
(GPT).
• Cohesive forces act within the thin film of saliva.
Watery serous saliva forms a thinner film and is more
cohesive than thick mucous saliva.
• Cohesive forces increase with increase in denture-
bearing area.
c. lnterfacial surface tension
The tension or resistance to separation possessed by the film
of liquid between the two well adapted surfaces- (GPT).
To obtain maximum interfacial surface tension:
• Saliva should be thin and even.
• Perfect adaptation should be present between the tissues
and the denture base.
• The denture base should cover a large area.
• There should be good adhesive and cohesive forces,
which aid to enhance interfacial surface tension.
• Plays a major role in retention of maxillary denture and
is dependent on the presence of air at the margins of
liquid and solid contact (liquid air interface).
• If there is no liquid-air interface, then there will be no sur-
face tension. This phenomenon is seen in mandibular den-
tures, where there is excess saliva along the denture borders
with minimal interfacial surface tension and no retention.
Stefan's formula to calculate interfacial surface tension:
F= (3/2*3.14*Kr4/ H3) * v, where:
F - interfacial surface tension.
k - viscosity of the interposed liquid (saliva).
r - denture surface area.
h - width of the space between the denture base and the
mucosa.
v - velocity of the displacing force.
F decreases with the increase in h.
Increase in r increases the F.
A slow and steady increase in V will have least resis-
tance from interfacial surface tension than a rapid V .
d. Capillarity or capillary attraction
It is that quality or state, the surface tension of which causes
elevation or depression of the surface of a liquid that is in
contact with a solid (GPT).
Factors which improve capillary attraction and thus
retention are as follows:
• Closeness of adaptation of denture base to soft tissue.
• Greater surface of the denture-bearing area.
• Thin film of saliva should be present.
e. Atmospheric pressure and peripheral seal
Peripheral seal is the area of contact between the periph-
eral borders ofthe denture and the resilient-limiting
structures.
• It prevents air entry between the denture surface and the
soft tissue maintaining a low pressure in space between
the above two.
• To achieve good peripheral seal, the denture borders
should rest on soft and resilient tissues which allow
movement of mucosa along with the denture base during
function.

• When displacing forces act on denture, a partial vacuum
is produced between the denture and the soft tissues,
which aids in retention.
• This property is called the natural suction of a den-
ture. Hence, atmospheric pressure is referred to as
emergency retentive force or temporary restraining
force.
• Retention produced by an atmospheric pressure is di-
rectly proportional to the denture base area.
D. Mechanical factors
Mechanical factors which control retention are as follows:
• Undercuts
• Unilateral undercuts aid in retention.
• Bilateral undercuts interfere with denture insertion
and require surgical correction.
• Retentive springs.
• Magnetic forces: Intramucosal magnets aid in increas-
ing retention of highly-resorbed ridges.
• Denture adhesives: They are available as creams/gels/
powders. They are coated on tissue surface before
wearing.
• Suction chambers and suction discs: They are used in
maxillary dentures to aid in retention by creating an area
of negative pressure but avoided nowadays due to their
potency of causing palatal hyperplasia.
E. Muscular factors
• Muscles exercise supplementary retentive force on the
denture.
• There is a balance between the forces acting from the
buccal musculature and the tongue which is obtained
in the neutral zone and thus, the artificial teeth
should be arranged in neutral zone to achieve better
retention.
• Occlusal plane should be parallel to residual ridge and
divide the interarch space equally.
Stability
'The quality of a denture to be firm, steady, or constant, to
resist displacement by functional stresses and not to be
subject to change of position when forces are applied' -
GPT.
It is the ability of the denture to withstand horizontal
forces.
Factors controlling stability are:
Vertical height of the residual ridge: It should be suffi-
cient to obtain good stability.
Extremely resorbed ridges provide least stability.
Quality of soft tissue covering the ridge: For good sta-
bility, ridge should have a firm soft tissue base with
Quick Review Series for BOS 4th Year: Prosthodontics
adequate submucosa. Flabby tissues with excessive
submucosa offer poor stability.
Quality of the impression
i. It should be as accurate as possible.
ii. Impression surface should be smooth.
iii. It should be devoid of voids and any rough surfaces.
iv. It should not warp on removal.
v. It should be dimensionally stable and the cast should
be poured as soon as possible.
Occlusal plane
• It should be oriented parallel to the ridge.
• If it is inclined, then sliding forces will act on denture
and reduce its stability.
• It should divide the interarch space equally.
Arrangement of teeth and occlusion
i. It plays an important role in the stability of the denture.
Balanced occlusion facilitates even distribution of
forces across the denture. Its absence produces unbal-
anced, lever type forces on anyone side of the denture,
leading to loss of stability.
ii. Teeth should be arranged in the neutral zone which is
defined as, 'The potential space between the lips and
cheeks on one side and the tongue on the other. Natural
or artificial teeth in this zone are subject to equal and
opposite forces from the surrounding musculature' -
GPT.
Contour of the polished surfaces
• It should be harmonious with the oral structures and not
interfere with the action of oral musculature.
IV. Support
The resistance to vertical forces of mastication, occlusal
forces, and other forces applied in a direction towards the
denture-bearing area (GPT).
• For good support denture base should cover as much
denture-bearing area as possible which helps to distrib-
ute forces over a wide area known as the snow-shoe
effect. Thus, the force per unit area is reduced.
• Confining the occlusal forces to stress-bearing areas and
reliving the nonstress-bearing areas will aid in improv-
ing support.
V. Aesthetics
It is the most vital objective. It is governed by thickness
of denture flanges. Thick flanges are preferred to give
required mouth fullness in long-term edentulous patients.
Impression should accurately reproduce the width and
height of entire sulcus for proper fabrication of flanges.
Section I I Topic Wise Solved Questions of Previous Years
SHORT ESSAYS
Q. 1. Importance of preprosthetic evaluation of the
edentulous area before making impression.
Ans.
Preprosthetic Evaluation Importance
• To determine that no mental or physical condition exists
which would contraindicate the wearing and use of the
denture itself.
• A review of past and current medical history with par-
ticular attention to any condition that might increase the
surgical risk.
• Assessment of the nutritional status.
• An intraoral examination and assessment of the need for
surgery, as well as ruling out nonsurgical alternatives.
• Evaluation of the TMJ and jaw relationship.
• Additional diagnostic procedures like radiographic
studies, and blood and urine analyses, etc.
• Dental model evaluation and mock surgery on the diag-
nostic casts to get an idea about the actual surgery results.
Following sequential manner for preprosthetic evaluation
should be carried out:
i. Recording the general information.
ii. Recoding the chief complaint and assessing patient's
expectations.
iii. Recording the relevant medical history.
iv. Recording current medication.
v. Recording the relevant dental history.
vi. Performing the thorough visual and manual examina-
tion of the mouth and head and neck regions.
vii. Performing radiographic examination.
viii. Referring for additional tests, if required, e.g., blood,
sugar, and urine.
ix. Referring for medical consultation (when indicated).
x. Referring for second opinion and opinion from other
dental specialists (when required).
xi. Making alginate impressions and preparing mounted
study models (when indicated).
xii. Discussing the diagnosis, treatment planning, and
prognosis with the patient.
xiii. Finalising the fees and obtaining the informed consent.
Q. 2. Diagnostic cast and its uses.
Ans.
Diagnostic Cast
Diagnostic cast is a life-size reproduction of a part or parts
of oral cavity and/or facial structures for the purpose of
study and treatment planning (GPT).
Ideal Requirements of a Diagnostic Cast
i. It should be free of voids or projections.
ii. Surface should be smooth, dense, and free of sludge.
iii. It should cover all the areas, which provide denture
support, e.g., it should extend 3-4 mm beyond the
retromolar pad.
iv. The walls of cast should be vertical or tapering out-
ward, but never inward.
v. The tongue space in a mandibular cast should be
smooth. The lingual peripheral seal (lingual sulcus,
lingual frenum, and sublingual fold space) should
also be intact.
vi. The cast should not show any traces of moisture.
vii. The occlusal table should be parallel to the floor.
Uses of Diagnostic Cast
i. To measure the depth and extent of the undercuts.
ii. To determine the path of insertion of the denture.
iii. To identify and plan the treatment for interferences like tori.
iv. To perform mock surgeries for maxillofacial prosthesis.
v. To determine the amount of preprosthetic surgery
required.
vi. To evaluate the size and contour of the arch.
vii. To get an idea about retention and stability offered by
the tissues.
viii. To determine the need for additional retentive features
like over denture abutments, implant abutments, etc.
Q. 3. What are the objectives of complete denture
prosthodontics? Explain them.
Ans.
Objectives of Complete Denture
Prosthodontics
Five objectives of impression making in complete denture
prosthodontics as stated by Carl O Boucher 1944 are as
follows:
i. Preservation of alveolar ridge: Muller De Van (1952)
statement 'the preservation of that which remains is of
utmost importance and not the meticulous replacement
of that which has been lost' can be achieved by
• using techniques that reduce alveolar resorption, i.e.,
wider coverage so that force per unit area is less.
• placing more load on stress-bearing areas and less
load on nonstress-bearing areas.
ii. Retention: It is the ability of denture to withstand dis-
placement against its path of insertion.
iii. Stability: It is the ability of denture to resist horizontal
forces.

iv. Support: It is the resistance to vertical forces of mastica-
tion, occlusal forces, and other forces applied in the di-
rection towards the denture-bearing area.
v. Aesthetics: It is the most vital objective. It is governed
by thickness of denture flanges. Thick flanges are
SHORT NOTES
Q. 1. Preprosthetic surgery.
Ans.
Preprosthetic Surgery
Surgical procedures are designed to facilitate fabrication of a
prosthesis or to improve theprognosis of prosthodontic care.
Various preprosthetic surgical procedures are as follows:
A. Procedures to improve bony foundation:
i. Retained dentition.
ii. Removal of pathologic bony conditions.
iii. Techniques to deal with mandibular alveolar excess.
iv. Techniques to deal with excessive alveolar bone
resorption.
a. Techniques to reduce alveolar atrophy.
b. techniques to correct alveolar atrophy.
v. Techniques to compensate for alveolar atrophy.
B. Procedures to improve soft tissue foundation.
C. Procedures to improve ridge relationships.
D. Implants.
Q. 2. Mandibular stress-bearing areas.
Ans.
Mandibular Stress-bearing Areas
• Primary stress bearing area: Also called buccal shelf
area, because it is at right angles to vertical occlusal
loads and is covered with dense smooth cortical bone.
It is supporting structure of mandible.
Boundaries
Anteriorly: Buccal frenum.
Posteriorly: Retromolar pad.
Medially: Crest of the ridge.
Laterally: External oblique line.
Inferior part of buccinator is attached to this area, but as the
fibres run horizontally. It does not interfere with denture.
Histologically, mucosa is less keratinized and loosely
attached.
Secondary stress-bearing area: It forms the slopes of the
residual alveolar ridge, because they are composed of thin
plate of cortical bone.
Quick Review Series for BOS 4th Year: Prosthodontics
preferred to give required mouth fullness in long-term
edentulous patients. Impression should accurately re-
produce the width and the height of entire sulcus for
proper fabrication of flanges.
Q. 3. Buccal shelf area.
Ans.
Buccal Shelf Area
It is the supporting structure of mandible.
Boundaries
Anteriorly: Buccel frenum.
Posteriorly: Retromolar pad.
Medially: Crest of the ridge.
Laterally: External oblique line.
Inferior part of buccinator is attached to this area, but as the
fibres run horizontally, it does not interfere with denture.
Histology
Mucosa is less keratinized and loosely attached.
Function
It serves as the primary stress-bearing area, because it is at
right angles to vertical occlusal loads and is covered with
dense smooth cortical bone.
Q. 4. Incisive papilla.
Ans.
Incisive Papilla
• A small tissue projection located immediately behind
and between the central incisors in dentulous mouths.
• Location varies in the edentulous mouth. It may be located
on the crest of the ridge after resorption has occurred.
• It covers the incisive foramen through which the naso-
palatine nerves and vessels pass.
Significance: It serves as relief area.
• Relief is provided in the final impression to prevent
pressure on the emerging nasopalatine nerves and
vessels. Denture pressure on the papilla can cause par-
aesthesia, pain, burning sensation, and other vague
complaints.
Section I I Topic Wise Solved Questions of Previous Years

Q. 5. Muscles of the soft palate. • It provides room for tongue rest on flange leading to
retention.
Ans.
• It avoids impingement of sublingual gland and
submaxillary duct.
Muscles of the Soft Palate iii. Posterior region: Retromylohyoid fossa region
• It extends from the end of mylohyoid ridge to retro-
i. Tensor palati (tensor veli palatini): it is thin, triangular
mylohyoid curtain.
muscle.
• pposterior region slopes away from tongue and
Functions
towards the ridge.
a. Tightens the soft palate, chiefly the anterior part.
• It guides the tongue on top of the lingual flange.
b. Opens the auditory tube to equalize air pressure be-
tween the middle ear and the nasopharynx.
Q. 7. Muscles of mastication and facial expression.
ii. Levator palati (levator veli palatini):lt is a cylindrical
muscle that lies deep to the tensor veli palatine. Ans.
Functions
a. Elevates soft palate and closes the pharyngeal
Muscles of Mastication and Facial Expression
isthmus.
b. Opens the auditory tube, like the tensor veli palatini. Following are the muscles of mastication:
iii. Musculus uvulae i. Masseter-quadrilateral, covers lateral surface of ra-
It is the longitudinal strip placed on one side of the me- mus of mandible.
dian plane, within the palatine aponeurosis, which pulls • Nerve supply-masseteric nerve, a branch of ante-
up the uvula. rior division of mandibular nerve.
iv. Palatoglossus • Action
It pulls up the root of the tongue, approximates the palato- • It elevates mandible to close the mouth during biting.
glossal arches, and thus closes the oropharyngeal isthmus. ii. Temporalis-fan-shaped mucsle, which fills the tempo-
v. Palatopharyngeous ral fossa.
• Nerve supply-two deep temporal branches of the
It pulls up the wall of pharynx and shortens it during
anterior division of the mandibular nerve.
swallowing.
• Actions
Q. 6. Alveolingual sulcus. • It elevates mandible.
• Posterior fibre retracts the protruded mandible.
Ans.
• It helps in side to side grinding movement.
iii. Lateral pterygoid-short, conical, and has upper and
Alveolingual Sulcus lower heads.
• Nerve supply-a branch from anterior division of the
• Alveolingual sulcus is also called as lingual vestibule-
mandibular nerve.
limiting structure of mandible.
• Actions
• It extends from lingual frenum anteriorly to retromylo-
• It depresses the mandible to open the mouth with
hyoid curtain posteriorly.
suprahyoid muscle.
• It is divided into three parts:
• It helps in the protrusion of mandible.
i. Anterior part • It helps in side to side grinding movement.
• It extends from lingual frenum to premylohyoid fossa. iv. Medial pterygoid-quadilateral, has a small superficial
• It is the shallowest portion of the lingual flange. and large deep head.
ii. Middle part • Nerve supply-nerve to medial pterygoid, branch of
• It extends from premylohyoid fossa to distal end of the main trunk of the mandibular nerve.
mylohyoid ridge. • Actions
• It slopes towards the tongue. • It elevates mandible.
• It allows room for action of mylohyiod muscle. • It helps in the protrusion of mandible.
• Increased flange height as it can be extended beyond • It helps in side to side grinding movement.
the muscle attachment.
Q. 8. Balanced occlusion.
• It allows floor of mouth to raise without displacing
the denture. Ans.
 Quick Review Series for BOS 4th Year: Prosthodontics

Balanced Occlusion Contents

Balanced occlusion is defined as 'the simultaneous contact- • Glandular tissue.
ing of the maxillary and mandibular teeth on the right and • Temporalis tendon.
left and in the posterior and anterior occlusal areas in cen- • Buccinator fibres enter it from buccal side.
tric and eccentric positions, developed to lessen or limit • Superior pharyngeal constrictor enters it from lingual
tipping or rotating of the denture bases in relation to the side.
supporting structures' - GPT. • Pterygomandibular raphe enters it from back inside
corner.
Characteristic Requirements of Balanced
Occlusion Significance
• All the teeth of the working side ( central incisor to second • It forms part of valve seal area.
molar) should glide evenly against the opposing teeth. • It provides border seal.
• No single tooth should produce any interference or dis- • Extra pressure on the pad to be avoided to not to injure
occlusion of the other teeth. the muscle fibres.
• There should be contacts in the balancing side, but they
should not interfere with the smooth gliding movements
Q. 10. Anterior reference points.
of the working side.
• There should be simultaneous contact during protrusion. Ans.

Importance of Balanced Occlusion

It is one of the most important factors that affects denture Anterior Reference Points
stability. Its absence will result in leverage of denture dur- • Anterior reference points is a terminology used in face-
ing mandibular movement. bow transfer.
• It determines the level at which the casts are mounted
Factors Affecting Balanced Occlusion between the upper and lower members of the articulator
• Inclination of the condylar path or condylar guidance. using face-bow or it determines at what level in the
• Incisal guidance. articulator, the occlusal plane is placed.
• Orientation of the plane of occlusion or occlusal plane. Some commonly used anterior reference points are as
• Cuspal angulation. follows:
• Compensating curves. I. Orbitale: It is located by Hanau face-bow using orbital
pointer.
Q. 9. Retromolar pad. II. Orbitale minus 7 mm: It represents the Frankfort
Ans. plane.
III. Nasion:lt is used with quick mount face-bow (Whip
mix).
Retromolar Pad
IV. Ala of nose: It represents the camper's plane.
It is triangular pad of soft tissue found at the distal end of V. 43 mm superior from the lower border of upper lip. It
mandibular ridge. is located by Denar face-bowusing Denar reference
It is covered with nonkeratinized epithelium. plane locator.
Section I I Topic Wise Solved Questions of Previous Years
-------------------- -,( Topic 4)
Primary Impression in Complete Dentures and Lab
Procedures Prior to Master Impression Making
LONG ESSAYS
Q. 1. Give the importance of impression techniques used
for different patient treatment planning and post-
insertion instructions to the patient.
Or
Describe any one method of primary impression mak-
ing for maxillary complete denture by stating step by
step precautions and causes of error in the impression.
Or
Define the term impression in complete dentures prostho-
dontics. Classify impression techniques and explain the
objectives and theories of impression making.
Or
What is mucostatic impression? Give in detail the mu-
costatic impression procedure with special reference to
its underlying principle. Describe its merits.
Or
Define impression. Discuss various theories of impres-
sion making and describe your method of impression
making.
Or
Define impression and discuss in detail about the most
widely accepted technique of making impression in
complete denture prosthodontics. Describe the impres-
sion procedure you will follow for patient with upper
anterior movable flabby tissue.
Or
Various theories of impression making of edentulous
arches.
Or
Selective pressure impression technique or selective
compression theory.
Or
Controlled pressure theory of impression making.
Ans.
Impression
A negative likeness or copy in reverse of the surface of an
object, an imprint of the teeth and adjacent structures for
use in dentistry (GPT-8).
Objectives of Impression Making
Five objectives of impression making in complete denture
prosthodontics as stated by Carl O Boucher 1944 are as
follows:
i. Preservation of alveolar ridge: Muller De Van (1952)
stated 'the preservation of that which remains is of
utmost importance and not the meticulous replacement
of that which has been lost'. This can be achieved by
• using techniques that reduce alveolar resorption, i.e.,
wider coverage so that force per unit area is less.
• placing more load on stress-bearing areas and less
load on nonstress-bearing areas.
ii. Retention: It is the ability of denture to withstand dis-
placement against its path of insertion.
iii. Stability: It is the ability of denture to resist horizontal
forces.
iv. Support: It is the resistance to vertical forces of masti-
cation, occlusal forces, and other forces applied in the
direction towards the denture-bearing area.
v. Aesthetics: It is the most vital objective. It is governed
by thickness of denture flanges. Thick flanges are pre-
ferred to give required mouth fullness in long-term
edentulous patients. Impression should accurately re-
produce the width and height of entire sulcus for
proper fabrication of flanges.
Classification of Impression Techniques
A. Based on the theories of impression
• Pressure theory.
• Minimal pressure theory.
• Selective pressure theory.

B. Based on the position of the mouth while making the
impression
• Open mouth.
• Closed mouth.
C. Based on the method of manipulation for border
moulding
• Hand manipulation.
• Functional movements.
Theories of Impression
The various theories are follows:
A. Pressure theory.
B. Minimal pressure theory.
C. Selective pressure theory.
The selective pressure theory is the most widely
followed.
A. Pressure Theory
Synonyms: Mucocompressive or definite pressure.
It was proposed on the assumption that tissues re-
corded under functional pressure (as during mastication)
provided better support and retention for the denture and
for this, a heavy-bodied material such as impression com-
pound is used. A preliminary impression with compound
is made.
Technique introduced by Greene is as follows:
• A custom tray is fabricated with its periphery short by
1/8 inch.
• A second impression is made in this tray using com-
pound.
• Bite rims with uniform occlusal surfaces are then made.
• Areas to be relieved (e.g., median palatal raphe) are
softened and the impression is again inserted in the
mouth and is held under biting pressure for one or two
minutes.
• The borders are moulded by asking the patient to per-
form functional movements like whistling, smiling, etc.
Advantages
• Better retention and support during occlusal functions
like mastication.
Disadvantages
• Excess pressure could lead to increased alveolar bone
resorption eventually resulting in loose dentures.
• Excess pressure was applied to the peripheral tissues
and the palate which was not well suited to receive pres-
sure resulting in transient ischaemia.
• Dentures fit well during mastication, but tend to re-
bound when the tissue resume their normal resting state.
• The resorption eventually results in loose dentures.
• Pressure on sharp spiny ridges or other bony areas often
results in pain.
Quick Review Series for BOS 4th Year: Prosthodontics
B. Minimal Pressure Theory
Synonyms: Mucostatic or nonpressure or passive technique.
• The minimal pressure technique was based on the
principle of mucostatics (Page 1946).
• According to this principle, interfacial surface tension
was the only significant way of retaining complete
dentures.
• Retention is achieved through accurate tissue adapta-
tion. Accordingly, the impression should cover only
those areas of the denture foundation, where the mucosa
is firmly attached.
• Thus, dentures made with this technique have shorter
flanges.
According to Pascal's law, if pressure is applied to any-
one part of a confined fluid, it is transmitted equally to all
parts. Page contended that since tissues contain 80% or
more of water and are confined by the denture, they behave
according to Pascal's law, thus assuming good rigidity.
Advantages
• High regard for tissue health and preservation.
Disadvantages
A. Most of the disadvantages stem from the use of shorter
flanges.
B. The shorter flanges prevent the wider distribution of
masticatory stresses.
C. With reduced coverage, the possibility of getting greater
retention, including the retaining potential of surround-
ing musculature is lost.
D. The lack of border moulding reduces effective periph-
eral seal, thereby further reducing retention.
E. The lack of border seal also permits food to slip beneath
the denture.
F. The short denture borders are readily accessible to the
tongue which might provoke some irritation.
G. The shorter flanges may reduce support for the face
which can affect easthetics.
H. The shorter flange would mean less lateral stability.
I. Patients with poor residual ridges and reduced areas of
attached gingiva were difficult to treat.
Technique
• A compound impression is made.
• A baseplate wax space is adapted on the resulting cast
according to the outline of the denture.
• A special tray is adapted over the wax spacer.
• The spacer is removed and an impression made with a
free-flowing material with as little pressure as possible.
• Escape holes may be made for relief.
Many of Page's contentions have now been questioned
and his techniques based on this theory has fallen out of
favour.
Section I I Topic Wise Solved Questions of Previous Years
C. Selective Pressure Theory
Advocated by Boucher, this technique combines the prin-
ciples of both pressure and minimal pressure techniques.
This theory is based on a thorough understanding of the
anatomy and physiology of basal seat and surrounding
areas.
Boucher divided the basal seat area into different zones,
according to their
• Capacity to withstand masticatory loads without under-
going resorption (primary stress-bearing area).
• Other areas were to be recorded at rest (secondary
stress-bearing area).
• While other areas could be relieved (relief areas).
• He also advocated maximum extension within the com-
fort and functional limits of the surrounding muscles
and tissue.
Advantages
The technique considers the physiologic functions of the
tissues of the basal seat, and therefore appears more sound
and appealing.
Disadvantages
A. Some feel that it is impossible to record areas with
varying pressure.
B. Since some areas are still recorded under functional
load, the denture still faces the potential danger of re-
bounding and loosing retention.
Impression techniques based on the selective pressure
technique are most popular even today.
Impression Technique for Upper Anterior
Movable Flabby Ridges
• The upper anterior movable flabby tissue presents a
special problem.
• The hypermobile tissues should be recorded without
distortion.
Various techniques available to achieve this are as follows:
• A primary impression is made with alginate and a spe-
cial tray is constructed with relief wax placed over the
mobile tissues. Border moulding is carried out and the
final impression is made after removing the wax spacer
using a free-flowing material. Escape holes are placed
in the hypermobile area of the tray.
• In one technique given by Hobkirk, the impression is
made with heavy-bodied silicone in a border moulded
special tray. The heavy-bodied material overlying the hy-
permobile tissue is cut away and escape holes are made. A
wash impression is then made with light-bodied material.
• In technique given by Zafrulla Khan, a custom tray is
constructed with a window cut in the area of the mobile
tissues. Two impression materials are used. The first
material is used to record the areas covered by the tray.
The mobile tissues visible through open window area
are recorded with free-flowing impression plaster or
zinc oxide eugenol.
Post-insertion instructions to the patient
i. Insertion and removal of prosthesis
• Patient is taught to insert and remove the denture
repeatedly.
• Prosthesis should be inserted along the path of insertion.
• If unilateral undercut present, then patient is taught
to insert the denture into undercut first, and then
rotate the prosthesis into its final position.
• If the denture is very retentive and difficult to re-
move, then patient is asked to blow with lips closed
to break the peripheral seal and remove the denture.
ii. Prosthesis maintenance
Denture should be cleaned using a denture brush and
tooth paste/soap water ( or any cleansing agent) as
follows:
i. Chemical cleansers: Dilute solutions of chlorhexi-
dine, sodium perborate, or nystatin can be used to
store the dentures. Mineral acids should not be
used, as it corrodes the metallic part.
ii. Ultrasonic cleaners: It is a sonic cleaner in which
bubbles (which help to clear away the food parti-
cles) are bombarded against the denture.
iii. Prosthesis nightwear
• Patient is advised not to wear the denture at night
and store it in water or any dilute medicinal solution.
• This is done to provide rest to mucosa to improve
the blood supply and prevent mucosal degeneration
and bone resorption.
Nightwear is allowed in the following conditions:
• Bruxism patients where damage to oral tissues is
more, if denture is not worn at night.
• In cases of maxillary complete denture and man-
dibular partial denture.
iv. Periodic recall
• Regular recall to check for proper denture extension
and occlusion.
• Patient is recalled after 24 h of insertion, to correct
occlusal disharmony and to check for immediate
tissue reaction.
• Then patient is called after one week to check for
tissue reaction and his/her comfort enquiry done and
problems corrected.
• Then patient is recalled after 3-6 months to deter-
mine tissue reaction and to see the amount of resid-
ual ridge resorption.
• Post-insertion instructions should be reinforced
during recall appointments.

• In case of any tissue reactions like ulcers, soreness,
etc., the patient is advised to stop wearing the pros-
thesis and report immediately to the dentist.
• Yearly recall visit to check the need for relining/
rebasing.
Q. 2. Discuss the material and methods for recording a
complete denture impression.
Ans.
Complete Denture Impression
A thorough understanding of the material's properties and
manipulation is vital to the success of the impression pro-
cedure.
Classification
Based on elasticity
• Rigid - like zinc oxide eugenol impression paste, im-
pression compound, impression plaster, etc.
• Elastic - like alginate and elastomeric impression materials.
Based on its prosthodontic use
• Preliminary impression materials.
• Final impression materials.
Preliminary Impression Materials
I. Modelling compound
It is available in three forms:
• Impression compound.
• Tray compound.
• Stick compound.
Impression compound is a good material for a prelimi-
nary impression. It is easily correctable, can be border
moulded, and is not influenced by saliva. It can also be
used as an impression tray, as it can be separated easily
from the stock tray. It can also be scraped easily (where
relief is needed). Since it cannot record fine details, it is
not suitable as a final impression material. It is very vis-
cous and can therefore compress or displace tissues.
Tray compound is used to make a custom tray directly
in the mouth.
Stick compounds are available in different colours and
are used to record the border seal areas (border moulding).
II. Alginate
Alginate has been used as both preliminary impression
material (when used in a stock tray), as well as final impres-
sion material (when used in a custom tray). It records good-
detail, but is affected by saliva, and so the mouth should be
Quick Review Series for BOS 4th Year: Prosthodontics
relatively dry. It is not very stable and so must be cast im-
mediately. It is not correctable easily, but is easily remade.
Since it is elastic, it is well suited for ridges with severe
undercuts.
Final Impression Materials
The final impression material should be accurate as well as
dimensionally stable.
I. Alginate
Alginate when used in conjunction with a custom tray
makes a final impression material. It does not adhere to the
tray and must be retained with an adhesive.
II. Rubber base
Rubber-based materials records fine details and are very
stable. Being elastic, it is a perfect material for recording
undercuts. An adhesive is needed to hold it to the tray. It is
generally 'water-phobic' (water-hating) and so, the areas to
be recorded must be absolutely dry.
Ill. Zinc oxide eugenol
Zinc oxide eugenol paste is probably the most popular com-
plete denture impression material and has been in use for a
long time. It flows well and records fine details. It is rigid
and inelastic when set and is therefore not particularly well
suited when severe undercuts are present. The mouth
should be dry (but not desiccated) before the impression, as
it is affected by water and thick saliva. Some patients com-
plain of a burning sensation and tissue irritation. This mate-
rial adheres well to the tray and so tray adhesives are not
required.
IV. Tissue conditioners
This material is used to condition the tissue as well as make
what is known as 'functional impressions'. The old denture
itself is used as a final impression tray (see functional im-
pression technique).
V. Impression plaster
Impression plaster was one of the earliest impression
material used in dentistry. It was used for the minimal
pressure technique, because it flows readily and records
fine details. It absorbs saliva and is therefore not affected
much by saliva. Because of its setting expansion, it is
most accurate in thin sections and so is favoured as a
wash impression. It is not suitable for severely undercut
ridges because of its rigidity. In the old days, this prob-
lem was solved by breaking the impression and then reas-
sembling it. Separating medium is applied before the cast
is poured. Currently, it is not as commonly used for im-
pressions as before because of the availability of better
alternatives.
Section I I Topic Wise Solved Questions of Previous Years
VI. Waxes
Waxes which flow at mouth temperature are sometimes used
for final impressions. They exert some amount of pressure
and too fine a detail cannot be expected. A more common
use for waxes is to correct deficiencies in final impressions
made with other materials such as plaster or eugenol. An-
other use is to make impressions for distal extension partial
dentures in the 'altered cast technique'. Because, it is sus-
ceptible to thermal change, it must be poured immediately.
Q. 3. Explain how different groups of muscles causes
dislodgement of maxillary and mandibular complete
dentures and how muscular power can be harnessed for
further retention of complete denture?
Ans.
The surrounding musculatures which effect denture reten-
tion are:
Cheek muscles: The muscles of the cheek (buccinator) can
cause dislodgment of the denture, if the teeth are placed too
far buccally, or if the flanges are overextended in the buccal
sulcus, or if the denture base is not contoured well.
Lips: The lips can unseat a denture if the teeth are placed
too far forward.
Modiolus: The modiolus or tendinous node is located at
the corner of the mouth and is formed by the intersection
of several muscles of the cheeks and lips. The modiolus
can cause unseating of the denture in the premolar region.
Tongue: The tongue is a very strong and active organ. If
the teeth are placed too far lingually, then it can crowd
or interfere with the activity of the tongue. The tongue
can also be trained to improve seating of the denture.
Floor of the mouth: The floor of the mouth is a relatively
mobile and unstable area. The act of swallowing raises and
tenses the muscles of the floor of the mouth. The activity of
the muscles of the floor of the mouth can cause instability
of the mandibular denture.
SHORT ESSAYS
Q. 1. Influence of saliva on retention and stability.
Or
Saliva and its role in complete dentures.
Ans.
Saliva and its Influence on Retention and
Stability
Saliva is an important factor in denture retention as well as
in the health of the tissues. The amount (rate of secretion)
and consistency of the saliva is noted.
Soft palate: The soft palate moves considerably during
various functions. The soft palate can cause unseating of
the maxillary denture, if the posterior border is overex-
tended or over post-dammed.
Masseter: The tensing of the masseter muscle (clenching
the teeth) can affect thedistobuccal region of the upper and
lower dentures leading to instability.
Steps to be followed to harness the muscular power to
increase retention of denture:
i. Neutral zone: In order to understand the effect of the
surrounding musculature, one must understand the
neutral zone. It is defined as the potential space bet-
ween the lips and cheeks on one side and the tongue on
the other; that area or position, where the forces be-
tween the tongue and cheeks or lips are equal. The
teeth should be located within the neutral zone. Place-
ment of the teeth outside this zone, either buccally or
lingually, can cause the cheek or the tongue to dislodge
the denture.
ii. Shape of denture borders and denture flange: Denture
base should be shaped, such as:
a. To minimise interference with the functioning of
surrounding musculature (follow proper border
moulding technique).
b. To utilise the surrounding musculature to provide a
positive seating
• Buccal flanges are contoured to accommodate
the buccinators.
• Lingual flange is designed to guide the tongue to
rest over the flange and permit any horizontal
forces generated against the denture to be trans-
mitted as seating forces.
iii. Border moulding: It is also knows as muscle trimming.
It keeps the denture border in harmony with the func-
tional limits of the peripheral tissues, muscles, and
other structures.
Consistency can be as follows:
• Thin serous: This saliva is more favourable for denture
retention.
• Thick mucus: The thick ropy consistency is difficult to
work with and tends to displace the denture.
• Mixed: Contains equal quantities of both kinds.
Amount
The salivary flow should neither be excessive nor less. The
flow may be
Normal: Ideal for denture retention.

Excessive: Some patients are very sensitive. A dentist con-
ducting dental procedures on a patient can stimulate copi-
ous amounts of salivary flow. Excessive salivary flow
makes denture construction difficult and messy.
Reduced: Reduced flow results in (dry mouth or xerosto-
mia) retention of the denture. There is increased potential
for soreness of the tissues. It can also result in a coated
tongue. Reduced flow is seen with some drugs, certain syn-
dromes, and after radiation therapy. Salivary substitutes or
oral moisturizers may be prescribed.
Q. 2. Impression technique for a flabby ridge.
Ans.
Impression Technique for Flabby Ridges
The hypermobile or hyperplastic ridge presents a special
problem. The hypermobile tissues should be recorded with-
out distortion. There are many techniques available to
achieve this.
• A primary impression is made with alginate and a spe-
cial tray is constructed with relief wax placed over the
mobile tissues. Border moulding is carried out and the
final impression is made after removing the wax spacer
using a free-flowing material. Escape holes are placed
in the hypermobile area of the tray.
• In one technique (Hobkirk), the impression is made
with heavy-bodied silicone in a border moulded spe-
cial tray. The heavy-bodied material overlying the hy-
permobile tissue is cut away and escape holes are
made. A wash impression is then made with light-
bodied material.
• In another technique (Zafrulla Khan), a custom tray is
constructed with a window, cut in the area of the mobile
tissues. Two impression materials are used. The first
material is used to record the areas covered by the tray.
The mobile tissues visible through open window area
are recorded with free-flowing impression plaster or
zinc oxide eugenol.
Q. 3. Classify methods of impression making in com-
plete denture.
Or
Pressure theory of impression making.
Ans.
Classification of Impression Techniques
A. Based on the theories of impression
• Pressure theory.
• Minimal pressure theory.
• Selective pressure theory.
Quick Review Series for BOS 4th Year: Prosthodontics
B. Based on the position of the mouth while making the
impression
• Open mouth.
• Closed mouth.
C. Based on the method of manipula tion for border
moulding
• Hand manipulation.
• Functional movements.
Pressure Theory of Impression Making
Synonyms: Mucocompressive or definite pressure theory.
This theory was proposed on the assumption that
tissues recorded under functional pressure (as during
mastication) provided better support and retention
for the denture. In order to record under functional
pressure, a heavy-bodied material, such as impression
compound is used. A preliminary impression with com-
pound is made.
Technique
Introduced by Greene is as follows:
• A custom tray is fabricated with its periphery short by
1/8 inch.
• A second impression is made in this tray using com-
pound.
• Bite rims with uniform occlusal surfaces are then made.
• Areas to be relieved (e.g., median palatal raphe) are
softened and the impression is again inserted in the
mouth and is held under biting pressure for one or two
minutes.
• The borders are moulded by asking the patient to per-
form functional movements like whistling, smiling,
etc.
Advantages
• Better retention and support during occlusal functions
like mastication.
Disadvantages
• Experience has showed that the excess pressure could
lead to increased alveolar bone resorption eventually
resulting in loose dentures.
• The excess pressure was often applied to the peripheral
tissues and the palate which was not well suited to re-
ceive pressure resulted in transient ischaemia.
• Dentures which fit well during mastication tend to
rebound, when the tissue resume their normal resting
state.
• The resorption eventually results in loose dentures.
Section I I Topic Wise Solved Questions of Previous Years
• Pressure on sharp spiny ridges or other bony areas often
resulted in pain.
Q. 4. Discuss various philosophies of impression making
in complete denture.
Ans.
Various Philosophies of Impression Making
in Complete Denture
i. Pressure theory.
ii. Minimal pressure theory.
iii. Selective pressure theory.
The selective pressure theory is the most widely followed.
i. Pressure Theory
Synonyms: Mucocompressive or definite pressure.
• It was proposed on the assumption that tissues recorded
under functional pressure (as during mastication) pro-
vided better support and retention for the denture and
for this a heavy-bodied material, such as impression
compound is used. A preliminary impression with com-
pound is made.
Technique
Introduced by Greene is as follows:
• A custom tray is fabricated with its periphery short by
1/8 inch.
• A second impression is made in this tray using compound.
• Bite rims with uniform occlusal surfaces are then made.
• Areas to be relieved (e.g., median palatal raphe) are soft-
ened and the impression is again inserted in the mouth
and is held under biting pressure for one or two minutes.
• The borders are moulded by asking the patient to per-
form functional movements like whistling, smiling, etc.
Advantages
• Better retention and support during occlusal functions
like mastication.
Disadvantages
• Excess pressure could lead to increased alveolar bone
resorption, eventually resulting in loose dentures.
• Excess pressure was applied to the peripheral tissues
and the palate which was not well suited to receive pres-
sure resulted in transient ischaemia.
• Dentures fit well during mastication, but tend to rebound
when the tissues resume their normal resting state.
• The resorption eventually results in loose dentures.
• Pressure on sharp spiny ridges or other bony areas often
resulted in pain.
ii. Minimal Pressure Theory
Synonyms: Mucostatic or nonpressure or passive technique.
• The minimal pressure technique was based on the prin-
ciple of mucostatics.
• According to this principle, interfacial surface tension was
the only significant way of retaining complete dentures.
• Retention is achieved through accurate tissue adaptation.
Accordingly, the impression should cover only those areas of
the denture foundation where the mucosa is firmly attached.
• Thus, dentures made with this technique have shorter
flanges.
According to Pascal's law, if pressure is applied to any-
one part of a confined fluid, it is transmitted equally to all
parts. Page contended that since tissues contain 80% or
more of water and are confined by the denture, they behave
according to Pascal's law, thus assuming good rigidity.
Advantages
• High regard for tissue health and preservation.
Disadvantages
• Most of the disadvantages stem from the use of shorter
flanges.
• The shorter flanges prevent the wider distribution of
masticatory stresses.
• With reduced coverage, the possibility of getting greater
retention, including the retaining potential of surround-
ing musculature is lost.
• The lack of border moulding reduces effective periph-
eral seal, thereby further reducing retention.
• The lack of border seal also permits food to slip beneath
the denture.
• The short denture borders are readily accessible to the
tongue which might provoke some irritation.
• The shorter flanges may reduce support for the face
which can affect aesthetics.
• The shorter flange would mean less lateral stability.
• Patients with poor residual ridges and reduced areas of
attached gingiva are difficult to treat.
Technique
• A compound impression is made.
• A baseplate wax space is adapted on the resulting cast
according to the outline of the denture.

• A special tray is adapted over the wax spacer.
• The spacer is removed and an impression made with a
free-flowing material with as little pressure as possible.
• Escape holes may be made for relief.
Many of Page's contentions have now been questioned
and his techniques based on this theory, has fallen out of
favour.
iii. Selective Pressure Theory
• Advocated by Boucher, this technique combines the
principles of both pressure and minimal pressure tech-
niques. This theory is based on a thorough understand-
ing of the anatomy and physiology of basal seat and
surrounding areas.
Boucher divided the basal seat area into different zones,
according to their
• Capacity to withstand masticatory loads without under-
going resorption (primary stress bearing area).
• Other areas need to be recorded at rest (secondary stress
bearing area).
• While other areas could be relieved (relief areas).
• Boucher also advocated maximum extension within the
comfort and functional limits of the surrounding mus-
cles and tissue.
Advantages
• The technique considers the physiologic functions of
the tissues of the basal seat, and therefore appears more
sound and appealing.
Disadvantages
• Some feel that it is impossible to record areas with vary-
ing pressure.
• Since some areas are still recorded under functional
load, the denture still faces the potential danger of re-
bounding and loosing retention.
Impression techniques based on the selective pressure
technique are most popular today.
Q. 5. Impression compound.
Ans.
Impression Compound
• Impression compound is a good material for a prelimi-
nary impression.
• It is supplied in the form of sheets (brown in colour).
Quick Review Series for BOS 4th Year: Prosthodontics
Composition
• Natural/synthetic resin: 40%-for thermoplasticity,
flow, and cohesion.
• Waxes (bees/carnauba): 7%-thermoplasticity, character-
izes softening temperature, and produces smooth surface.
• Stearic acid, shellac, and gutta percha: 3%-provides
plasticity and workability.
• Diatomaceous earth, French chalk, and talc: 50%-
filler, increases strength, reduces flow at mouth tem-
perature, and reduces plasticity.
• Rouge (iron oxide): It is used in trace amounts. Acts as
a colour pigment to produce characteristic red colour.
Advantages
• It is easily correctable, can be border moulded, and is
not influenced by saliva.
• It can also be used as an impression tray, as it can be
separated easily from the stock tray.
• It can also be scraped easily (where relief is needed).
Disadvantages
• It cannot record fine details and not suitable as a final
impression material.
• It is very viscous and can therefore, compress or dis-
place tissues.
Q. 6. Alginate impression materials.
Ans.
Alginate Impression Materials
• Alginate is used both as preliminary impression mate-
rial (when used with stock tray) and a final impression
material (when used with custom tray), because it pro-
duces accurate and dimensionally stable impression.
• It is used in conjunction with a custom tray to make a
final impression material. It does not adhere to the tray
and must be retained with an adhesive.
• It is an irreversible hydrocolloid which sets by a chemi-
cal reaction.
It shows phenomena of:
• Syneresis: It is a process of losing water by the impres-
sion when placed in dry atmosphere.
• Imbibition: It is a process of absorbing water by the
impression when placed in water.
These effects can be minimized by:
• Keeping the impression in 100% relative humidity or in
a damp cloth.
• Pouring the cast immediately after taking the impression.
Section I I Topic Wise Solved Questions of Previous Years

SHORT NOTES
Q. 1. What are the advantages of zinc oxide eugenol Advantages
impression paste? State its composition.
• Better retention and support during occlusal functions
Ans. like mastication.

Zinc Oxide Eugenol Disadvantages

Zinc oxide eugenol is the most commonly used final im- • Excess pressure could lead to increased alveolar bone
pression material. resorption eventually resulting in loose dentures.
Advantages of zinc oxide eugenol paste as follows: • Excess pressure was applied to the peripheral tissues
• Dimensionally stable. and the palate which was not well suited to receive pres-
• Flows well and produce excellent surface details in the sure resulted in transient ischaemia.
impression. • Dentures fit well during mastication, but tend to re-
• Inexpensive and hygienic to use. bound when the tissue resume their normal resting
• Material adheres well to the tray and so tray adhesives state.
are not required. • The resorption eventually results in loose dentures.
• Pressure on sharp spiny ridges or other bony areas often
resulted in pain.
Composition
Q. 3. Selective pressure impression technique in patient
Base paste
with complete dentures.
i. Zinc oxide-87%.
ii. Natural/synthetic oils-13%. Or
Selective pressure impression.
Reactor paste
Eugenol-12%.
i. Ans.
Gum-50%.
ii.
iii.Kaolin talc-20%.
Selective Pressure Theory
iv.Resinous balsam-IO%.
v. Kaolin-3%. It was given by Boucher. This technique combines the
vi. Calcium or magnesium chloride-5%. principles of both pressure and minimal pressure tech-
niques. It is based on a thorough understanding of the
Q. 2. What is functional impression and state the tech-
anatomy and physiology of basal seat and surrounding
nique for making the same?
areas.
Or Boucher divided the basal seat area into different zones,
according to their
Mucocompressive impression technique.
• Capacity to withstand masticatory loads without under-
Ans. going resorption (primary stress-bearing area).
• Other areas were to be recorded at rest (secondary
stress-bearing area).
Pressure Theory
• While other areas could be relieved (relief areas).
• It is also known as mucocompressive or definite pres- • Boucher also advocated maximum extension within the
sure theory. comfort and functional limits of the surrounding mus-
• It was introduced by Greene. cles and tissue.
• It was proposed on the assumption that tissues recorded
under functional pressure (as during mastication) pro-
Advantages
vided better support and retention for the denture and
for this, a heavy-bodied material such as impression • The technique considers the physiologic functions of
compound is used. A preliminary impression with com- the tissues of the basal seat, and therefore appears more
pound is made. sound and appealing.

Disadvantages
• Some feel that it is impossible to record areas with
varying pressure.
• Since some areas are still recorded under functional
load, the denture still faces the potential danger of
rebounding and loosing retention.
Impression techniques based on the selective pressure
technique are most popular even today.
Q. 4. Syneresis and imbibition.
Ans.
Syneresis and lmbibition
Hydrocolloids (agar and alginate) show phenomena of:
i. Syneresis: It is a process of losing water by the impres-
sion when placed in dry atmosphere.
-------------------1( Topic 5)
Secondary Impression in Complete Dentures and Lab
Procedures Prior to Jaw Relation
LONG ESSAYS
Q. 1. What is posterior palatal seal and give its signifi-
cance? Describe one of the methods of projecting poste-
rior palatal seal in complete denture patients?
Or
What is posterior palatal seal? Describe how it is
obtained.
Or
Mention the importance of posterior palatal seal in
complete denture? Describe in detail the anatomic loca-
tion and methods of recording the same.
Or
Discuss in detail posterior palatal seal.
Ans.
Posterior Palatal Seal
• The posterior palatal seal is the seal area at the posterior
border of a maxillary removable prosthesis (GPT).
Quick Review Series for BOS 4th Year: Prosthodontics
ii. Imbibition: It is a process of absorbing water by the
impression when placed in water.
These effects can be minimised by:
iii. Keeping the impression in 100% relative humidity or in
a damp cloth.
iv. Pouring the cast immediately after taking the impression.
Q. 5. Disadvantages of condensation silicone.
Ans.
Disadvantages of Condensation Silicone
• Hydrophobic, so requires a dry field of operation.
• Liquid component of the paste may be toxic.
• Dimensionally unstable.
• More expensive.
• Putty-wash method is technique sensitive.
• It is the soft tissue area at or beyond the junction of hard
and soft tissues on which pressure, within physiological
limits, can be applied by denture to aid in its retention
(GPT).
• Also called as post-dam or post-palatal seal area.
Functions/Significance of Posterior Palatal Seal
Area
a. It aids in denture retention.
b. Prevents food accumulation beneath the maxillary denture.
c. Maintains contact with moving soft palate and thus
reduces patient's awareness and gag reflex.
d. Compensation for curing shrinkage.
e. Reduces tongue irritation.
f. When seal is placed in impression tray using compound,
then it:
• prevents impression material form flowing down the
throat.
• helps in tray positioning.
• gives idea about denture retention.
Section I I Topic Wise Solved Questions of Previous Years
Parts of Posterior Palatal Seal
a. Posterior palatal seal.
b. Pterygomaxillary seal.
• It is placed in pterygomaxillary notch or hamular
notch and located just behind the maxillary tuberosity.
• It is located using a T-burnisher/mouth mirror in-
strument that is moved posteriorly until a soft de-
pression is felt immediately beyond the maxillary
tuberosity.
Boundaries of Posterior Palatal Seal
• Anteriorly, anterior vibrating line.
• Posteriorly, posterior vibrating line.
• Laterally, pterygomaxillary notch.
Anterior vibrating line
• It is an imaginary line located at the junction of attached
tissues overlying the hard palate and the movable tissues
of the immediately adjacent soft palate.
Shape
• Cupid's bow due to projection of posterior nasal spine.
Location method
a. Valsalva manner: Here, both nostrils are held firmly when
the patient gently blows through the nose which places the
soft palate downwards at its junction with hard palate.
b. Patient is asked to 'ah' with short vigorous bursts.
Posterior vibrating line
• It is an imaginary line at the junction of aponeurosis of
tensor veli palatini and the muscular portion of soft palate.
• It represents the junction between slightly movable part
of soft palate and part of soft palate that is markedly
displaced during function.
Location method
• Patient is asked to say 'ah' in a normal, unexaggerated
fashion.
Methods to Record Posterior Palatal Seal
A. Arbitrary techniques
i. Conventional technique by Winkler
Recording stage: It is at the start of jaw relations.
Method
• Firstly, hamular notch is located using T-burnisher/
mouth mirror and marked with indelible pencil.
• Posterior vibrating line is located by above method and
marked with indelible pencil.
• The temporary denture base is pressed into place in
mouth and then on the cast to transfer the markings and
base is shortened accordingly.
• Then anterior vibrating line is determined by method de-
scribed above and transferred to cast as done previously.
Kingsley scraper is used to score the cast as follows:
a. Deepest area on either side of midline which are at a
distance of one third in front of posterior vibrating
line, i.e., 1-1.5 mm deep.
b. Scraping tapers to feather edge as it approaches the
anterior vibrating line.
Seal is then checked in the mouth, if gap is there be-
tween temporary denture base and soft tissue, then cast can
be scrapped more.
ii. Boucher's technique
Recording stage: It is done during jaw relations.
Method
• Posterior vibrating line is located and transferred to cast
and temporary denture base reduced to this line, then a
V-shaped groove (1-1.5 mm deep and 1.5 mm wide) is
scrapped anterior to this line.
• If the above markings are too high, area of redness will be
seen within 24 h on tissues, in which case it can be relieved.
Advantage
Narrow bead-like seal is obtained by this method which is
more effective as compared to broad seal which causes
greater tissue displacement.
B. Physiological techniques
i. Fluid wax technique
Recording stage: It is done after making the final impression.
Method: It is by using zinc oxide eugenol or plaster
impression.
• Both vibrating lines are marked in mouth and trans-
ferred to impression surface using indelible pencil.
• Waxes which flow at mouth temperature are used.
a. Korrecta wax no. 4 (orange).
b. Iowa wax (white).
c. H-L physiological paste.
d. Adaptol (green).
• Molten wax is painted between two lines, allowed to
cool and pressed gently into place for 4-6 min 30° down-
ward flexion of head is done and side to side rotation is
made to bring the soft palate downward and forward.
Glossy appearance of wax - indicates good tissue contact.
Dull appearance - indicates poor tissue contact.
Wax should terminate in feather edge near anterior vibrating
line. Excess wax is trimmed off.
 Quick Review Series for BOS 4th Year: Prosthodontics

Advantages • Region is flamed lightly and process repeated.

• Compression of tissues within physiological limits. • Good contact indicated by dull appearance of com-
• More retentive trial base. pound.

Disadvantages iii. Extended palatal technique by Silverman in 1971.

• Time-consuming. • Denture border is extended 8.2 mm beyond the anterior
• Material handling is difficult. vibrating line.

ii. Stick compound technique Method

Recording stage: It is during border moulding of special
tray before final impression is made.
Method: Stick compound and acrylic special tray is used.
• It is softened and applied on tray between anterior and
posterior vibrating line and pressed gently into mouth.
Once material hardens, excess material beyond ante-
rior vibrating line is trimmed off and tapered.
• Following border moulding, tray posterior border is
extended by adding black compound.
• 30° downward flexion of head is made and greenstick
compound is applied to seal area and procedure
repeated.
• Angular depression resembling curved gothic arch is
seen in compound.

SHORT ESSAYS
Q. 1. Posterior palatal seal. Functions/Significance of Posterior Palatal
Or Seal Area
Define and explain posterior palatal seal with diagram. i. Aids in denture retention.
ii. Prevents food accumulation beneath the maxillary denture.
Or iii. Maintains contact with moving soft palate and thus re-
Write about the significance of posterior palatal seal duces patient's awareness and gag reflex.
with diagram. iv. Compensation for curing shrinkage.
v. Reduces tongue irritation.
Ans. vi. When seal is placed in impression tray using compound, it
• Prevents impression material form flowing down the
Posterior Palatal Seal throat.
• Helps in tray positioning.
• Gives idea about denture retention.

Parts of Posterior Palatal Seal

Projection of a. Posterior palatal seal.
posterior nasalsplna b. Pterygomaxillary seal.
IV!terior
iibratlng • It is placed in pterygomaxillary notch or hamular
line notch and located just behind the maxillary tuberosity.
Postpalatal
seal area
• It is located using a T-bumisher/mouth mirror instru-
ment that is moved posteriorly until a soft depression
is felt immediately beyond the maxillary tuberosity.

Boundaries of Posterior Palatal Seal

Posterior vibrating line P!erygomaxillary seal area
• It is the seal area at the posterior border of a maxillary
removable prosthesis (GPT).
• It is the soft tissue area at or beyond the junction of hard and
soft tissues on which pressure, within physiological limits,
can be applied by denture to aid in its retention (GPT).
• Also called post-dam or post-palatal seal area.
• Anteriorly, anterior vibrating line.
• Posteriorly, posterior vibrating line.
• Laterally, pterygomaxillary notch.
Anterior vibrating line
• It is an imaginary line located at the junction of attached
tissues overlying the hard palate and the movable tissues
of the immediately adjacent soft palate.
Shape: Cupid's bow due to projection of posterior nasal spine.
Section I I Topic Wise Solved Questions of Previous Years
Location method
a. Valsalva manner: Here, both nostrils are held firmly
when the patient gently blows through the nose which
places the soft palate downwards at its junction with
hard palate.
b. Patient is asked to 'ah' with short vigorous bursts.
Posterior vibrating line
• It is an imaginary line at the junction of aponeurosis of
tensor veli palatini and the muscular portion of soft palate.
• It represents the junction between slightly movable part
of soft palate and part of soft palate that is markedly
displaced during function.
Location method
• Patient is asked to say 'ah' in a normal, unexaggerated
fashion.
Q. 2. Pascal's law.
Or
Write briefly about minimal pressure technique.
Ans.
Pascal's law
• According to Pascal's law, if pressure is applied to any
one part of confined fluid, then it is transmitted equally
to all parts.
• It is applied in minimal pressure technique for making
impression in complete denture prosthodontics given by
Page 1946 based on principle of mucostatics.
Minimal Pressure Technique
• It is also called as mucostatic/nonpressure/passive technique.
• According to principle of mucostatics, interfacial sur-
face tension is the only way to retain complete denture
which is achieved through accurate tissue adaptation.
Impression should cover areas of firmly attached mu-
cosa only.
• Dentures made with this technique have shorter flanges.
Advantages
• More tissue health and preservation.
Disadvantages
a. Short flanges inhibit wider distribution of masticatory
forces.
b. Less retention due to less coverage area.
c. No border moulding, no peripheral seal, and less retention.
d. Due to absence of border seal, food slips beneath the denture.
e. Short denture borders are readily available to tongue
causing its irritation.
f. Less lateral stability.
g. Poor facial support due to shorter flanges and hence,
less aesthetic.
Technique
• Compound impression is made and baseplate wax
adapted to cast according to denture outline.
• Special tray is made over wax spacer.
• Spacer is removed and impression made with free-
flowing material with as little pressure as possible and
escape holes are made for relief.
Q. 3. Border moulding in mandible.
Ans.
Border Moulding
• Border moulding is defined as the shaping of the bor-
der areas of an impression material by functional or
manual manipulation of the soft tissue adjacent to the
borders to duplicate the contour and size of the vesti-
bule. It determines the extension of a prosthesis by
using tissue function or manual manipulation of the
tissues to shape the border areas of an impression
material (GPT-8).
Importance of Border Moulding
• It shapes the impression borders and allows the muscles
to function in harmony with denture in absence of
which muscles can destabilize the denture and also, it
improves the border seal.
Materials Used for Border Moulding
a. Modelling compound sticks come in colours gray and
green, and are most popular.
b. Auto-polymerizing acrylic resins.
c. Polyether impression paste.
d. Impression waxes.
e. Periodontal pack.
Mandibular Border Moulding
a. Labial frenum and labial flange: The lower lip is lifted
outward, upward, and inward.
b. Buccal frenum: Cheek is lifted outward, upward, in-
ward, and finally forward and backward.
c. Buccal flange (distal to frenum): Cheek is moved
outward, upward, and inward.
d. Masseteric notch: Recorded in distobuccal corner.
Compound is softened and patient is asked to close his
jaws against downward pressure from the operator's
thumb in molar region.
e. Lingual flange: It is moulded by functional movements
of tongue. Patient training is important.

f. Lingual frenum and sublingual flange (premolar to
premolar):
• Patient is asked to protrude the tongue to determine the
height of flange anteriorly. Then, compound is reheated
and patient is asked to push his tongue forcefully against
the front part of palate to develop thickness of flange.
g. Mylohyoid portion of lingual flange (premolar to molar
region):
• Stick compound is placed between premylohyoid
eminence and post-mylohyoid eminence and patient
is asked to protrude the tongue which determines the
flange length in this region.
• Tongue is made to contact left cheek to mould right
lingual flange and vice-versa.
• Flange here, should slope towards the tongue to
allow mylohyoid muscle action which raises the
floor of mouth, and distolingual portion curves to-
wards the ramus (when viewed through impression
surface) to complete the characteristic S-curve.
h. Retromylohyoid portion:
It limits the distal most part of lingual flange which rises
toward the retromolar pad.
• Patient is asked to open the mouth and protrude the
tongue which activates the superior constrictor.
SHORT NOTES
Q. 1. Materials used for master impression.
Or
Final impression material for complete dentures.
Or
Materials which can be used for wash impressions in
final impression for complete dentures.
Ans.
Materials Used for Master Impression
Materials used for final impression should be accurate
and dimensionally stable. Commonly used materials are:
• Alginate: It should be retained mechanically to tray us-
ing adhesive or making perforations in tray.
• Rubber base: It is elastic, records fine details and under-
cuts, and is very stable. But, adhesive required to hold
the material to tray should be a water-phobic material.
So, areas to be recorded should be absolutely dry.
• Zinc oxide eugenol: It is most popular, flows well, re-
cords fine details, adheres well to tray, but rigid and in-
elastic, not suitable for undercuts recording, material
affected by water and saliva, so areas to be recorded
should be absolutely dry.It causes burning sensation and
tissue irritation in some patients.
• Tissue conditioners: Old denture is used as final impres-
sion tray.
Quick Review Series for BOS 4th Year: Prosthodontics
• Next, jaws are closed against resistance to operator's
thumb which activates the medial pterygoid muscle and
limits the space in this region.
• Patient is asked to wipe the lower lip and contact the
opposite right and left buccal mucosa with tongue tip.
Q. 4. Rubber base impression materials.
Ans.
Rubber Base Impression Materials
Rubber base is_used as a final impression material.
Advantages
a. Records fine details.
b. Very stable.
c. As it is elastic, it perfectly records undercuts.
Disadvantages
a. Acts as an adhesive required to hold the material totray.
b. It is a water-phobic material. So, areas to be recorded
should be absolutely dry.
• They are used to condition the tissue and make func-
tional impression.
• Impression plaster: It was used earlier as an impression
material, but not commonly used now.
• Waxes: Flow at mouth temperature.
Used to correct deficiencies in final impression made with
other materials and it does not itself recorded, as it exerts pres-
sure and fine details can't be recorded. It is susceptible to
thermal change, so cast should be poured immediately.
Q. 2. Posterior palatal seal area.
Or
Significance of posterior palatal seal. Enumerate tech-
niques used to develop the same.
Or
Enumerate the functions of posterior palatal seal.
Ans.
Posterior Palatal Seal Area
• It is the seal area at the posterior border of a maxillary
removable prosthesis (GPT).
• It is the soft tissue area at or beyond the junction of hard and
soft tissues on which pressure, within physiological limits,
can be applied by denture to aid in its retention (GPT).
• Also called as post-dam or post-palatal seal area.
Section I I Topic Wise Solved Questions of Previous Years

Functions/Significance of Posterior Palatal Seal Border Moulding

Area • Border moulding is defined as the shaping of the border
• Aids in denture retention. areas of an impression material by functional or manual
• Prevents food accumulation beneath the maxillary denture. manipulation of the soft tissue adjacent to the borders,
• Maintains contact with moving soft palate and thus to duplicate the contour and size of the vestibule.
reduces patient's awareness and gag reflex. • For determining the extension of a prosthesis by using
• Compensation for curing shrinkage. tissue function or manual manipulation of the tissues
• Reduces tongue irritation. to shape the border areas of an impression material
• When seal is placed in impression tray using compound, it (GPT-8)
i. Prevents impression material form flowing down
the throat.
ii. Helps in tray positioning.
Purpose of Border moulding
iii. Gives idea about denture retention. • It shapes the impression borders and allows the muscles
to function in harmony with denture in absence of
Methods to Record Posterior Palatal Seal which muscles can destabilize the denture and also it
improves the border seal.
a. Arbitrary techniques
i. Conventional technique by Winkler. Q. 5. Fabrication of custom tray for completely edentu-
ii. Boucher's technique. lous arches.
b. Physiological techniques
i. Fluid wax technique. Ans.
ii. Stick compound technique.
iii. Extended palatal technique.
Custom Tray for Completely Edentulous
Q. 3. Disinfecting the impression. Arches
Or • Custom tray is also called as special tray or individualised
tray.
Disinfection of impression.
• It is used to make final impression.
Ans. • It is fabricated on a primary cast made from primary
impression of the patient.
Disinfection of Impression
Materials Used for its Fabrication
Both maxillary and mandibular impressions are rinsed in
running water and disinfected using iodophor or 2% gluter- • Tray acrylic: It is the most stable and preferred material.
aldehyde. Impression should be left undisturbed for 10 min. sprinkle on or dough technique
• Vacuum formed baseplate.
Q. 4. Border moulding. • Shellac: There is high risk of warpage and low strength,
Or so discontinued.
• Wax.
What is the purpose of border moulding? • Tray compound.
Ans. • Old denture.

------------------ - <( Topic 6)
Maxillomandibular Relations
LONG ESSAYS
Q. 1. What is orientation relation? Write in detail about
recording of orientation relation in complete denture
patient.
Or
What is a face-bow? Discuss the importance of face-bow
transfer for an edentulous patient.
Or
What is face-bow? Discuss the importance of same in
complete dentures and partial removable prosthesis.
Or
Describe and classify face-bow? Mention the parts of
face-bow. Discuss the uses of face-bow.
Ans.
Orientation Relation and Face-bow
• It is the jaw relation when the mandible is kept in pos-
terior most position. It can rotate in the sagittal plane
around an imaginary transverse axis passing through or
near the condyles.
• Recording of orientation jaw relation is done using a
device called face-bow.
• Face-bow is a caliper-like instrument used to record
the spatial relationship of the maxillary arch to some
anatomic reference point or points and then transfer
this relationship to an articulator; it orients the dental
cast in the same relationship to the opening axis of the
articulator.
• The face-bow is used to record the relationship of the jaws
to the opening axis of the jaws and to orient the casts in this
same relationship to the opening axis of the articulator.
Indications for Face-bow Use
• When balanced occlusion is desired.
• When cusps form teeth are used.
• When interocclusal check records are used.
• For constructing accurate crowns and bridges.
• In full mouth rehabilitation, when accurate occlusal
restorations are to be made.
• When occlusal vertical dimension is to be changed dur-
ing teeth setting.
Quick Review Series for BOS 4th Year: Prosthodontics
• For diagnostic mounting and treatment planning.
• In gnathological studies and treatment.
• For making occlusal corrections after denture processing.
Basic Parts of a Face-bow
The parts of the face-bow are:
a. U-shaped frame.
b. Condyle rods.
c. Bite fork.
d. Orbital pointer (optional).
e. Locking clamps.
Classification of Face-bow
a. Arbitrary face-bows
i. Fascia type.
ii. Earpiece type.
b. Kinematic face-bows.
Arbitrary face-bows
i. They are used as arbitrary or approximate points on the
face as the posterior reference points.
ii. The condyle rods are positioned on these predeter-
mined points during the face-bow transfer procedure.
iii. These are most widely used type of face-bow and
are sufficient for fabrication of most complete den-
ture, fixed partial, and removable partial denture
prostheses.
A. Fascia type
• Utilises approximate posterior reference points on the
skin over the temporomandibular region.
• These points are located by measuring from certain ana-
tomical landmarks on the face. The fascia bow uses
condylar rods instead of ear inserts.
B. Earpiece type
• First described by Dalbry in 1914.
• This type of face-bow uses the external auditory meatus
as the arbitrary posterior reference point, which is as-
sumed to have a fixed relationship to the hinge axis.
• For this, a special earpiece is used instead of a condylar
rod. Attached to the medial end of each scale is a
rounded nylon earpiece which has a central hole that
connects to the auditory pin on the articulator.
Section I I Topic Wise Solved Questions of Previous Years
• The external auditory meatus is located behind the
actual hinge axis. The auditory pin is also located
posterior to the opening axis of the articulator.
• In articulators that don't have an auditory pin, a condy-
lar compensator is needed which compensates for above
by positioning the condylar inserts at a fixed distance
behind the hinge axis of the articulator.
Earpiece face-bow has gained popularity because:
i. It is simple to use.
ii. It does not require measurements or marks on the face.
iii. It gives accuracy that is similar to other arbitrary methods.
Kinematic face-bows
• They are also known as hinge-bow and adjustable axis
face-bow.
• They are used to locate and transfer the true hinge-axis.
• Complex instrument and requires the fabrication of
clutches, which are attached to lower jaws.
• They require more chair-side time and are rarely indi-
cated for routine prosthodontic procedures.
• They require the use of articulator with extendable con-
dylar shafts, e.g., Hanau H2 X which must be extended
to meet the stylus of face-bow.
Indications
• For cases where, high level of accuracy is required, for
e.g., for full mouth rehabilitation, occlusal equilibra-
tion, and gnathological studies.
Plane of orientation
• Relationship of maxilla to skull and TMJ is different in
most individuals.
• This can be easily transferred, if we relate maxilla to
three points in the skull.
• Two points located posterior to maxilla (posterior refer-
ence points) and one anterior (anterior reference point).
• The spatial plane formed by joining the anterior
and posterior reference points is known as plane of
orientation.
Anterior reference point
a. By using face-bow, casts can be positioned at any point
between the upper and lower arms of the articulator,
because the face-bow can rotate upward or downward
around the hinge axis of the articulator.
b. So, a standard is needed which can be used to mount
most casts. Some operators prefer the midway point in
the articulator, whereas, others prefer to orient it accord-
ing to anatomical landmarks obtained from the patient.
c. Thus, the anterior point of reference determines at what level
in the articulator the occlusal plane is placed or in other
words, it determines the level at which the casts are mounted.
Some commonly used anterior reference points:
a. Nasion: Used with quick mount face-bow (whip mix).
b. Orbitale: Located by Hanau face-bow with the help of
orbital pointer.
c. Orbitale minus 7 mm: This plane represents Frankfort
plane.
d. Ala of nose: This plane represents Camper's plane.
e. 43 mm superior from lower border of upper lip: Also
called as Denar reference plane
f. locator. Denar face-bow uses this reference point.
Commonly used planes of orientation
The commonly used planes during the face-bow transfer
are as follows:
a. Axis-orbitale plane.
b. Frankfort plane.
c. Camper's plane.
d. Axis-nasion plane.
Posterior reference point
It is defined as a terminal hinge axis or opening axis of the jaw.
It is usually taken as the posterior points. It may be determined
approximately (arbitrarily) or absolutely (kinematically).
Arbitrary method
• By measurement - as mentioned above.
• By palpation - palpation of the TMJ area to locate the
hinge axis, as the patient opens and closes the mouth.
Kinematic method
• Most accurate method of locating the hinge axis is
through the use of a kinematic face-bow.
a. U-shaped frame is slipped over the bite fork exten-
sion. The locking clamps are then tightened gently at
first and then firmly. This secures the bite fork to the
rest of the face-bow.
b. Orbitale pointer when present is positioned, so that
its tip points to the orbitale. All the locking nuts and
clamps are secured.
c. Whole assembly is disengaged from the patient's
face by loosening the condylar rods. The face-bow
assembly including the bite fork with attached face-
bow is slipped off the patient's face.
d. Whole assembly (including occlusal rim) is then po-
sitioned in the articulator. Condylar rods are locked
on to the hinge axis extensions of the condylar ana-
logues on the articulator. In the earpiece type, the
condylar rod is positioned behind the articulator
hinge axis to compensate for the posterior position of
the auditory meatus (a small pin known as auditory
pin is present behind the hinge axis of the articulator
on the condylar housing, which slips into a hole in the
ear insert). A condylar compensator may be used in
articulators which do not have an auditory pin.

e. The position of the occlusal plane in the articulator
is decided and the face-bow is raised or lowered ac-
cordingly (using the elevating screw of the face-
bow). Many use the midplane of the articulator as
marked on the incisal pin, whereas others adjust it
according to the Frankfort plane (the orbital pointer
of the face-bow is related to the orbitale indicator on
the upper member of the articulator).
f. The upper cast is attached to upper record base. The
weight of the occlusal rim and cast is supported with
the help of a cast support (also called mounting prop).
g. The notches (indices) in the base of the cast are lightly
lubricated. The upper cast is then secured to the upper
arm of the articulator with plaster (special low-setting
expansion mounting plaster recommended).
h. After the plaster sets, the face-bow is disassembled.
The articulator is placed upside down. The lower oc-
clusion rim is related to the upper occlusion rim with
the help of the centric relation record made earlier. The
lower mounting is completed with mounting plaster.
The articulator is now ready for customizing, i.e., pro-
gramming of the condylar and incisal guidances.
Advantages of the Face-bow
a. It reduces errors in occlusion.
b. It permits more accurate programming of the articulator.
c. It supports the cast, while mounting on the articulator.
d. The vertical dimension may be increased or decreased
directly on the articulator without having to make new
centric relation records.
Q. 2. Classify jaw relation. Define centric relation.
Explain its clinical significance. What are the methods
of recording the centric jaw relation?
Or
Explain one in detail: a) Note on eccentric jaw relation.
b) Add a note on difficulties encountered during record-
ing centric jaw relation.
Or
What are the different maxillomandibular relationships
and discuss importance and different methods of re-
cording horizontal jaw relation.
Ans.
Jaw Relation
• Jaw relation is defined as any spatial relationship of the
maxillae to the mandible; anyone of the infinite rela-
tions of the mandible to the maxillae (GPT-8).
• In the natural dentition, the presence of teeth makes it
easy to determine the relationship of the jaws to each
Quick Review Series for BOS 4th Year: Prosthodontics
other. In edentulous patients, the absence of teeth makes
it necessary for the dentist to determine and establish
the relationship between the jaws.
Classification
a. Orientation relations.
b. Vertical relations (vertical dimension).
c. Horizontal relations.
Importance
• In edentulous mouth, above three relations together help
determine the height of the jaws, while mouth is opened,
and the way they are related to each other.
• In patients with natural teeth, the teeth determine how
the jaws are related to each. However, in edentulous
patients, the maxillomandibular relations have to be es-
tablished by the dentist.
Face-bow Index
• It is a record of the orientation of the maxillary denture
or teeth in relation to the articulator. It is an imprint of
the teeth in plaster.
• When the denture is replaced into this index, it reorients
the maxillary denture or teeth back into the original re-
lation without having to make a new face-bow record.
• It may be made before removing the maxillary cast from the
articulator prior to processing. The denture can be remounted
back on to the articulator with the help of this index.
• A new face-bow index can be made after final occlusal
correction and before delivery of the denture to the pa-
tient. If at any future date, the dentures need to be re-
turned to the articulator for corrections, the face-bow
index would be useful for remounting.
Horizontal Jaw Relations
• Philipp Pfaff (1756), described a technique of 'taking a
bite', also known as 'mush' or 'biscuit' or 'squash' bite.
Classification
Horizontal jaw relations may be classified as:
i. Centric relations.
ii. Eccentric relations.
a. Protrusive relation.
b. Lateral relations
• Left lateral.
• Right lateral.
i. Centric relation
• After establishing vertical relation, centric relation is
recorded.
Section I I Topic Wise Solved Questions of Previous Years
• It is a bone-to-bone relation and is classed as a horizon-
tal relation, because variations from it occur in the hori-
zontal plane.
• It is defined as the maxillomandibular relationship, in
which the condyles articulate with the thinnest avascu-
lar portion of their respective disks with the complex in
the anterior-superior position against the shapes of the
articular eminencies.
• This position is independent of tooth contact. This posi-
tion is clinically discernible when the mandible is di-
rected superiorly and anteriorly. It is restricted to a
purely rotary movement about the transverse horizontal
axis
Significance of Centric Relation
a. Artificial teeth are best set to occlude evenly at centric
relation
b. more definite than the vertical relation and is indepen-
dent of the presence or absence of teeth.
c. It is recordable and reproducible over a period of time.
d. Centric relation serves as a reference for establishing an
occlusion.
e. When centric relation and centric occlusion of natural
teeth do not coincide, the periodontal structures around
the teeth are endangered.
f. When centric relation and centric occlusion of artificial
teeth do not coincide, there is instability of the dentures
and the patient may experience pain and discomfort.
g. Errors in mounting the casts on the articulator can be
detected, when the centric relation is used as the hori-
zontal reference position.
h. An accurate centric relation is recorded properly and it
orients the lower cast to the opening axis of the articula-
tor and the mandible.
i. Accurately recorded centric relation when transferred to
the articulator permits proper adjustments of the condy-
lar guidances for the control of eccentric movements of
the instrument.
Difficulties in obtaining mandibular retrusion (centric
relation)
• Centric relation is a learned position and obtaining cor-
rect centric relation involves training the patient to re-
trude the mandible. Many patients find this difficult as
edentulous patients tend to protrude the mandible.
a. Biologic difficulties
i. Due to lack of coordination between muscles.
ii. In the edentulous state, some patients assume a
more prognathic position for convenience.
iii. Old denture wearers assume habitual eccentric positions
due to wear of teeth or due to a previous wrong
centric relation.
iv. Senility or other neuromuscular diseases.
b. Psychological difficulties
When a patient fails to follow instructions, the dentist
may get frustrated, leading to more anxiety in the patient.
It is extremely important that the dentist does not display
his disappointment or frustration to the patient.
c. Mechanical difficulties
These difficulties are due to ill-fitting bases or due to
some interference between the bases. Ill-fitting bases
tend to shift around making observations difficult.
Methods of assisting the patient to retrude the
mandible
The patient may be instructed to
a. Let the jaw relax, pull it back and close slowly on the
back teeth.
b. Push the upper jaw out and close the back teeth.
c. Protrude and retrude the mandible repeatedly, while
patient holds a finger lightly against the chin.
d. Boos stretch-relax exercises-open wide and relax,
move the jaws to the left and relax, right and relax, for-
ward and relax. This helps the patient to coordinate
movements and follow the dentist's instructions.
e. Roll the tongue backwards towards posterior border of
upper denture and close the rims until they meet.
f. Swallow and close. The disadvantage is that a patient
can swallow in slight eccentric positions also.
g. Tapping rims together rapidly and repeatedly.
h. Tilting the head backwards tends to pull the mandible
backwards, because of tension on the infrahyoid muscles.
i. Massaging or palpation of the temporalis and masseter
muscles to relax them.
j. In the terminal hinge position, closing the mandible tenses
the temporalis muscle which can be felt by the dentist.
k. The dentist can also assist and guide in retruding using
fingers placed on the sides of the lower rims.
Recording centric relation or bite registration
After sufficient training of the patient to retrude the man-
dible to centric relation, it must be recorded. This is known
as a centric relation record. This record is necessary to
transfer it to an articulator.
There are two schools of thought regarding pressure
used while recording centric relation.
A. Minimal closing pressure.
B. Heavy closing pressure.
A. Minimal closing pressure
• Advocated to reduce tissue displacement. Thus, the op-
posingdenture teeth will touch uniformly and simulta-
neously at first contact.
B. Heavy closing pressure
• The objective is to produce the same displacement of
soft tissues that occurs when the patient masticates.

Advantage
• Occlusal forces are evenly distributed over the residual
ridges under heavy loads.
Disadvantages
a. If the soft tissues have uneven thickness, then the teeth
contact unevenly at first contact.
b. Uneven contacts may cause clenching in nervous
patients.
Methods used for recording centric jaw relations
i. Tactile or interocclusal check records.
ii. Functional (chew-in) methods
a. Needle-house method.
b. Patterson's method.
c. Meyer's method.
iii. Graphic methods (Excursive method)
a. Intraoral tracing.
b. Extraoral tracing.
iv. Terminal hinge axis method.
v. Other methods
a. Strips of celluloid placed between the rims.
b. Heating the surface of one of the rim.
c. Deep heating or pooling method.
d. Soft wax is placed over the occlusal surfaces of man-
dibular posterior teeth.
e. Soft cones of wax placed on the lower denture bases.
i. lnterocclusal check records
• Also known as bite registration, interocclusal record.
• They are most widely used methods of recording centric
relation.
Uses
a. To record centric relation.
b. To record eccentric relations, e.g., protrusive, left and
right lateral relations.
c. To verify centric relation on the articulator.
Method
Before recording centric relation, the bases are checked for
interferences.
• Training the patient
a. The patient is trained to retrude the mandible into
centric relation using one of the various methods
described above.
b. A line is scribbed in the wax from the upper to the
lower occlusion rim in the canine-premolar region.
c. A mark is also made along the midline of the upper
and lower rims, which will serve as reference marks
during patient training and later while creating an
index. These lines should coincide repeatedly when
the patient closes in centric relation.
Quick Review Series for BOS 4th Year: Prosthodontics
• Indexing the rim
a. 'Notches' are created in the upper occlusal rim on
either side in the mid-posterior region.
b. A small section of wax is removed from the lower
rim to create space for the registration material (cor-
responding to the notches in the upper rim).
c. The indices should be sharp and well defined.
d. Some operators prefer to create notches in the lower
rim while placing the registration material in the
maxillary rim.
• Recording centric relation
a. Once the patient is well trained and the dentist is
confident, the record is made. The notches are lubri-
cated with petroleum jelly. A recording material like
quick-setting plaster or bite registration wax is
placed in the relief space in the opposite rim.
b. The patient is instructed to close in centric relation.
The reference lines are used to visually verify cor-
rect closure. The jaws are held stationary, till the
material sets or hardens.
c. Other bite registration materials may also be used.
d. Once the maxillary cast is mounted on the articulator, this
record can then be used to mount the mandibular cast.
e. The index maintains a record of the relation between
the upper and lower occlusion rims. Even if the two
rims are separated, they can be reassembled back in
the exact same relation with the help of the index.
• Trimming the record
The registration wax is hardened in chilled water. A heated
instrument may be used to trim the excess. The rims are re-
placed in the mouth to verify the accuracy of the registration.
An interocclusal check record can be made
a. Between upper and lower occlusion rims.
b. Between upper and lower artificial or natural teeth.
c. Between a central-bearing plate and pin.
Bite registration materials
a. Quick setting plaster.
b. Bite registration (ZOE) paste.
c. Bite registration wax.
d. Bite registration silicone.
Requirements of bite registration materials
a. Should be dimensionally accurate after setting.
b. Should be fluid in consistency to avoid pressure during
recording.
c. Adequate working time.
d. Short setting time to reduce discomfort to patient and
distortion due to movement.
ii. Functional method of recording centric relation
a. Needle-House method: Four metal styli fixed in the
compound maxillary rim carve four diamond-shaped
Section I I Topic Wise Solved Questions of Previous Years
tracings in the mandibular rim as the mandible is moved
through various excursive movements.
b. The records can be transferred only to a Needle-House
articulator.
c. Patterson's method: A trench is made in a wax mandibu-
lar rim and filled with a mixture of plaster and carborun-
dum paste. Compensating curves are generated in this.
d. Meyer's method: This method uses soft wax to establish
a generated path. A plaster index is made of the wax
path and this is used to set the teeth.
iii. Excursive methods-gothic arch tracing:
Arrow point tracer or height tracer.
Uses
a. To verify or confirm centric relation obtained by other
methods.
b. It is also used to obtain protrusive and lateral records.
The tracings obtained resemble a Gothic arch or an
arrow point.
Attaching the tracing devices: Prior to using, a tracing
device, the occlusion rims are mounted on an articulator
using a tentative centric relation record (using an interoc-
clusal check record). The tracing devices are attached to the
occlusion rims while they are on the articulator.
Types
a. lntraoral (arrow points posteriorly).
b. Extraoral (arrow points anteriorly).
Tracing assembly: The tracing assembly consists of a trac-
ing table and a stylus. The stylus traces the Gothic arch on
to the tracing table.
Extraoral tracer-the tracing assembly is located outside
the mouth.
lntraoral tracer-it is located inside the mouth.
Central bearing device: It consists of a small fixed ball and
a plate. They are located inside the mouth between the up-
per and lower occlusion rims. They help to maintain the
vertical relation while the patient performs the mandibular
movements.
Terminal hinge axis: It is determined using kinematic
face-bow. As the mandible rotates around the hinge axis
and occludes with the wax rims, it comes automatically in
centric relation.
iv. Other methods
a. Strips of celluloid: After adjusting the rim, a strip of celluloid
is placed between the rims and pulled. If it pulls out easily,
then it indicates uneven contact and the rim is readjusted.
Disadvantage: Unequal pressure error may still be present.
b. Deep heating or 'pooling' of the posterior portions of
the mandibular rim leaving the anterior portion cold (to
maintain OVD).
c. Softened wax is placed on the mandibular posterior
teeth and maxillary teeth are closed into it.
Advantage: Smaller surface contact instead of a large
flat wax surface.
Disadvantage: Record has to be made at an increased
vertical relation to avoid contact of teeth.
d. Swallowing technique using soft cones of wax establish
vertical as well as centric relation.
Disadvantage: Results are not consistent.
v. Eccentric relations
An eccentric maxillomandibular relation is any other hori-
zontal relationship of the mandible to the maxilla other than
centric position.
The eccentric relation records are used to program the
articulator to simulate the patient's jaw movements.
The important eccentric relations are:
Protrusive and Lateral (left and right)
Importance
These are necessary to program an adjustable articulator to
simulate the patient's jaw movements which are helpful in
constructing a balanced denture occlusion and restorations
which are in harmony with the functional movements of the
mandible.
The eccentric positions are recorded by:
a. Functional methods.
b. Excursive (graphic) methods.
c. Direct check records.
a. Protrusive relation
Mandible can be protruded to a position anterior to that of
centric relation which is known as the protruded jaw relation.
In this position, a wedge-shaped opening is observed in
the posterior section between the upper and the lower oc-
clusion rims known as Christensen's phenomenon.
Applications
• To program the articulator (to program the horizontal
condylar guidance which together with the incisal guid-
ance guides the protrusive movement of the articulator).
Protrusive records are made by
1. Direct protrusive check record: After suitable training, the
patient is asked to protrude by 5--6 mm and close. The posi-
tion is recorded using the interocclusal check record method
and a suitable recording material. The protrusive check re-
cord is made at a slightly increased vertical dimension.
2. Graphic method: Using the gothic arch tracing, the pa-
tient is asked to protrude the mandible and close at a point
5-6 mm forward of the apex of the arrow point (centric).
This position is then recorded using quick setting plaster
or a suitable recording medium. The record is preserved
and used to program the adjustable articulator.

3. Functional procedures are similar to those described
earlier.
a. Lateral jaw relations
The mandible can also be moved to the left or right sides. The
relations of the mandible to the maxilla when it is moved to the
left or right of centric relation are known as lateral jaw relations.
When the mandible is moved to one side, a separation
may be observed between the occlusion rims on the oppo-
site side which is the result of the downward displacement
of condyle (balancing side) as it travels downward and me-
dially along the medial slope of the mandibular fossa (also
known as Bennett movement).
Applications
• To program the articulator (to program the lateral con-
dylar guidance which together with the incisal guidance
guides the lateral movement of the articulator).
However, this can be done only in an articulator that
accepts lateral relation records. The Hanau semi-adjustable
articulators do not accept lateral relation records. Instead, a
formula is used to derive the lateral condylar settings.
Recording Lateral Relations
• Lateral jaw relations can be recorded using functional
techniques, graphic techniques, or direct check records.
In addition, Hanau's formula can be used.
1. Graphic method: With the help of the Gothic arch
tracing, two separate records are made, one in the left
lateral position and one in the right lateral position.
2. Lateral check records: These are made similar to the
protrusive record except that the mandible is held in
the lateral position, while the record is being made.
Left and right lateral records are made.
Hanau's formula: Around 1930, Hanau recommended a
formula to derive the lateral inclination as follows:
L = H + 12/8
where, L = Lateral condylar inclination (in degrees)
H = Horizontal condylar inclination (in degrees)
This formula is used only with the Hanau articulator.
Q. 3. Define physiological rest position of mandible.
Give the importance of Silverman closest speaking
space and discuss the effects of increased and decreased
vertical dimension in complete dentures.
Ans.
Vertical Relations
It is used determine the amount of separation between the
two jaws and needs to be established correctly for the
proper comfort, health, and function of the mouth.
Quick Review Series for BOS 4th Year: Prosthodontics
Definition
It is defined as the distance between two selected anatomic
or marked points (usually one on the tip of the nose and the
other upon the chin), one on a fixed, and one on a movable
member (GPT-8).
Types
1. The rest vertical dimension (RVD) or vertical relation of
rest.
2. The occlusal vertical dimension (OVD) or vertical rela-
tion of occlusion.
3. The difference between RVD and OVD also known as
'interocclusal dimension' (IOD) or 'rest space' or 'free-
way space'.
4. Other vertical relations.
Physiologic Rest Position
Physiologic rest position occurs somewhere downward
and slightly forward from centric relation. In this posi-
tion, the jaw opening and closing muscles are in tonic
balance.
Factors affecting are as follows:
• Tonicity of jaw muscles.
• Position of head (it modifies the effect of gravity).
Rest Vertical Dimension (RVD)
It is defined as the distance between two selected points
(one of which is on the middle of the face or nose and the
other of which is on the lower face or chin) measured when
the mandible is in the physiologic rest position.
Occlusal Vertical Dimension (OVD)
It is defined as the distance measured between two points
when the occluding members are in contact (GPT-8).
The OVD in dentulous individuals is established by the
occlusal stops provided by the teeth. It is affected by tooth
loss, wear, caries, etc.
The OVD in edentulous patients is established with the
help of occlusal rims. It is usually determined by first find-
ing out the physiologic rest position (RVD) and then reduc-
ing to 2-4 mm (interocclusal distance or IOD).
lnterocclusal Rest Space (lnterocclusal
distance - /OD)
It is also known as freeway space or interocclusal distance.
It is the difference between the rest vertical relation and
the occlusal vertical relation.
In natural teeth, it is 1-8 mm.
Section I I Topic Wise Solved Questions of Previous Years

In complete dentures, it is 2-4 mm at premolar region Disadvantages

tolerated well by most patients • Not reliable in cases of marked resorption.
Importance • When teeth are lost at irregular intervals, the re-
An adequate interocclusal rest space is necessary for the sidual ridges are not parallel.
comfort of the patient, health of the tissues, and proper i. Measurement of former dentures
functioning of the dentures. The former dentures can be measured between the bor-
OVD = RVD - 2-4 mm ders of the maxillary and mandibular dentures with a
Thus, OVD = RVD - IOD or Boley gauge (after compensating for occlusal wear).
Other vertical relations such as when the mouth is half ii. Pre-extraction records
open or wide open are of no significance in the construction Sometimes it is possible to see a patient before he or
of dentures. she loses his/her natural teeth. In such a case any of
the following methods can be used to record the
Methods of Determining Vertical Relation distance.
A. Mechanical Methods a. Profile radiographs are made with teeth in occlusion.
1. Ridge relations These are compared with those made with occlusion
• Distance from incisive papilla. rims in position.
• Parallelism of the ridges. Disadvantages
2. Measurement of former dentures. 1. Image may be distorted.
3. Pre-extraction records 2. Time-consuming.
• Profile radiographs. 3. Radiation hazards.
• Profile photographs. b. Profile photographs are compared before and after treatment.
• Articulated casts. Disadvantage: Profile angles can change with changes
• Lead wire silhouettes. in the patient's posture.
• Resin facemasks. c. Articulated casts measurements are made between sta-
• Facial measurements. ble landmarks with the teeth in occlusion, e.g., between
B. Physiologic Methods the upper and lower freni.
1. Physiologic rest position tests d. Lead wire silhouettes (not commonly used currently).
• Parting the lips after swallowing. Lead wires are adapted to the patients (profile) before
• Niswonger's method. extraction. The outline is transferred to a cardboard and
2. Phonetics cut out. After extraction, the cut out is placed against the
• Using the M sound. patient's profile to check vertical relation.
• Using h, s, and j sounds. e. Acrylic facemask (Swenson's technique) is made before
• Silverman's closest speaking space. extraction using a facial impression and cast. This
• Facial expression. method is not practical.
3. Facial expression and aesthetics as guides. f. Facial measurements
4. Swallowing threshold. Dakometer: The instrument is positioned on the bridge of
5. Tactile sense the nose with compound. The chin piece is screwed till it
• Lytle's method (neuromuscular perception). touches the front of the chin. A spring pressure gauge con-
• Boos bimeter (power point). trols pressure. An incisor attachment records position of
• Patient's tactile sense as guide. the central incisors. Records are noted and the compound
6. Electromyography. nosepiece preserved for reassembly after extraction.
Willis-gauge: One arm contacts the base of the nose and
A. Mechanical methods the other arm is moved along the side until it touches the
1. Ridge relations base of the chin.
a. Incisive papilla distance: The distance of the incisal pa- Disadvantage: Is not accurate as there may be variations
pilla from incisal edge of mandibular incisors is about in applying pressure.
4 mm. It is 6 mm away from edge of central incisors. Sorensen's profile guide: It is one of the devices for
Disadvantage: Useful only in treating single com- recording facial measurement.
plete dentures.
B. Physiological methods (Post-extraction methods)
b. Parallelism of ridges: Sears suggested that correct
vertical relation is at a point where the jaws are 1. Physiologic rest position tests
parallel, with a 5 degree opening in the posterior Swallow and relax: The patient is asked to swallow and
region. relax. The lips are parted gently after instructing the patient

to hold the jaws still. There should be 2--4 mm of space
between the rims in the premolar region.
Niswonger's method (1934): Two markings are made, one
on the upper lip below the nasal septum, and the other on
the chin. The patient is told to swallow and relax. The dis-
tance between the marks is measured. The occlusal rims are
adjusted until the distance between the marks is 2--4 mm
less during occlusion.
Disadvantage: The marks move with the skin.
2. Phonetics as guide
a. The dentist asks the patient to speak certain words and
then makes observations of the relationship of the oc-
clusion rims to each other and to the lips.
b. Using 'm' sound: The patient repeats the letter 'm'.
When the lip touches, all jaw movements are stopped.
The distance between the two reference points are mea-
sured. The occlusion rims are then adjusted, so that
they are 2--4 mm short of this position when they are
occluded.
c. The ch, s, and j sounds: When correctly placed, these
sounds bring the upper and lower incisors close to-
gether. The lower central incisors come forward nearly
directly below the upper centrals almost touching them.
At the right vertical height there should be a 1 mm
space between the upper and lower occlusion rims. If
the rims contact, wax should be removed to reduce the
vertical height of the rims. If the space is more than 1
mm, then the wax is added to increase the vertical
height.
d. Using thirty-three: When repeating this word there
should be enough space for the tip of the tongue to pro-
trude between the anterior teeth.
e. Using for v sounds: The maxillary incisal edge should
lightly contact the lower lip at the vermillion border
when the patient produces a 'V' or 'F' sound. If the pa-
tient contacts the lower lip well into the oral portion, the
maxillary incisal edge may be too short. If the lower lip
is contacted with such force causing it to fold when
producing an 'F' or 'V', the maxillary rim may be too
long.
Silverman's closest speaking space
It is different from freeway space.
The freeway space establishes vertical dimension when
the muscles are at rest.
The closest speaking space establishes vertical relation
when the jaws are in the function of speech. Thus, one is
'static' and the other is 'dynamic'.
Pound and Murrells technique: Using 'f', 'v', and 's'
sounds and speaking wax, the positions of the upper and
lower anterior teeth are established.
Quick Review Series for BOS 4th Year: Prosthodontics
3. Aesthetics as guide
Facial aesthetics: An experienced dentist evaluates facial
expression. In the normal relaxed position, the lips are
even anteroposteriorly and in slight contact. The nares and
the skin around the eyes and chin are relaxed. If the face
appears strained, the vertical height may be too much. If
the corners of the mouth droop, making the chin appear too
close to the nose, then vertical dimension may be too less.
Disadvantage: Not practical method. It requires skill and is
expensive equipment.
Effects of decreased vertical dimension
a. Decreased chewing efficiency.
b. Cheek biting-flabby cheek tissues get trapped.
c. Appearance: The chin appears close to nose, lips lose
their fullness, and vermilion border is reduced to a line,
wrinkles are deepened. Face appears flabby.
d. Angular cheilitis: A deep crease forms at the comer of
the mouth. Constant wetness due to saliva leads to in-
fection and soreness.
e. TMJ pain, clicking sounds, headaches, etc.
f. Costen's syndrome (now disputed) is due to prolonged
over closure.
g. Limited tongue space.
Effects of increased vertical dimension
Excessive vertical height (inadequate freeway space) can
cause certain problems:
• Discomfort and annoyance to the patient.
• Trauma to the underlying mucosa.
• Rapid resorption of alveolar bone.
• Clicking of teeth.
• Rapid wear of acrylic teeth.
• Strained face appearance (elongated face).
• Difficulty in closing lips.
• Difficulty in swallowing.
Willis method (Facial proportions): The distance between the
outer canthus of the eye and the comer of the mouth should
be equal to the distance between the lower border of the
septum of the nose and the lower border of the chin.
1. Swallowing threshold
When a person swallows, the teeth come together with very
light contact.
Method
Cones of soft wax having excessive height are placed on the
lower base. Salivation is stimulated (e.g., using candy) and the
patient is instructed to swallow. The repeated swallowing re-
duces the height of the wax to the occlusal vertical dimension.
Disadvantage
The results obtained are not consistent and are affected by
the length of time the swallowing motion is performed.
Section I I Topic Wise Solved Questions of Previous Years
2. Tactile or neuromuscular perception methods
Patient's tactile sense: The patient is asked if the rims
appear to touch too soon, or if the jaw closes too much
or if it feels just right.
Disadvantage
Some patients are not always able to judge correctly. Not ef-
fective in senile patients or mentally compromised patients.
a. Boos bimeter: Boos (1940) stated that maximum biting
force occurs at OVD. A device that measures the biting
force is attached to the mandibular record base and a
SHORT ESSAYS
Q. 1. Classification of jaw relations.
Or
Discuss the various jaw relation procedures in complete
denture patients.
Or
Classify jaw relations. Discuss in detail the significance
of jaw relations in complete denture construction.
Ans.
Jaw Relation
Jaw relation is defined as any spatial relationship of the
maxillae to the mandible; and anyone of the infinite rela-
tions of the mandible to the maxillae (GPT-8).
In the natural dentition, the presence of teeth makes it
easy to determine the relationship of the jaws to each other.
In edentulous patients, the absence of teeth makes it neces-
sary for the dentist to determine and establish the relation-
ship between the jaws.
Classification
Boucher classified maxillomandibular relations into three
groups:
a. Orientation relations.
b. Vertical relations (vertical dimension).
c. Horizontal relations.
Importance
a. In edentulous mouth, above three relations together
help to determine the height of the dentures and the way
they are related to each other.
b. In patients with natural teeth, the teeth determine how the
jaws are related to each other. However, in edentulous
metal plate (central bearing point) to the maxillary. A
screw is turned to adjust vertical relation. The maximum
power point is determined on the spring gauge.
b. Lytle's method (Neuromuscular perception): Using a
central bearing plate and pin, vertical relation is increased
beyond physiologic rest position (the pin is made too
long). The pin is lowered by a half tum at a time until the
patient signifies over closure. The procedure is then re-
versed until the patient signifies that it is just right.
c. Electromyography: Rest position can be determined by
recording the minimal activity of muscles of mastication.
patients, the maxillomandibular relations have to be
established by the dentist.
Q. 2. Physiologic rest position of mandible and its
significance.
Ans.
Physiologic Rest Position
It occurs somewhere downward and slightly forward from
centric relation.
Importance
In this position, the jaw opening and closing muscles are in
tonic balance.
Factors Affecting Jaw Relations
• Tonicity of jaw muscles.
• Position of head (it modifies the effect of gravity).
Physiologic Rest Position Tests
a. Swallow and relax: The patient is asked to swallow and
relax. The lips are parted gently after instructing the
patient to hold the jaws still. There should be 2-4 mm
of space between the rims in the premolar region.
b. Niswonger's method (1934): Two markings are made,
one on the upper lip below the nasal septum, and the
other on the chin. The patient is told to swallow and
relax. The distance between the marks is measured. The
occlusal rims are adjusted until the distance between the
marks is 2-4 mm less during occlusion.
Disadvantage
• The marks move with the skin.

Q. 3. Write about orientation relation in complete denture.
Or
Define orientation relation. Write a note on its impor-
tance in complete denture.
Or
Orientation jaw relation.
Or
Plane of orientation.
Ans.
Orientation Relation
Orientation relation is defined as the jaw relation when the
mandible is kept in the posterior most position. It can rotate
in the sagittal plane around an imaginary transverse axis
passing through or near the condyles.
Recording of orientation jaw relation is done using a
device called face-bow.
Plane of Orientation
• Relationship of maxilla to skull and TMJ is different in
most individuals.
• This can be easily transferred if we relate maxilla to
three points in the skull.
• Two points located posterior to maxilla (posterior ref-
erence points) and one anterior ( anterior reference
point).
• The spatial plane formed by joining the anterior
and posterior reference points is known as plane of
orientation.
Commonly Used Planes of Orientation
• Axis-orbitale plane.
• Frankfort plane.
• Camper's plane.
• Axis-nasion plane.
Anterior Reference Points
By using face-bow, casts can be positioned at any point
between the upper and lower arms of the articulator, be-
cause the face-bow can rotate upward or downward around
the hinge axis of the articulator.
So, a standard is needed which can be used to mount
most casts. Some operators prefer the midway point in the
articulator, whereas, others prefer to orient it according to
anatomical landmarks obtained from the patient.
Quick Review Series for BOS 4th Year: Prosthodontics
Thus, the anterior point of reference determines at what
level in the articulator the occlusal plane is placed or in
other words, it determines the level at which the casts are
mounted.
Commonly used anterior reference points
A. Nasion: Used with Quick Mount face-bow (Whip Mix).
B. Orbitale: Located by Hanau face-bow with the help of
orbital pointer.
C. Orbitale minus 7 mm: This plane represents Frankfort
plane.
D. Ala of Nose: This plane represents Camper's plane.
E. 43 mm superior from lower border of upper lip: (Denar
reference plane
F. Locator: Denar face-bow uses this reference point.
Posterior Reference Points
Terminal hinge axis or opening axis of the jaw is usually
taken as the posterior points. It may be determined ap-
proximately (arbitrarily) or absolutely (kinematically).
Arbitrary method
• By measurement-as mentioned above.
• By palpation-palpation of the TMJ area to locate the
hinge axis, as the patient opens and closes the mouth.
Kinematic method
It is the most accurate method of locating the hinge axis
ithrough the use of a kinematic face-bow.
Commonly used posterior reference points
a. 13 mm from posterior margin of tragus to canthus.
b. 13 mm in front of anterior margin of meatus.
c. 13 mm from foot of tragus to canthus.
d. 10 mm anterior to centre of external auditory meatus
and 7 mm below Frankfurt plane.
e. Ear axis.
Importance
a. In edentulous mouth, above three relations together help
to determine the height of the dentures and the way they
are related to each other.
b. In patients with natural teeth, the teeth determine how
the jaws are related to each. However, in edentulous
patients, the maxillomandibular relations have to be
established by the dentist.
Q. 5. Vertical jaw relationship.
Or
Methods of recording vertical jaw relations.
Or
Section I I Topic Wise Solved Questions of Previous Years

Increased and decreased vertical dimension. e. Tactile sense.

i. Lytle's method (neuromuscular perception).
Or
ii. Boos bimeter (power point).
Effect of incorrect vertical dimensions. iii. Patient's tactile sense as guide.
f. Electromyography.
Ans.

Effects of Decreased Vertical Dimension

Vertical Jaw Relations
a. Decreased chewing efficiency.
It is used to determine the amount of separation be- b. Cheek biting: Flabby cheek tissues get trapped.
tween the two jaws and needs to be established correctly c. Appearance: The chin appears close to nose, lips lose
for the proper comfort, health, and function of the
their fullness, vermilion border is reduced to a line, and
mouth. wrinkles are deepened. Face appears flabby.
Vertical dimension is defined as the distance between d. Angular cheilitis: A deep crease forms at the corner
two selected anatomic or marked points (usually one on the of the mouth. Constant wetness due to saliva leads to
tip of the nose and the other upon the chin), and one on a infection and soreness.
fixed and the other on a movable member. e. TMJ pain, clicking sounds, headaches, etc.
f. Costen's syndrome (now disputed) is due to prolonged
Types over closure.
g. Limited tongue space.
• The rest vertical dimension (RVD) or vertical relation of
rest.
• The occlusal vertical dimension (OVD) or vertical rela- Effects of Increased Vertical Dimension
tion of occlusion.
Excessive vertical height (inadequate freeway space) can
• The difference between RVD and OVD also known as
cause certain problems. They are:
'interocclusal dimension' (IOD) or rest space' or free-
a. Discomfort and annoyance to the patient.
way space'.
b. Trauma to the underlying mucosa.
• Other vertical relations. c. Rapid resorption of alveolar bone.
d. Clicking of teeth.
Methods of Determining Vertical Relation e. Rapid wear of acrylic teeth.
f. Strained face appearance (elongated face).
A. Mechanical methods
g. Difficulty in closing lips.
a. Ridge relations
h. Difficulty in swallowing.
i. Distance from incisive papilla.
ii. Parallelism of the ridges. Q. 6. Face-bow.
b. Measurement of former dentures.
Ans.
c. Pre-extraction records
i. Profile radiographs.
ii. Profile photographs. Face-bow
iii. Articulated casts. Face-bow is a caliper-like instrument used to record the
iv. Lead wire silhouettes. spatial relationship of the maxillary arch to some anatomic
v. Resin facemasks. reference point or points and then transfer this relationship
vi. Facial measurements. to an articulator; and it orients the dental cast in the same
B. Physiologic methods relationship to the opening axis of the articulator.
a. Physiologic rest position tests The face-bow is a caliper-like device that is used to re-
i. Parting the lips after swallowing. cord the relationship of the jaws to the opening axis of the
ii. Niswonger's method. jaws and to orient the casts in this same relationship to the
b. Phonetics opening axis of the articulator.
i. Using the M sound.
ii. Using h, s, and j sounds.
iii. Silverman's closest speaking space. Indications for Face-bow Use
iv. Facial expression. • When balanced occlusion is desired.
c. Facial expression and aesthetics as guides. • When cusps from teeth are used.
d. Swallowing threshold. • When interocclusal check records are used.

• For constructing accurate crowns and bridges.
• In full mouth rehabilitation, when accurate occlusal
restorations are to be made.
• When occlusal, vertical dimension is to be changed
during teeth setting.
• For diagnostic mounting and treatment planning.
• In gnathological studies and treatment.
• For making occlusal corrections after denture processing.
Basic Parts of a Face-bow
The parts of the face-bow are:
• U-shaped frame.
• Condyle rods.
• Bite fork.
• Orbital pointer (optional).
• Locking clamps.
Classification
a. Arbitrary face-bows.
i. Fascia type
ii. Earpiece type
b. Kinematic face-bows.
Advantages of the Face-bow
• Reduces errors in occlusion.
• Permits more accurate programming of the articulator.
• It supports the cast while mounting on the articulator.
• The vertical dimension may be increased or decreased
directly on the articulator without having to make new
centric relation records.
Face-bow Index
• It is a record of the orientation of the maxillary denture or
teeth in relation to the articulator. It is an imprint of the teeth
in plaster. When the denture is replaced into this index, it
reorients the maxillary denture or teeth back into the origi-
nal relation without having to make a new face-bow record.
• It may be made before removing the maxillary cast from the
articulator prior to processing. The denture can be remounted
back on to the articulator with the help of this index.
• A new face-bow index can be made after final occlusal
correction and before delivery of the denture to the pa-
tient. If at any future date, the dentures need to be
returned to the articulator for corrections, then the face-
bow index would be useful for remounting.
Q. 7. Pre-extraction records for complete denture.
Or
Quick Review Series for BOS 4th Year: Prosthodontics
Importance of pre-extraction records.
Ans.
Pre-extraction Records
Following are the pre-extraction records which provide
valuable information about the patient dentition and facial
profile before extraction:
• Profile radiographs: These are made with teeth in occlu-
sion and compared with those made with occlusal rims
in position, but has following disadvantages:
i. Distorted image.
ii. Time-consuming.
iii. Radiation hazards.
• Profile photographs: These can be compared before and
after treatment, but profile angles can change with
change in patient's posture.
• Articulated casts: With teeth in occlusion, measure-
ments are made between stable landmarks, i.e., between
upper and lower frena.
• Lead wire silhouettes: These are adapted to patients
before extraction and outline is transferred to cardboard
as a cut out. After extraction, this cut out is placed
against patient's profile to check vertical relation. It is
not commonly used now.
• Acrylic facemasks (Swenson's technique): It is not a
practical method. Before extraction, it is made using
facial impression and cast.
• Facial measurements:
i. Dakometer: This instrument is positioned on the
bridge of the nose with impression compound and
chin piece is screwed until it touches the chin
front. A spring pressure gauge controls pressure.
An incisor attachment records position of central
incisors. Records are noted and compound nose-
piece preserved for reassembly after extraction.
ii. Willis gauge: One arm contacts the base of the
nose and the other arm is moved along the side,
until it touches the base of the chin. It is not an
accurate method.
iii. Sorensen's profile guide. It is one of the devices for
recording facial measurement.
Q. 8. Centric relation.
Or
Methods of recording centric jaw relation.
Or
Significance of recording centric relation.
Ans.
Section I I Topic Wise Solved Questions of Previous Years
Centric Relation
Centric relation is defined as the maxillomandibular rela-
tionship in which the condyles articulate with the thinnest
avascular portion of their respective disks with the complex
in the anterosuperior position against the shapes of the ar-
ticular eminencies. This position is independent of tooth
contact. This position is clinically discernible when the
mandible is directed superiorly and anteriorly. It is re-
stricted to a purely rotary movement about the transverse
horizontal axis.
Significance of Centric Relation
• Artificial teeth are best set to occlude evenly at centric
relation.
• It is more definite than the vertical relation and is inde-
pendent of the presence or absence of teeth.
• It is recordable and reproducible over a period of time.
• Centric relation serves as a reference for establishing an
occlusion.
• When centric relation and centric occlusion of natural
teeth do not coincide, the periodontal structures around
the teeth are endangered.
• When centric relation and centric occlusion of artificial
teeth do not coincide, there is instability of the dentures
and the patient may experience pain and discomfort.
• Errors in mounting the casts on the articulator can be
detected, when the centric relation is used as the hori-
zontal reference position.
• An accurate centric relation record properly orients the
lower cast to the opening axis of the articulator and the
mandible.
• Accurately recorded centric relation when transferred to
the articulator permits proper adjustments of the condy-
lar guidances for the control of eccentric movements of
the instrument.
Classification of Methods Used for Recording
Centric Relation
a. Tactile or interocclusal check records.
b. Functional (chew-in) methods
i. Needle-House method.
ii. Patterson's method.
iii. Meyer's method.
c. Graphic methods (Excursive method).
i. lntraoral tracing.
ii. Extraoral tracing.
d. Terminal hinge axis method.
e. Other methods
i. Strips of celluloid placed between the rims.
ii. Heating the surface of one of the rim.
iii. Deep heating or pooling method.
iv. Soft wax is placed over the occlusal surfaces of
mandibular posterior teeth.
v. Soft cones of wax placed on the lower denture bases.
Q. 9. Gothic arch tracing.
Ans.
Gothic Arch Tracing
• It is also known as Arrow point tracer or Height tracer.
• The tracings obtained resemble a gothic arch or an
arrow point.
Uses
a. It is used to verify or confirm centric relation obtained
by other methods.
b. It is also used to obtain protrusive and lateral records.
Attaching the Tracing Devices
Prior to using a tracing device, the occlusion rims are
mounted on an articulator using a tentative centric relation
record (using an interocclusal check record). The tracing
devices are attached to the occlusion rims, while they are on
the articulator.
Types
a. Intraoral (arrow points posteriorly).
b. Extraoral (arrow points anteriorly).
Tracing assembly: The tracing assembly consists of a trac-
ing table and a stylus. The stylus traces the Gothic arch on
to the tracing table.
Extraoral tracer: The tracing assembly is located outside the
mouth.
Intraoral tracer: It is located inside the mouth.
Central bearing device: It consists of a small fixed ball and
a plate. They are located inside the mouth between the up-
per and the lower occlusion rims. They help maintain the
vertical relation, while the patient performs the mandibular
movements.
Q. 10. Mention about training the patient to retrude
mandible.
Ans.
Methods of assisting the patient to retrude the mandible:
The patient may be instructed to
a. Let the jaw relax, pull it back and close slowly on the
back teeth.
b. Push the upper jaw out and close the back teeth.
c. Protrude and retrude the mandible repeatedly, while
patient hold a finger lightly against the chin.

d. Boos stretch-relax exercises: Open wide and relax,
move the jaws to the left and relax, right and relax, and
forward and relax. This helps the patient to coordinate
movements and follow the dentist's instructions.
e. Roll the tongue backwards towards posterior border of
upper denture and close the rims until they meet.
f. Swallow and close: The disadvantage is that a patient
can swallow in slight eccentric positions also.
g. Tapping rims together rapidly and repeatedly.
SHORT NOTES
Q. 1. Describe the importance of marking the midline
canine-line and the high line during jaw relation.
Ans.
• Midline is marked for bilateral symmetry.
• Canine-line determines the space for setting the anterior
teeth that is central, lateral incisors and canine.
• High line refers to upper lip line, while smiling about
2 mm of incisal edge of upper teeth should be exposed.
At rest, upper lip border should cover 1-2 mm of incisal
edge of lower teeth.
• These lines aid in making jaw relation record and are
marked prior to jaw relation.
Q. 2. Vertical jaw relation.
Or
Problems with reduced vertical dimension in complete
dentures.
Ans.
Vertical Jaw Relation
Vertical jaw relation is defined as the distance between two
selected anatomic or marked points (usually one on the tip
of the nose and the other upon the chin), and one on a fixed
and the other on a movable member.
Effects of Decreased Vertical Dimension
are as follows:
• Decreased chewing efficiency.
• Cheek biting: Flabby cheek tissues get trapped.
• Appearance: The chin appears close to nose, lips lose
their fullness, vermilion border is reduced to a line, and
wrinkles are deepened. Face appears flabby.
• Angular cheilitis: A deep crease forms at the corner of
the mouth. Constant wetness due to saliva leads to in-
fection and soreness.
• TMJ pain, clicking sounds, headaches, etc.
• Costen's syndrome (now disputed) is due to prolonged
over closure.
• Limited tongue space.
Quick Review Series for BOS 4th Year: Prosthodontics
h. Tilting the head backwards tends to pull the mandible
backwards, because of tension on the infrahyoid
muscles.
i. Massaging or palpation of the temporalis and masseter
muscles to relax them. In the terminal hinge position,
closing the mandible tenses the temporalis muscle
which can be felt by the dentist.
j. The dentist can also assist and guide in retruding, using
fingers placed on the sides of the lower rims.
Q. 3. State the consequences of increased vertical rela-
tion recording in complete denture.
Or
Increased vertical relation.
Or
Enumerate characteristics of increased vertical relation
in complete denture patient.
Or
Effects of increased vertical dimension.
Ans.
Increased Vertical Dimension
Excessive vertical height (inadequate freeway space) can
cause certain problems. They are:
• Discomfort and annoyance to the patient.
• Trauma to the underlying mucosa.
• Rapid resorption of alveolar bone.
• Clicking of teeth.
• Rapid wear of acrylic teeth.
• Strained face appearance (elongated face).
• Difficulty in closing lips.
• Difficulty in swallowing.
Q. 4. Freeway space.
Or
Interocclusal distance.
Ans.
lnterocclusal Rest Space (lnterocclusal
Distance, IOD)
It is also known as freeway space or interocclusal distance.
It is the difference between the rest vertical relation and the
occlusal-vertical relation.
In natural teeth, this distance is 1-8 mm.
In complete dentures, it is 2--4 mm at the premolar re-
gion tolerated well by most patients.
Section I I Topic Wise Solved Questions of Previous Years

Importance Centric jaw relation records.

An adequate interocclusal rest space is necessary for the Or

comfort of the patient, health of the tissues, and for proper
functioning of the dentures. Define centric relation. Write various methods for
assisting the patient to retrude the mandible during
Q. 5. Enumerate the various methods of determining
centric relation registration.
vertical relation of occlusion.
Ans.
Ans.

Methods of Determining Vertical Relation Centric Relation

Mechanical Methods Centric relation is defined as the maxillomandibular rela-
tionship in which the condyles articulate with the thinnest
a. Ridge relations avascular portion of their respective disks with the complex
i. Distance from incisive papilla.
in the anterosuperior position against the shapes of the
ii. Parallelism of the ridges.
articular eminencies. This position is independent of tooth
b. Measurement of former dentures. contact. This position is clinically discernible, when the
c. Pre-extraction records
mandible is directed superiorly and anteriorly. It is
i. Profile radiographs.
restricted to a purely rotary movement about the transverse
ii. Profile photographs.
horizontal axis
iii. Articulated casts.
iv. Lead wire silhouettes.
v. Resin facemasks. Classification of Methods Used for Recording
vi. Facial measurements. Centric Relation
a. Tactile or interocclusal check records.
Physiologic Methods b. Functional (chew-in) methods.
a. Physiologic rest position tests c. Graphic methods (Excursive method).
i. Parting the lips after swallowing. d. Terminal hinge axis method.
ii. Niswonger's method. e. Other methods.
b. Phonetics
i. Using the M sound.
Methods of Assisting the Patient to Retrude the
ii. Using h, s, and j sounds.
Mandible
iii. Silverman's closest speaking space.
iv. Facial expression. The patient may be instructed to
c. Facial expression and aesthetics as guides. a. Let the jaw relax, pull it back and close slowly on the
d. Swallowing threshold. back teeth.
e. Tactile sense. b. Push the upper jaw out and close the back teeth.
i. Lytle's method (neuromuscular perception). c. Protrude and retrude the mandible repeatedly, while
ii. Boos bimeter (power point). patient holds a finger lightly against the chin.
iii. Patient's tactile sense as guide. d. Boos stretch-relax exercises: Open wide and relax,
f. Electromyography. move the jaws to the left and relax, right and relax, and
forward and relax. This helps the patient to coordinate
Q. 6. Niswonger's method of establishing vertical relation.
movements and follow the dentist's instructions.
Ans. e. Roll the tongue backwards towards posterior border of
upper denture and close the rims until they meet.
Niswonger's method (1934): In this method, two markings
f. Swallow and close: The disadvantage is that a patient
are made, one on the upper lip below the nasal septum, and
can swallow in slight eccentric positions also.
the other on the chin. The patient is told to swallow and
g. Tapping rims together rapidly and repeatedly.
relax. The distance between the marks is measured. The
h. Tilting the head backwards tends to pull the mandible
occlusal rims are adjusted, until the distance between the
backwards, because of tension on the infrahyoid muscles.
marks is 2-4 mm less during occlusion.
i. Massaging or palpation of the temporalis and masseter
Disadvantage: The marks move with the skin. muscles to relax them. In the terminal hinge position,
closing the mandible tenses the temporalis muscle
Q. 7. Define centric relation. Write in brief about
which can be felt by the dentist.
different methods to record it.
j. The dentist can also assist and guide in retruding using
Or fingers placed on the sides of the lower rims.
 Quick Review Series for BOS 4th Year: Prosthodontics

Q. 8. Interocclusal clearance. Hinge axis

Ans. • Hinge axis is also known as transverse horizontal
axis.
Interocclusal rest space (Interocclusal distance, IOD) is
• It is an imaginary line around which the mandible may
also known as Freeway space or Interocclusal distance.
rotate within the sagittal plane.
It is the difference between the rest vertical relation and
• It runs horizontally from the right side on the mandible
the occlusal verticalrelation.
to the left.
In natural teeth, this distance is 1-8 mm.
• Rotation around this axis is seen during protrusive
In complete dentures, it is 2-4 mm at premolar region
movements.
tolerated well by most patients.
• This transverse axis varies during different phases of
Importance protrusive movement.
An adequate interocclusal rest space is necessary for the • Initial mouth opening passes through head of condyle.
comfort of the patient, health of the tissues, and for proper • Later stage of mouth opening passes through mandibu-
functioning of the dentures. lar foramen.
Q. 9. Physiological rest position of mandible.
• It is determined by kinematic face-bow accurately.
Q. 12. Perleche.
Or
Ans.
Rest position of mandible.
• Also known as angular cheilitis.
Or
• It is a deep crease formed at the corner of the mouth.
Significance of rest position of mandible. Constant wetness due to saliva leads to infection and
soreness.
Ans.
• Corners of mouth are moist and drooping.
• Fungal infection is seen at the folds.
Physiologic Rest Position • This condition is seen cases of decreased vertical
dimension and also in cases of vitamin deficiency or
It occurs somewhere downward and slightly forward from
secondary to fungal (Candida) infection in the mouth.
centric relation.
Q. 13. Beyron's point?
Importance Ans.
In this position, the jaw opening and closing muscles are in
tonic balance. Beyron's Point
Factors affecting are: • A posterior reference point-arbitrary terminal hinge
• Tonicity of jaw muscles. axis/opening axis of the jaw taken while determining
• Position of head (it modifies the effect of gravity). the plane of orientation.
• It is located 13 mm from posterior margin of tragus to
Q. 10. Closest speaking space.
canthus.
Or • It gives 98% accuracy.
• It was given by Beyron.
Silverman's speaking space.
Q. 14. Freeway importance.
Ans.
Ans.
The closest speaking space establishes vertical relation
when the jaws are in the function of speech. Freeway is also known as interocclusal rest space (Interoc-
Pound and Murrell's technique: Using 'f', 'v', and 's' clusal distance, IOD)
sounds and speaking wax, the positions of the upper and It is the difference between the rest vertical relation and
lower anterior teeth are established. the occlusal vertical relation.
In natural teeth, this distance is 1-8 mm.
Q. 11. Hinge axis.
In complete dentures, it is 2-4 mm at premolar region
Ans. tolerated well by most patients.
Section I I Topic Wise Solved Questions of Previous Years
Importance
An adequate interocclusal rest space is necessary for the
comfort of the patient, health of the tissues, and for proper
functioning of the dentures.
Q. 15. Orientation jaw relation.
Ans.
Orientation Jaw Relation
Orientation jaw relation is defined as the jaw relation when
the mandible is kept in the posterior most position. It can
rotate in the sagittal plane around an imaginary transverse
axis passing through or near the condyles.
Recording of orientation jaw relation is done using a
device called face-bow.
Plane of Orientation
Relationship of maxilla to skull and TMJ is different in
most individuals.
This can be easily transferred if we relate maxilla to
three points in the skull.
Two points located posterior to maxilla (posterior refer-
ence points) and one anterior (anterior reference point).
The spatial plane formed by joining the anterior and
posterior reference points is known as plane of orientation.
Q. 16. Importance of pre-extraction records.
Ans.
Importance of Pre-extraction Records
They provide valuable information about the patient denti-
tion and facial profile before extraction.
a. Profile radiographs: These are made with teeth in occlu-
sion and compared with those made with occlusal rims
in position, but has following disadvantages:
i. Distorted image.
ii. Time-consuming.
iii. Radiation hazards.
b. Profile photographs: The can be compared before and
after treatment, but profile angles can change with
change in patient's posture.
c. Articulated casts: With teeth in occlusion, measure-
ments are made between stable landmarks, i.e., between
upper and lower frena.
d. Lead wire silhouettes: These are adapted to patients
before extraction and outline is transferred to cardboard
as a cut out. After extraction, this cut out is placed
against patient's profile to check vertical relation. It is
not commonly used now.
e. Acrylic facemasks (Swenson's technique): It is not a
practical method. Before extraction, it is made using
facial impression and cast.
f. Facial measurements:
i. Dakometer: This instrument is positioned on the
bridge of the nose with impression compound and
chin piece is screwed, until it touches the chin front.
A spring pressure gauge controls pressure. An inci-
sor attachment records position of central incisors.
Records are noted and compound nosepiece pre-
served for reassembly after extraction.
ii. Willis gauge: One arm contacts the base of the nose and
the other arm is moved along the side, until it touches
the base of the chin. It is not an accurate method.
iii. Sorensen's profile guide: It is one of the devices for
recording facial measurement.
Q. 17. Needle's chew-in technique.
Ans.
Functional Method of Recording Centric
Relation
Needle-House method: Four metal styli fixed in the com-
pound maxillary rim carve four diamond-shaped tracings in
the mandibular rim, as the mandible is moved through
various excursive movements. The records can be trans-
ferred only to a Needle-House articulator.
Q. 18. Overjet and overbite.
Ans.
Overjet
It is the horizontal overlap of the maxillary and mandibular
anterior teeth. In normal class 1 relationship, the mandibular
incisors are located 2-4 mm behind the maxillary incisors.
Overbite
It is the vertical overlap between maxillary and mandibular
anterior teeth. Adequate overbite is required for aesthetics.
If excessive, then it can resist anterior movement of
denture, causing dislodgement.
Normal value is 2-4 mm.
Q. 19. Occlusal rims for construction of complete
dentures.
Ans.
Occlusal Rim
It is also known as record rim or bite rim.
Definition
Occlusal rims are occluding surfaces fabricated on
interim or final denture bases for the purpose of making

maxillomandibular relationship records and for arrang-
ing teeth.
Uses
a. To determine lip support and facial aesthetics.
b. To determine arch form and plane of occlusion.
--------------------<( Topic 7)
Lab Procedures Prior to Try-in
LONG ESSAYS
Q. 1. What is balanced occlusion? What are the laws of
articulation of developing balanced occlusion in com-
plete denture prosthesis?
Or
What is balanced articulation? Mention its importance/
rationale. Describe the factors responsible for balanced
articulation in complete dentures.
Or
Define balanced occlusion. Enumerate the advantages
of a balanced occlusion. Describe any two factors that
affect a protrusive balance.
Or
What is balanced occlusion and how do you establish it,
while fabricating a complete denture?
Ans.
Balanced Occlusion
'The simultaneous contacting of the maxillary and man-
dibular teeth on the right and the left and in the posterior
and the anterior occlusal areas in centric and eccentric posi-
tions, developed to lessen or limit tipping or rotating of the
denture bases in relation to the supporting structures'.
Importance/Rationale
• It is one of the most important factors that affect denture
stability.
• Absence of it will result in leverage of the denture during
mandibular movement.
Quick Review Series for BOS 4th Year: Prosthodontics
c. To establish the teeth size and position.
d. To establish the contour of polished surface.
e. For tentative establishment, i.e., for recording and
transfer of jaw relations.
f. To know the patient's response to denture-like
form.
g. For arrangement of artificial teeth.
• More important during parafunctional movements to
maintain denture stability.
Factors responsible for balanced articulation in complete
dentures or laws of articulation of developing balanced
occlusion are as follows:
a. Condylar guidance.
b. lncisal guidance.
c. Compensating curves.
d. Relative cusp height.
e. Plane of orientation of the occlusal plane.
Condylar Guidance
• First factor of occlusion.
• Only factor which can be recorded from the patient.
• Registered using protrusive registration. The patient is
asked to protrude with the occlusal rims.
• lnterocclusal record material is injected between the oc-
clusal rims in this position. The occlusal rims with inter-
occlusal record are transferred to the articulator. Since
the occlusal rims are in a protrusive relation, the upper
member of the articulator is moved back to accommo-
date them.
• Interocclusal record is carefully removed and the upper
member is allowed to slide forward to its original posi-
tion. The condylar guidance should be adjusted or rotated
till the upper member slides freely into position. It is
transferred to the articulator as the condylar guidance.
• Increase in the condylar guidance increases the jaw
separation during protrusion.
• This factor cannot be modified. All the other four factors
of occlusion should be modified to compensate the
effects of this factor.
Section I I Topic Wise Solved Questions of Previous Years
• In patients with steep condylar guidance, the incisal
guidance should be decreased to reduce the amount of
jaw separation produced during protrusion and vice
versa. But, it should be remembered that the incisal
guidance cannot be made very steep, because it has its
own ill effects.
lncisal Guidance
It is defined as 'the influence of the contacting surfaces
of the mandibular and the maxillary anterior teeth on
mandibular movements' (GPT).
• It is the second factor of occlusion.
• It is determined by the dentist and customized for patient
during anterior try-in.
• It acts as a controlling path for the movement of casts in
an articulator.
• It should be set depending upon the desired overjet and
overbite planned for the patient. If the overjet is in-
creased, then the inclination of the incisal guidance is
decreased. If the overbite is increased, then the incisal
inclination increases.
• The incisal guidance has more influence on the poste-
rior teeth than the condylar guidance, because the action
of the incisal inclination is closer to the teeth than the
action of the condylar guidance.
• During protrusive movements, the incisal edge of
the mandibular anterior teeth move in a downward and
forward path corresponding to the palatal surfaces of the
upper incisors. This is known as the protrusive incisal
path or incisal guidance. The angle formed by this
protrusive path to the horizontal plane is called as the
protrusive incisal path of inclination or the incisal guide
angle.
• It influences the shape of the posterior teeth. If the inci-
sal guidance is steep, then steep cusps or a steep occlusal
plane or a steep compensatory curve is needed to pro-
duce balanced occlusion
• In a complete denture, the incisal guide angle should be
as flat (more acute) as possible.
• The incisal guidance cannot be altered beyond limits.
The location and angulation of the incisors are gov-
erned by various factors like aesthetics, function, and
phonetics etc.
Compensating Curve
It is 'The anteroposterior and lateral curvatures in the
alignment of the occluding surfaces and incisal edges of
artificial teeth which are used to develop balanced occlu-
sion' (GPT).
• It is an important factor for establishing balanced occlu-
sion and determined by the inclination of the posterior
teeth and their vertical relationship to the occlusal plane.
• The posterior teeth should be arranged such that their
occlusal surfaces form a curve which should be in har-
mony with the movements of the mandible guided
posteriorly by the condylar path.
• A steep condylar path requires a steep compensatory
curve to produce balanced occlusion otherwise there will
be loss of balancing molar contacts during protrusion.
There are two types of compensating curves, namely:
i. Anteroposterior Compensating curves.
ii. Lateral compensating curves.
Curve of Spee, Wilson's curve, and Manson's curve are
associated with natural dentition. In complete dentures,
compensating curves similar to these curves should be
incorporated to produce balanced occlusion.
i. Anteroposterior compensating curves
These are compensatory curves running in an anteroposte-
rior direction. They compensate for the curve of Spee seen
in natural dentition.
Compensating curve for curve of Spee
• Curve of Spee is defined as, 'Anatomic curvature of
the occlusal alignment of teeth beginning at the tip of the
lower canine and following the buccal cusps of the natu-
ral premolars and molars, and continuing to the anterior
borderofthe ramus as described by Grafvon Spee'(GPT).
• It is an imaginary curve joining the buccal cusps of the
mandibular posterior teeth starting from the canine
passing through the head of the condyle.
• It is seen in the natural dentition and should be repro-
duced in a CD.
• The significance of this curve is that when the patient
moves his mandible forward, the posterior teeth set on
this curve will continue to remain in contact. If the
teeth are not arranged according to this curve, there
will be disocclusion during protrusion of the mandible
(Christensen's phenomenon).
ii. Lateral compensating curves
These curves run transversely from one side of the arch to
the other. The following curves fall in this category:
Compensating curve for Manson's curve
It is 'The curve of occlusion in which each cusp and incisal
edge touches or conforms to a segment of a sphere of
8 inches in diameter with its centre in the region of the
Glabella' (GPT).
This curve runs across the palatal and buccal cusps of
the maxillary molars.
• During lateral movement, the mandibular lingual cusps
on the working side should slide along the inner inclines
of the maxillary buccal cusp. In the balancing side,
the mandibular buccal cusps should contact the inner

inclines of the maxillary palatal cusp. This relationship
forms a balance, only if the teeth are set following the
Manson's curve, then there will be lateral balance of
occlusion.
Compensating curve for anti-Monson or Wilson's
curve
It is 'A curve of occlusion which is convex upwards' (GPT).
• This curve runs opposite to the direction of the Manson's
curve.
• It is followed when the first premolars are arranged, so
that they do not produce any interference to lateral
movements.
Reverse curve
It is 'A curve of occlusion which in transverse cross-section
conforms to a line which is convex upward' (GPT).
• It improves the stability of the denture.
• It is explained in relation to mandibular posterior
teeth.
• The reverse curve was modified by Max. Pleasure to
form the pleasure curve.
Pleasure curve
It is 'A curve of occlusion which in transverse cross-section
conforms to a line which is convex upward except for the
last molars' (GPT).
• It was proposed by Max. Pleasure to balance the occlusion
and increase the stability of the denture.
• Here, the first molar is horizontal and the second pre-
molar is buccally tilted.
• The second molar independently follows the anteropos-
terior compensating curve and is lingually tilted.
• This curve runs from the palatal cusp of the first premolar
to the distobuccal cusp of the second molar.
• The second molar gives occlusal balance and the second
premolar gives lever balance.
a. Relative cusp height
Cuspal angulation
It is 'The angle made by the average slope of a cusp with
the cusp plane measured mesiodistally or buccolingually'
(GPT).
• The mesiodistal cusps which lock the occlusion and
repositioning of teeth do not occur due to settling of
denture base.
• To prevent the above, the mesiodistal cusps are reduced
during occlusal reshaping. In the absence of mesiodistal
cusps, the buccolingual cusps are considered as a factor
for balanced occlusion.
• Shallow overbite cases: The cuspal angle should be re-
duced to balance the incisal guidance, so that the jaw
separation will be less. Teeth with steep cusps will pro-
duce occlusal interference in these cases.
Quick Review Series for BOS 4th Year: Prosthodontics
• Deep bite (steep incisal guidance): The jaw separation
is more during protrusion. Teeth with high cuspal in-
clines are required in these cases to produce posterior
contact during protrusion.
Protrusive balanced occlusion
• It is present when mandible moves in a forward direction
and the occlusal contacts are smooth and simultaneous
anteriorly and posteriorly.
• There should be at least three points of contact in the
occlusal plane. Two located posteriorly and one located
in the anterior region. This is absent in natural dentition.
Factors that govern protrusive balance are:
• The inclination of the condylar path recorded on the
patient represents the path travelled by the condyle in
protrusion, which is modified by the combined action of
all the tissues in the temporomandibular joint and the
ridges covered by the recording bases.
• Angle of the incisal guidance chosen for the patient.
• Angle of the plane of occlusion.
• The compensating curves chosen for orientation with
the condylar path and the incisal guidance.
• Cuspal height and inclination of the posterior teeth.
b. Plane of occlusion or occlusal plane
It is 'An imaginary surface which is related anatomically to
the cranium and which theoretically touches the incisal edges
of the incisors and the tips of the occluding surfaces of the
posterior teeth. It is not a plane in the true sense of the word,
but represents the mean curvature of the surface' (GPT).
• It is established anteriorly by the height of the lower
canine, which nearly coincides with the commissure of
the mouth.
• It is established posteriorly by the height of the retromo-
lar pad. It is usually parallel to the ala-tragus line or
Camper's line.
• It can be slightly altered. Tilting the plane of occlusion
beyond 10° is not advisable.
Q. 2. What is an articulator? Classify articulator and
write uses and requirements of an articulator.
Or
Define articulator. Discuss the advantages, disadvan-
tages, and classification of articulators.
Or
What is an articulator? Give the classification, functions,
and requirements of an articulator.
Or
Define articulators. Give classification, uses of articulator,
and discuss in detail about a semi-adjustable articulator.
Ans.
Section I I Topic Wise Solved Questions of Previous Years
Articulator
Articulator is 'A mechanical device which represents the
temporomandibular joints and the jaw members to which
maxillary and mandibular casts may be attached to simulate
jaw movements' (OPT).
Uses of an Articulator
• To diagnose the state of occlusion in both the natural
and artificial dentitions.
• To plan dental procedures based on the relationship
between opposing natural and
artificial teeth, e.g., in evaluation of the possibility of
balanced occlusion.
• To aid in the fabrication of restorations and prosthodon-
tic replacements.
• To correct and modify completed restorations.
• To arrange artificial teeth.
Requirements of an Articulator
Minimal requirements
• It should hold casts in the correct horizontal relationship.
• The incisal guide table should be customizable and
allow modification.
• It should hold casts in the correct vertical relationship.
• The cast should be easily removable and reattachable.
• It should provide a positive anterior vertical stop
(incisal pin).
• It should accept face-bow transfer record using an anterior
reference point.
• It should open and close in a hinge movement.
• It should be made of non-corrosive and rigid materials
that resist wear and tear.
• It should not be bulky or heavy.
• There should be adequate space present between the
upper and lower members.
• The moving parts should move freely without any
friction.
• The non-moving parts should be of a rigid articulator's
construction.
Additional requirements
• The condylar guides should allow protrusive and lateral
jaw motion.
• The condylar guide should be adjustable in a horizontal
direction.
• The articulator should be adjustable to accept and alter
the Bennett movement.
Advantages of Articulators
• Properly-mounted casts allow the operator to visualize
the patient's occlusion, especially from the lingual view.
• Patient cooperation is not a factor when using an articu-
lator once the appropriate interocclusal records are
obtained from the patient.
• The refinement of complete denture occlusion in the
mouth is extremely difficult, because of shifting den-
ture bases and resiliency of the supporting tissues.
This difficulty is eliminated when articulators are
used.
• Reduced chair time and patient's appointment time.
• The patient's saliva, tongue, and cheeks are not factors
when using an articulator.
Disadvantages of Articulators
• Metal articulators show errors in tooling (manufacture)/
errors resulting from metal fatigue.
• The articulator may not exactly simulate the intraborder
and functional movements of the mandible.
• Errors in jaw relation procedures are reproduced as
errors in denture occlusion. Articulators do not have any
provision to correct these errors.
Classification of Articulators
The most popular methods of classifying are:
a. Based on the theories of occlusion.
b. Based on the type of interocclusal record used.
c. Based on the ability to simulate jaw movements.
d. Based on the adjustability of the articulator.
a. Based on the theories of occlusion
i. Bonwill theory of articulator
• It was designed by WGA Bonwill.
• According to the Bonwill's theory of occlusion, teeth
move in relation to each other as guided by the condylar
and the incisal guidances.
• It is also known as the Theory of equilateral triangle.
The distance between the condyles is equal to the dis-
tance between the condyle and the midpoint of the
mandibular incisors (incisal point).
• An equilateral triangle is formed between the two con-
dyles and the incisal point and the dimension of the
equilateral triangle is 4 inches.
• This articulator allows lateral movement and permits
the movement of the mechanism (joint) only in the
horizontal plane.
ii. Conical theory of articulators (proposed by
RE Hall)
• It was proposed that the lower teeth move over the
surfaces of the upper teeth as over the surface of a cone,
generating an angle of 45° with the central axis of the
cone tipped 45° to the occlusal plane, e.g., the Hall
automatic articulator is designed by RE Hall.

iii. Spherical theory articulators
• It was proposed that lower teeth move over the surface
of upper teeth as over a surface of sphere with a diam-
eter of 8 inches.
• The centre of the sphere was located in the region
of glabella. The surface of the sphere passed through
the glenoid fossa and along with the articulating
eminences, e.g., the articulator devised by GS
Monson.
Disadvantages of articulators based on theory of occlu-
sion are:
• These articulators are based on theoretical concepts and
no provision for variations from the theoretical relation-
ships that occur in different persons is provided.
b. Based on the type of record used for their
adjustment
Based on the type of record accepted by the articulator, they
are classified as:
i. lnterocclusal record adjustment
• Most articulators are adjusted by some kind of
interocclusal records.
• These records are made of base plate wax, plaster of
Paris, zinc oxide eugenol paste, or cold-cure acrylic
resin.
ii. Graphic record adjustment
• It consists of records of the extreme border positions of
mandibular movements.
• These articulators are capable of accurately reproducing
the border movements of the mandible.
• The face-bow and jaw-writing apparatus (pantograph)
can be attached to transfer the records.
• Hinge axis location for adjusting articulators: A transo-
graphic record can be used to record the accurate location
of the hinge axis in an articulator.
c. Based on the ability to simulate jaw movements
This is the most widely used classification.
At the International Prosthodontic Workshop on com-
plete denture occlusion at the University of Michigan in
1972, the articulators were classified based on the instru-
ment's capability, intent, recording procedure, and record
acceptance.
Class I
• Simple articulators capable of accepting a single static
registration.
• Only vertical motion is possible.
• These articulators are used in cases where a tentative
jaw relation is done, e.g., Slab articulator and Barn door
articulator.
Quick Review Series for BOS 4th Year: Prosthodontics
Class II
• They permit horizontal and vertical movements, but do
not orient the movement to TMJ with a face-bow.
• Type A: Limited eccentric motion is possible based on
the average values, e.g., mean-value articulator.
• Type B: Limited eccentric motion is possible based on
theories of arbitrary motion, e.g., Manson's articulator
and Hall's articulator.
• Type C: Limited eccentric motion is possible based
on engraving records obtained from the patient, e.g.,
House's articulator.
Class Ill
• These articulators permit horizontal and vertical move-
ments.
• They do accept face-bow transfer, but this facility is
limited.
• They cannot allow total customization of condylar path-
ways.
• These instruments simulate condylar pathways by using
average or mechanical equivalents for the whole or part
of the condylar motion.
• Type A: It accepts static protrusive registration and use
equivalents for other types of motion, e.g., Hanau H,
Hanau II, and Bergstorm articulator.
• Type B: It accepts static lateral protrusive registration
and use equivalents for other type of motion, e.g., Pana-
dent, trubite, and Teledyne Hanau university series.
Class IV
• These articulators accept three-dimensional dynamic
registrations.
• They are capable of accurately reproducing the condylar
pathways for each patient.
• They allow point-orientation of the casts using a face-
bow transfer.
• Type A: The condylar path is determined by the engraving
registrations produced by the patient. This path cannot be
modified, e.g., TMJ articulator.
• Type B: They are similar to type A, but they allow angu-
lations and customization of the condylar path, e.g.,
Stuart instrument gnathoscope.
d. Based on the adjustability of the articulator
It is classified as:
• Non-adjustable.
• Semi-adjustable.
• Fully-adjustable.
Non-adjustable articulators
• They can open and close in a fixed horizontal axis.
• They have a fixed condylar path along which the condy-
lar ball can be moved to simulate lateral and protrusive
jaw movement.
Section I I Topic Wise Solved Questions of Previous Years
• The incisal guide pins ride on an inclined plate in a fixed
inclination.
Semi-adjustable articulators
• They have adjustable horizontal condylar paths, adjust-
able lateral condylar paths, adjustable incisal guide
tables, and adjustable intercondylar distances.
• Degree and ease of these adjustments differ.
Two types of semi-adjustable articulators are:
Arcon articulators
• The term was derived by Bergstorm from the words ar-
ticulator and condyle, e.g., Hanau University series and
Whip-mix articulators.
• Condylar element attached to lower member and condy-
lar guidance to upper member of articulator.
• Resemble TMJ.
• Advantages: Face-bow transfer. Occlusal plane and re-
lationships of opposing casts are preserved when articu-
lator is opened or closed.
Non-arcon articulators
• These have condylar elements attached to upper mem-
ber and condylar guidance to lower member.
• Reverse of TMJ, e.g., Hanau H Series, Dentatus, and
Gysi.
Fully adjustable articulators
• These are capable of being adjusted to follow the man-
dibular movement in all directions.
• These have numerous adjustable readings, which can be
customized for each patient.
• These do not have the condylar guidance. Instead, they
have receptacles in which acrylic dough can be contoured
to form a customized condylar and incisal guidance.
• These are complex and are not commonly used,
e.g., Stuart instrument gnathoscope, simulator by
E Granger.
Q. 3. Write in detail the procedures involved in selection
of anterior teeth in complete denture patient.
Or
What are the factors for the selection of anterior teeth
for a complete denture patient?
Or
Define denture aesthetics and discuss the various factors
influencing denture aesthetics.
Or
Discuss the physical and biological factors involved in
selection of teeth for complete denture construction in
edentulous patient.
Or
Discuss the principles of arrangement of artificial teeth
in complete denture prosthesis.
Or
Selection of anterior and posterior teeth in complete
denture.
Or
Dentogenic concept.
Or
Shade selection.
Ans.
Anterior Teeth Selection
• Anterior teeth play an important role in aesthetics of a
patient. They are not subjected to heavy occlusal load
like the posteriors. Hence, aesthetics is given more
importance during anterior teeth selection.
• The following factors are also considered during the
selection of anterior teeth:
A. Size of the teeth.
B. Form of the teeth.
C. Colour/shade of the teeth.
A. Size of the Anterior Teeth
• The tooth size should be appropriate to the size of the
face and sex of the patient. The following methods are
used as a guide to select the size of the teeth:
i. Methods using pre-extraction records.
ii. Methods using anthropological measurements of
the patient.
iii. Methods using anatomical landmarks.
iv. Methods using theoretical concepts.
v. Other factors.
i. Methods using pre-extraction records
• Like diagnostic casts, photographs, and radiographs,
the teeth of close relatives and preserved extracted
teeth can be used to determine the size of the artificial
teeth.
• Diagnostic casts
i. They are prepared before the extraction of the teeth.
ii. They provide an idea about the size and shape of the
teeth.
iii. The actual size and shape required can be determined,
but the shade of the teeth cannot be determined using
this method.
• Pre-extraction photographs: The lateral, anterior, and
anterolateral views of the patient should be taken before
extraction. These photographs must show at least the

incisal edges of the anterior teeth. This method is useful
to determine the exact width and outline of the teeth.
• Pre-extraction radiographs: They are usually obtained
from the patient's previous dentist. Radiographic errors
are a major limitation to this method. The occluso-gingival
height and the outline of the teeth can be recorded. But the
contour and size cannot be accurately determined, as the
radiograph is a two-dimensional image.
• Teeth of close relatives: This method is usually followed
only if the other records are not available. The size and
contour of the patient's son or daughter's tooth is taken
as reference.
• Preserved extracted teeth: This is the best method to
determine the size of the anterior tooth. The exact de-
tails about the size and contour can be recorded from
this method.
ii. Methods using anthropological measurements of
the patient
• These are post-extraction records made directly from
the edentulous patient which measure certain anatomi-
cal dimensions and derive the size of the teeth using
certain formulae.
• Anthropometric cephalic index: The transverse circum-
ference of the head is measured using a measuring tape
at the level of the forehead. The width of the upper cen-
tral incisor can be derived from this measurement. Sears
called this formula as the anthropometric cephalic
index.
Width of upper central incisor = Circumference of the
head/13
• The bizygomatic width can be used to determine the
width of the central incisor and also the combined width
of the anteriors. The bizygomatic width is the distance
measured between the malar prominences on either
side. This measurement is also used in Berry's Biomet-
ric index and in H. Pound's formulae.
Total width ofupper anteriors= Bizygomatic width/3.36
Total width of lower anteriors = 4/5 the width of upper
anteriors
• Berry's biometric index: Berry's biometric index is used
to derive the width of the central incisor using the
bizygomatic width and/or the length of the face. The
formula using the length of the face cannot be used for
edentulous patients. The length of the face is the distance
measured between the hairline and the tip of the chin.
Width of the maxillary central incisor = Bizygomatic
width/16
Width of the maxillary central incisor = Length of the
face/20
• Based on the size of the face: This is a tentative mea-
surement in which the size of the teeth is determined by
the size of the face. For example, large teeth are selected
for patients with a large face.
Quick Review Series for BOS 4th Year: Prosthodontics
• H. Pound's formula: Pound derived two formulae to
determine the width and length of the central incisor
using the bizygomatic width and the length of the face,
respectively.
Width of the maxillary central incisor = Bizygomatic
width/16
Length of the maxillary central incisor = Length of
theface/16
• Based on the width of the nose: The width of the nose is
measured with a vernier calliper. This measurement
is transferred to the occlusal rim. The width of the nose
is equal to the combined width of the anterior teeth.
iii. Methods using anatomical landmarks
Various anatomical landmarks like the size of the maxillary
arch and location of the canine eminences, buccal frenal
attachments, corners of the mouth, and ala of the nose can
be used to determine the size of the artificial teeth.
• Size of the maxillary arch: The distance between the
incisive papilla and the hamular notch on one side is
added with the distance between two hamular notches.
This gives the combined width of all the anterior and
posterior teeth of the maxillary arch.
• Location of canine eminences: A canine eminence is
formed in the region between the canine and the first
premolar after extraction of teeth.
• The distance between the two canine eminences is mea-
sured along the residual ridge. This measured value
gives the combined width of the anterior teeth.
• Location of the buccal frenal attachments: The attach-
ments of the buccal frenum are marked on the residual
ridge. The distance between the two markings recorded
along the residual ridge gives the combined width of the
maxillary anteriors.
• Location of the corners of the mouth: The corner of the
mouth marks the distal end of the canine. The corners of
the mouth are recorded on the occlusal rim and the dis-
tance is measured between these markings. The anterior
teeth are set within these markings.
• Location of the ala of the nose: The patient is asked to
sit upright and look straight. A line passing through the
midpoint between the eyebrows and the lateral end of
the ala of the nose extended onto the occlusal rim gives
the combined width of the anterior teeth.
iv. Methods using theoretical concepts
• Winkler's concept: According to Winkler, the teeth
should be selected based on three different views, namely,
physiological, psychological, and biomechanical.
Psychological
• Positive self-evaluation patient shows a broad smile.
• Negative self-evaluation shows a tight-lipped small
smile.
Section I I Topic Wise Solved Questions of Previous Years
• The Camper's line is the psychological plane of orien-
tation.
• It is raised in happy people and is tilted downward in
depressed.
Biomechanical
• The teeth should be placed such that they fulfil the bio-
mechanics of the denture.
• It is not necessary to set the teeth on, outside, or inside
the ridge.
• Instead they should be set in the neutral zone
(the zone of balance between the buccal and lingual
musculature).
Physiological-biological
The facial musculature contributes to the aesthetics of a
patient.
Increased thickness of denture base in labial and buccal
sulci produces a puffy appearance. Facial wrinkles fade
when the vertical dimension is increased accordingly. The
dentist should evaluate the perioral tissues and arrange the
teeth.
• Typical form theory by Leon Williams (1917)
This theory helps determine the size and form of the
anterior teeth. According to him, the shape of the teeth
should be the inverse of the shape of the face. That is,
if the face tapers downwards, the teeth should taper
upward.
According to Leon Williams, facial forms fall into below
four categories:
Square
Ovoid
Tapering
Combination.
• Temperamental theory by Dr. Sparzheim
This theory is based on the concept of Hippocrates.
It is one of the oldest theories proposed around
2400 years ago.
Hippocrates stated that the body comprised of four
juices of humour, namely, blood, phlegm, yellow bile, and
black bile. Imbalance of these juices is the basis for the
various ailments and differences in man.
Man can be classified based on the dominance of
humour as follows:
Sanguinous type: Blood dominance.
Phlegmatic type: Phlegm dominance (phlegm is a watery
fluid elaborated from brain).
Choleric type: Yellow bile dominance (from liver).
Melancholic type: Black bile dominance (from spleen).
Association of certain mental, functional, and physical
characteristics created the Temperament theory. People of
each group exhibit a certain type of teeth.
• Concept of Harmony by J W White in 1872
According to him, the size and colour of the teeth should be
in harmony with the size of the head and colour of the eye,
respectively.
v. Other factors
Other factors that influence the size of teeth are:
• Size of the face.
• Inter-arch spacing.
• Distance between the distal ends of the maxillary
cuspids.
• Length of the lips.
• Size and relation of the arches.
B. Form of the Anterior Teeth
It can be determined using the following factors:
i. Shape of the patient's face or facial form
The teeth selected should be in harmony with the
facial form. Ovoid teeth are preferred for patients with
an oval face, etc.
ii. Patient's profile
• The patient may have a convex, straight, or a concave
profile.
• The labial form of the anterior teeth should be simi-
lar to the facial profile of the patient.
For example, the labial form should be straight for
patients with a straight profile and convex for a pa-
tient with a convex profile.
iii. Dentogenic concept and dynesthetics (Sex, Personality,
Age, or SPA factor)
• Described by Frush and Fisher, this concept states
that sex, personality, and age of the patient determine
the form of the anterior teeth.
Sex: The form or shape of the teeth differs in males and
females as follows:
i. In females, the incisal angles are more rounded and the
teeth have a lesser angulation.
ii. In males, the incisal angles are rounded to a lesser degree
and the teeth are more angular.
Age: It is important in teeth selection because of the
physiological and functional changes that occur in the
oral tissues. The patient can be young, middle-aged, or
old-aged.
The following changes are observed with an advance in
age of the patient:
• Due to decrease in muscle tone, sagging of the cheeks
and the lower lips occur. To prevent cheek biting due to
sagging, the horizontal overlap of the posterior teeth can
be increased.
• Interocclusal distance reduces with age. Hence, man-
dibular teeth are more visible than the maxillary
teeth.

• Old people usually have abraded teeth with worn out
contacts. Hence, placement of contoured teeth may look
artificial.
• Old patients have gingival recession. It can be repro-
duced in the dentures to provide a natural appearance.
• Old people show a blunt smile line and pathologic mi-
gration of teeth.
• The colour of the teeth also changes with age. In old
people, the enamel is abraded and the dentine which
carries a yellow tinge, is more visible.
Personality: The dentist should select and arrange the teeth,
so that it improves the patient's personality. The patient can
be either vigorous or delicate.
i. More squarish and large teeth-vigorous people.
ii. Anteriors in a flat plane for executives and teeth should
be relatively smaller and more symmetrically arranged.
The incisal edge of the central incisors is parallel to the
lips and the laterals are above the occlusal plane in
males. But, the incisal edges of the central and lateral
incisors, follow curve of the lower lip in females. The
distal surface of the centrals is rotated posteriorly for
females.
C. Colour/Shade of the Anterior Teeth
A single colour can be described under four parameters:
• Hue.
• Brilliance or value.
• Saturation or chroma.
• Translucency.
• Hue
• A specific colour produced by a specific wavelength
of light.
• It should be in harmony with the patient's skin
colour or else it will produce an artificial look for
the denture.
• Brilliance or value
• Lightness or darkness of the object.
• Dilution of colour with either black or white to pro-
duce lighter or darker shades respectively.
• In people with light skin colour, teeth with lighter
shades should be chosen and vice versa.
• Saturation or chroma
• It is the amount of colour per unit area of an object
or intensity of the colour. Objects with highly satu-
rated colours lack depth.
• Translucency
• Property of the object to partially allow passage of
light through it.
• Enamel has high brilliance and translucency; hence,
artificial teeth should also show the same properties
for a natural appearance.
Quick Review Series for BOS 4th Year: Prosthodontics
The hue and brilliance ofa tooth is influenced or determined
by the following factors:
Age
• Young people have lighter teeth where the colour of the
pulp is shown through the translucent enamel.
• Old people show dark and opaque teeth due to the depo-
sition of secondary dentine and consequent reduction in
size of the pulp chamber.
• Teeth shine more, in old people, as they get polished
due to regular wear of the teeth.
• Teeth of older people obtain a brownish tinge, because
exposed dentine tends to stain.
• Preserved extracted teeth are not used to select the
colour of the teeth, because they become discoloured
(as they are non-vital).
Habits
• Smokers, alcoholics, and pan chewers have discoloured
teeth due to stains.
• In such people, porcelain teeth are preferred, because
they are not porous and do not allow percolation.
Complexion
• Colour of the teeth chosen should be in harmony with
complexion of patient.
• Colour of the face is more important, because the teeth
fall into the framework of the face.
Colour of the eyes
Colour of the iris is considered unreliable, because the eyes
are too small and far away from the teeth to significantly
influence the choice of colour.
Colour of the patient's hair
It is very unreliable, because of factors like cosmetics, etc.
Also, hair colour changes with age.
Steps in the selection of contour for anterior teeth:
• For single tooth replacement, adjacent teeth are taken as
guide.
• For an edentulous patient, factors like skin colour, hair
colour, and eye colour are considered.
The following reference points on the face can be used to
select the colour of the tooth:
• Side of the nose: This point helps to determine the basic
hue, brilliance, and saturation.
• Under the lips with only the incisal edge exposed: This
reference point gives an idea of how the teeth will look
when the patient is relaxed.
• Under the lips with the mouth wide open and only the
cervical third covered: This gives an idea of how the
teeth will look when the patient is smiling.
Section I I Topic Wise Solved Questions of Previous Years
Hanau's Quint
Squint Test
• It is used to check and compare the colour of the teeth
with the colour of the face.
• The dentist should partially close his eyes to reduce
light and compare artificial teeth of different shades
with the colour of the face.
• The colour of the teeth that fades first from view is least
conspicuous (contrasting) to the colour of the face.
It is classified under two divisions, namely:
i. Size of the teeth.
ii. Form of the teeth.
Posterior Teeth Selection
i. Size of the Posterior Teeth
The following factors are considered while selecting the
size of the teeth:
Buccolingual width
• It should be decreased for artificial teeth, so that the
buccal and the lingual surfaces slope out from the oc-
clusal surface to provide a proper path of escapement of
food during mastication.
• It should be such that the forces from the tongue neu-
tralize the forces of the cheek.
• If the buccolingual width increases, the forces acting on
the denture will also increase, leading to increase in the
rate of ridge resorption.
• Broader teeth encroach into the tongue space leading to
instability of the denture. Also, the teeth should not en-
croach into the buccal corridor space to avoid cheek biting.
Occlusogingival height and mesiodistal length
• They are determined by the available interarch distance.
• The occlusal plane should be located at the midpoint of
interocclusal distance.
• Large teeth selected for cases with inadequate
interocclusal distance appear artificial and require
modification before arrangement.
• Measures like altering the thickness of the denture base
can also be done to accommodate large teeth.
• Each tooth should be selected such that the combined
length of all posterior teeth on that side of the arch does
not exceed the distance between the canine and the
retromolar pad.
• Posterior teeth should not be placed over steep antero-
posterior ridge slope, as this would lead to forward
displacement of the denture.
• Similarly, the teeth should not be placed over displace-
able tissues like the retromolar pad as it will cause
tipping of the denture during function.
• In cases with inadequate mesiodistal length, the premo-
lar can be omitted.
ii. Form of the Posterior Teeth
• Posterior teeth are available in different forms.
• Factors that control the selection of the form of a
tooth are:
Condylar inclination: Teeth with a high cuspal height
are required for patients with steep condylar guidance.
This is because the jaw separation will increase for pa-
tients with acute condylar guidance during protrusion.
Height of the residual ridge: Shallow cusped teeth go
better with shallow ridges.
Patient's age: Teeth with shallow cusps are preferred in
older people.
Ridge relationship: Monoplane teeth are preferred for
cases with posterior crossbite
or severe class II relationship.
Hanau's quint.
Morphologically teeth can be classified as:
i. Cusp teeth
a. Anatomic teeth.
b. Semi-anatomic or modified cusp or low cusp teeth.
ii. Cuspless teeth.
iii. Special forms.
i. Cusp teeth
They have cusps and fossae-like natural teeth. They are of
two types, namely anatomic and semi-anatomic. Cusp teeth
can be used in the following occlusal schemes:
• Bilateral balanced occlusion in centric and eccentric
relations.
• Balance in centric only.
• Non-intercusping cusp (modified occlusion).
a. Anatomic teeth
• These teeth resemble normal newly erupted teeth.
• They provide best aesthetics and are most commonly
used type of artificial teeth.
• Cusps resemble normal dentition with an angle of 33°.
Anatomic teeth with 30° cuspal angulation are also
available and are called Pilkington-Turner teeth.
Advantages of anatomic teeth
• They closely resemble natural teeth. They are highly
aesthetic.
• Proper contours for crushing and triturating.
• Presence of adequate sluiceways.
• There is greater chewing efficiency. Excessive chewing
pressure is minimized.
• More vertical chewing stroke.
• Cuspal inclines provide a depth to obtain eccentric
balance.

• They provide a greater resistance to rotation of dentures.
• They provide a comfortable position to return to, when
cusps are making contact in fossae.
Disadvantages of anatomic teeth
• More difficult and time-consuming to obtain balanced
occlusion.
• Settling (stabilization of occlusion) results in more
damaging interferences.
• Possibilities of more lateral stress in function.
• Settling also causes the vertical dimension at occlusion
to decrease and the mandible to move forward.
• Settling will lead to residual ridge.
b. Semi-anatomic teeth
• It also known as modified-cusp or low-cusp teeth.
• They may have 20° or 10° cuspal angulation.
• 10° semi-anatomic teeth are known as functional or
anatoline teeth.
• They are used in cases with mild discrepancies in jaw
relation. They are more flexible to arrange than ana-
tomic teeth, but they are not as flexible as non-anatomic
teeth.
Advantages of semi-anatomic teeth
• They are easier to arrange and obtain balanced occlusion.
• They can provide freedom, if settling occurs.
• Reduction of lateral stresses.
• They provide all the advantages of cusp teeth.
Disadvantages of semi-anatomic teeth
• Less aesthetic (buccal cusps are shorter).
• Less chewing efficiency (controversial: some claim greater).
ii. Cuspless Teeth
• They are also known as 0°, flat, or monoplane teeth. They
have no cuspal angulation hence are very flexible to set.
• It is easy to set non-anatomic teeth in balanced occlusion.
• Cuspless teeth can be used for the following occlusal
schemes:
a. Bilateral balance with a compensating curve.
b. Three-point balance with a balancing ramp.
c. Flat plane-balance in centric only.
d. Reverse-pitch (Anti-Monson) curve.
Advantages of cuspless occlusal schemes
• More stable lower denture during mastication.
• More vertical chewing stroke.
• More shear in chewing stroke.
• More tongue room.
Disadvantages of cuspless occlusal schemes
• Less stable upper denture.
• No balance during excursive guides-pleasure curve
needs to be added.
Quick Review Series for BOS 4th Year: Prosthodontics
Advantages of zero degree teeth
• Easy to set up.
• Less lateral stress.
• Least anteroposterior interferences after settling.
• Best for patients with poor neuromuscular control and
poor ridge relationships.
• Reduced buccolingual width.
• Sharp grooves and sluiceways compensate for cusps in
getting equal chewing efficiency.
Disadvantages of zero degree teeth
• Difficult to obtain balanced occlusion in excursive
movements.
• Less chewing efficiency for fibrous and tough food.
• Poor aesthetics.
• When set on flat plane, a space develops posteriorly when
excursions occur called Christenson's phenomena causing
excessive pressure and resorption in the anterior region.
iii. Special tooth forms
Include French's posteriors, cutter bars, masticators, VO
posteriors, Sosin- bladed teeth, etc.
Advantages
• They provide moderate to excellent function.
Disadvantages
• Poor aesthetics.
• They require meticulous execution and skill.
• They are more expensive.
• They are poorly designed and have only 'gimmick'
value.
Q. 4. Discuss the importance of try-in stage in complete
denture prosthodontics.
Ans.
Try-in stage in Complete Denture
Prosthodontics
The try-in stage is a preliminary insertion of removable
denture wax-up or a partial denture casting or a finished
restoration to determine the fit, aesthetics, and maxilloman-
dibular relations (GPT).
Procedure for Try-in
It involves verification of all the procedures carried out in
fabrication of complete denture as follows:
a. Primary evaluation
• Check for adaptation: Base plate adaption is checked
on an articulator extraorally first and then intraorally
in patient.
• Occlusion evaluation: Complete intercuspation of
denture teeth should be present in centric relation.
Section I I Topic Wise Solved Questions of Previous Years
• Evaluation of vertical height: Both at rest and occlu-
sion verified.
• Evaluation of polished surfaces: Should be smooth
and void-free to avoid discomfort and food
entrapment.
b. Preliminary evaluation in articulator
• Evaluation of impression surface: Checked for
adaptation and it should be free of projections.
• Evaluation of polished surface: Free of any void and
be in harmony with tissue contour.
• Evaluation of occlusal surface: Should be free of wax
and gingival margins should be carved out properly.
c. Evaluation of mouth
• Denture coverage is verified and denture border ex-
tension is seen, so that it does not extend over the
non-supporting structures.
d. Evaluation of preliminary trial denture (maxillary and
mandibular in mouth)
• Evaluation of denture extension.
• Evaluation of retention, stability, support, and
aesthetics.
e. Evaluation of cheek support
• The incisal third of anterior teeth should be visible
when upper lip is at rest (low lip line).
• The middle third should also be visible while smiling
(high lip line).
• Thickness of labial and buccal flanges of denture
determines the labial and the buccal fullness of
face.
f. Occlusal plane evaluation
Occlusal verification of maxillary trail denture
Intraoral
• Parotid papilla-maxillary occlusal plane should be
1/4th inch below it.
• Linea alba buccalis.
Extraoral
• Interpupillary line: The anterior part of maxillary oc-
clusal plane should be parallel to it and 2 mm below the
upper lip line or smile line.
• Camper's line or ala-tragal line: Posterior part of the
maxillary occlusal plane should be parallel to it when
the patient is in upright sitting position.
Occlusal verification of mandibular trail denture
Intraoral
• Retromolar pad area-height of mandibular plane is
usually placed at level of junction between anterior
two-third and posterior one-third of retromolar pad area.
• Tongue: Normally it rests on lingual part of mandibular
anteriors.
• Linea alba buccalis.
Extraoral
• Mandibular occlusal plane is kept at the level of corners
of the mouth.
g. Evaluation of vertical height
• Physiological rest position verification:
• Patient is seated erect on dental chair, so that the
ala-tragal line is parallel to the floor and two
points are marked on patient's face - one on tip of
the nose and other one at chin tip.
• Patient is instructed to relax and swallow and
distance between above marked points is re-
corded and measured. This is physiological rest
position.
• Next, trial dentures are placed in patient's mouth
and height measured at occlusion which should
be 2-4 mm less than above.
• Tactile sense method.
• Phonetics.
• Silverman's closest speaking space.
h. Evaluation of centric relation
lntraoral
Patient is asked to keep the tongue at the junction of
hard and soft palate and close the mouth, till the teeth attain
maximum intercuspation.
• Swallowing technique.
• Head position.
Extraoral
Extraoral evaluation is done using kinematic face-bow.
i. Aesthetic arrangement of anterior teeth
Following factors are checked:
• Harmony of arch form and residual ridge form.
• Harmony of opposing inclines of labial and lingual
surfaces.
• Harmony of teeth and profile.
• Harmony of incisal edge of maxillary anteriors with
smiling line of lower lip.
j. Eccentric relation evaluation
• Protrusive and lateral relations are verified by man-
dibular movements and if any occlusal interferences
are present, then they should be eradicated by selective
grinding.
k. Incorporation of posterior palatal seal area
• Patient is asked to keep the mouth open and
say 'ah'.
• Line is drawn in mouth across the palate extending
from one hamular notch to other.
• The denture should extend till this line that is PPS.
• Checked by placing the mouth mirror at distal end of
denture. There should be no gap between the tissues
and denture, when patients say 'ah'.
• Checking of phonetics.
Maxillary Canine
• The long axis of the tooth is parallel to the vertical axis
when viewed from the front. A mild mesial tilt is sup-
posed to improve its aesthetics.
 Quick Review Series for BOS 4th Year: Prosthodontics

• The long axis of the tooth is parallel to the vertical axis • Both the buccal and the palatal cusps should touch the
when viewed from the side. occlusal plane.
• The cuspal tip of the canine touches the plane of
occlusion. Maxillary First Molar
• The cervical third of the canine should be more prominent
than the cuspal third. • The long axis of the tooth is tilted buccally when
viewed from the front.
Q. 5. Discuss the role of arrangement of artificial teeth
• The long axis of the tooth is tilted distally when viewed
in complete denture prosthesis.
from the side.
Or • The mesiopalatal cusp alone should touch the occlusal
plane. This arrangement gives rise to the lateral curves.
Discuss the principle in arrangements of artificial teeth
in complete denture prosthodontics.
Maxillary Second Molar
Ans.
It is arranged similar to a first molar except in a higher
An artificial tooth is set by softening the wax in that portion
level.
of the occlusal rim and positioning the tooth on it.
• The long axis of the tooth is tilted buccally when
viewed from the front.
Principles of Tooth Arrangement • The long axis of the tooth is tilted distally when viewed
Each tooth is attached/luted/sealed to the occlusal rim from the side.
based on the following principles: • The mesiopalatal cusp should be the nearest cusp to the
occlusal plane.
Maxillary Lateral Incisor
Mandibular Central Incisor
• The long axis of the tooth is tilted towards the midline
when viewed from the front. • The long axis of the tooth is parallel to the vertical axis
• The long axis of the tooth is sloping labially when when viewed from the front.
viewed from the side. The inclination of the slope is • The long axis of the tooth slopes slightly labially when
greater than that of the central incisor. viewed from the side.
• The incisal edge is 2 mm above the level of the occlusal • The incisal edge of the tooth should be 2 mm above the
plane. And the edge is tilted towards the midline. plane of occlusion.

Maxillary First Premolar Mandibular Lateral Incisor

Maxillary central incisor • The long axis of the tooth is parallel to the vertical axis
• The long axis of the tooth is parallel to the vertical axis when viewed from the front.
when viewed from the front. • The incisal edge of the tooth should be 2 mm above the
• The long axis of the tooth is sloping labially when plane of occlusion.
viewed from the side.
• The incisal edge of the tooth evenly contacts the occlu- Mandibular Canine
sal plane.
• The long axis of the tooth is parallel to the vertical axis • The long axis of the tooth is very slightly tilted lingually
when viewed from the front. when viewed from the front.
• The long axis is parallel to the vertical axis when • The long axis of the tooth slopes slightly mesially when
viewed from the side. viewed from the side.
• The buccal cusp touches the occlusal plane and the • The canine tip is slightly more than 2 mm above the
palatal cusp is positioned about 0.5 mm above the oc- occlusal plane.
clusal plane.

Maxillary second premolar Mandibular Second Premolar

• The long axis of the tooth is parallel to the vertical axis • The long axis of the tooth slopes slightly lingually when
when viewed from the front. viewed from the front.
• The long axis of the tooth is parallel to the vertical axis • The long axis of the tooth is parallel to the vertical axis
when viewed from the side also. when viewed from the side.
Section I I Topic Wise Solved Questions of Previous Years
• The long axis of the tooth slopes slightly labially when
viewed from the side, but not so steeply as the central
incisor.
• Both the cusps are 2 mm above the level of the occlusal
plane.
Mandibular First Molar
• The long axis of the tooth slopes slightly lingually when
viewed from the front.
• The long axis of the tooth is tilted mesially when
viewed from the side.
• All the cusps are above the level of the occlusal plane
with the mesial and lingual cusps being lower than the
distal and buccal cusps.
Mandibular First Premolar
• The long axis of the tooth slopes slightly lingually when
viewed from the front.
• The long axis of the tooth is parallel to the vertical axis
when viewed from the side.
• The lingual cusp is below the occlusal plane and the
buccal cusp should be 2 mm above the occlusal plane.
Mandibular Second Molar
• The long axis of the tooth slopes slightly lingually when
viewed from the front.
• The long axis of the tooth is tilted mesially when
viewed from the side.
• All the cusps are above the level of the first molar with
the mesial and the lingual cusps being lower than the
distal and the buccal cusps.
Other guidelines for arrangement of teeth
The arrangement of teeth should satisfy the following con-
cepts:
1. Key of occlusion: It denotes the relationship of the upper
and the lower teeth during function.
a. Canine key of occlusion: According to this principle,
usually the distal arm of the lower canine should
align with the mesial arm of the upper canine. The
artificial teeth should be arranged according to this
rule.
b. Molar key of occlusion: According to this principle,
the mesiobuccal cusp of the maxillary permanent
molars should coincide with the mesiobuccal groove
(also called buccal groove) of the mandibular perma-
nent molars.
• This is class I molar relationship. Artificial teeth
should be set according to this principle. Even if
there is an abnormal jaw relation, the molar rela-
tionship is always maintained, as it is the most
efficient relationship.
2. Arch form: The maxillary arch is usually 'U' -shaped
and the mandibular arch is 'V' - shaped. But it is not
mandatory for anyone to follow a fixed arch form.
Whatever is the shape of the arch, the symmetry should
never be lost.
The maxillary arch should have a smooth curve
formed by the incisal edge of the anteriors. The canine
will mark the tum of the arch and is the most prominent
tooth among the anteriors.
Regarding the posteriors, there are two concepts
followed:
a. Aligned occlusal groove concept: The central grooves
of all the maxillary posteriors should lie on the straight
line joining the tip or distal arm of the canine anteriorly
and the midpoint of the occlusal rim posteriorly.
b. Aligned buccal ridge concept: According to this con-
cept, the line formed by the central grooves should
pass lingual to the canine, and the buccal ridges of the
maxillary canine, maxillary first premolar, maxillary
second premolar, and the mesiobuccal line angle of
the maxillary first molar should lie in a straight line.
According to this concept, the arch makes a slight
medial curvature at the first molar region.
3. Overjet and Overbite
• Overjet denotes the distance between the upper and
lower incisors measured in the horizontal plane. It
should be at least 2 mm in a normal individual. Over-
jet is increased in cases with class II malocclusion
and decreased in cases with class III malocclusion.
• Overbite denotes the vertical overlap of the maxillary
and mandibular anteriors. It is usually 0.5 mm in a
normal individual. Increase in overjet or overbite can
alter the incisal guidance of the occlusion.
4. Compensating curves: The compensating curve for
curve of Spee, Wilson's curve, and the Manson's curve
are normally incorporated to obtain a balanced occlu-
sion. Arranging the teeth according to the previously
mentioned setting principles will automatically incorpo-
rate the compensating curves.
5. Neutral zone: Teeth should be arranged in the neutral
zone where the forces of the buccal musculature are
compensated by the lingual musculature.
• If the teeth are arranged buccally, the buccinator will
destabilize the denture.
• Similarly, if the teeth are arranged lingually, there
will be reduction of the tongue space and the tongue
will destabilize the denture.
6. Tooth to ridge relation: The following factors should be
considered:
• The mandibular posterior teeth should be arranged
on the ridge for more stability.
• The mandibular anteriors should be inclined such
that the incisive forces are transferred to the crest of
the ridge.

• Generally all posterior teeth should have their long axis
coinciding with the long axis of the residual ridge.
7. Characterization of dentures
• Artificial teeth have ideal morphology. This fre-
quently imparts an artificial appearance to the den-
ture, because, it is almost impossible for anyone to
have a perfect set of teeth in the perfect arrangement
especially in old age.
• Hence, the dentist can add his personal touch and
produce small imperfections, which make the teeth
SHORT ESSAYS
Q. 1. Rationale of balanced occlusion.
Or
Laws of balanced occlusion.
Or
Enumerate the factors affecting balanced occlusion.
Ans.
Balanced Occlusion
It is 'The simultaneous contacting of the maxillary and man-
dibular teeth on the right and left and in the posterior and the
anterior occlusal areas in centric and eccentric positions,
developed to lessen or limit tipping or rotating of the denture
bases in relation to the supporting structures' (GPT).
Importance/Rationale of Balanced Occlusion
• Balanced occlusion is one of the most important factors
that affects denture stability.
• Absence of it will results in leverage of the denture
during mandibular movement.
• It is more important during parafunctional movements
to maintain denture stability.
Factors responsible for balanced articulation in complete
dentures or laws of articulation of developing balanced
occlusion are:
Heneu's Quint
Five factors which govern balanced articulation are:
i. Condylar guidance.
ii. lncisal guidance.
iii. Compensating curves.
iv. Relative cusp height.
v. Plane of orientation of the occlusal plane.
Q. 2. Try-in procedure.
Ans.
Quick Review Series for BOS 4th Year: Prosthodontics
look natural. These imperfections should not com-
promise the functions of the denture.
• Methods of characterization include mild chip-
ping, occlusal wear facets, small restorations on
the teeth, staining to depict the endemic condi-
tions, mild rotations, and alteration in anterior
teeth arrangement.
• Though these characterizations produce a striking
resemblance to natural teeth, patient prefers to have
white, unaltered artificial looking teeth.
'Try-in procedure is a preliminary insertion of remov-
able denture wax-up or a partial denture casting or a
finished restoration to determine the fit, aesthetics, and
maxillomandibular relations' (GPT).
Procedure of Try-in
a. Primary evaluation
• Check for adaptation: Base plate adaption is checked
on an articulator extraorally first and then intraorally
in patient.
• Occlusion evaluation: Complete intercuspation of
denture teeth should be present in centric relation.
• Evaluation of vertical height: Both at rest and occlu-
sion verified.
• Evaluation of polished surfaces: Should be smooth and
void-free to avoid discomfort and food entrapment.
b. Preliminary evaluation in articulator
• Evaluation of impression surface: Checked for adap-
tation and it should be free of projections.
• Evaluation of polished surface: Free of any void and
be in harmony with tissue contour.
• Evaluation of occlusal surface: Should be free of wax
and gingival margins should be carved out properly.
c. Evaluation of mouth
• Denture coverage is verified and denture border ex-
tension is seen, so that it does not extend over the
non-supporting structures.
d. Evaluation of preliminary trial denture (maxillary and
mandibular in mouth)
• Evaluation of denture extension.
• Evaluation of retention, stability, support, and aesthetics.
e. Evaluation of cheek support
• The incisal third of anterior teeth should be visible
when upper lip is at rest (low-lip line).
• The middle third should also be visible while smiling
(high-lip line).
• Thickness of labial and buccal flanges of denture
determines the labial and the buccal fullness
of face.
Section I I Topic Wise Solved Questions of Previous Years
f. Occlusal plane evaluation
i. Occlusal verification of maxillary trail denture
lntraoral
• Parotid papilla-maxillary occlusal plane should
be 114th inch below it.
• Linea alba buccalis.
Extraoral
• lnterpupillary line: The anterior part of maxillary
occlusal plane should be parallel to it and 2 mm
below the upper lip line or smile line.
• Camper's line or ala-tragal line: Posterior part of
the maxillary occlusal plane should be parallel to
it when the patient is in upright sitting position.
ii. Occlusal verification of mandibular trail denture
lntraoral
• Retromolar pad area-height of mandibular plane
is usually placed at the level of junction between
anterior two-third and posterior one-third of ret-
romolar pad area.
• Tongue: Normally it rests on lingual part of man-
dibular anteriors.
• Linea alba buccalis.
Extraoral
• Mandibular occlusal plane is kept at the level of
comers of the mouth.
g. Evaluation of vertical height
• Physiological rest position verification:
• Patient is seated erect on dental chair, so that the ala-
tragal line is parallel to the floor and two points are
marked on patients face-one on tip of the nose and
other one at chin tip.
• Patient is instructed to relax and swallow, and dis-
tance between the above marked points is recorded
and measured. This is physiological rest position.
• Next, trial dentures are placed in patient's mouth
and height measured at occlusion which should be
2-4 mm less than above.
• Tactile sense method.
• Phonetics.
• Silverman's closest speaking space.
h. Evaluation of centric relation
lntraoral
• Patient is asked to keep the tongue at the junction of
hard and soft palate and close the mouth, till the teeth
attain maximum intercuspation.
• Swallowing technique.
• Head position.
Extraoral
Evaluation is done using kinematic face-bow.
i. Aesthetic arrangement of anterior teeth
Following factors are checked:
• Harmony of arch form and residual ridge form.
• Harmony of opposing inclines of labial and lingual
surfaces.
• Harmony of teeth and profile.
• Harmony of incisal edge of maxillary anteriors with
smiling line of lower lip.
j. Eccentric relation evaluation
• Protrusive and lateral relations are verified by man-
dibular movements and if any occlusal interfer-
ences are present, then they should be eradicated
by selective grinding.
k. Incorporation of posterior palatal seal area
• Patient is asked to keep the mouth open and
say 'ah'.
• Line is drawn in mouth across the palate extending
from one hamular notch to other.
• The denture should extend till this line that is
PPS.
• Checked by placing the mouth mirror at distal end of
denture. There should be no gap between the tissues
and denture when patients say 'ah'.
• Checking of phonetics.
Q. 3. Anterior teeth selection for complete denture.
Or
Dentogenic concept.
Or
Shade selection.
Ans.
Anterior Teeth Selection
• Anterior teeth play an important role in aesthetics of a
patient. They are not subjected to heavy occlusal load
like the posteriors.
• Hence, aesthetics is given more importance during ante-
rior teeth selection.
• The following factors are also considered during the
selection of anterior teeth:
a. Size of the teeth.
b. Form of the teeth.
c. Colour/shade of the teeth.
a. Size of the Anterior Teeth
• The tooth size should be appropriate to the size of the
face and sex of the patient. The following methods are
used as a guide to select the size of the teeth:
i. Methods using pre-extraction records.
ii. Methods using anthropological measurements of
the patient.
iii. Methods using anatomical landmarks.
iv. Methods using theoretical concepts.
v. Other factors.

b. Form of the Anterior Teeth
It can be determined using the following factors:
1. Shape of the patient's face or facial form
• The teeth selected should be in harmony with the
facial form. Ovoid teeth are preferred for patients
with an oval face, etc.
2. Patient's profile
• The patient may have a convex, straight, or a concave
profile.
• The labial form of the anterior teeth should be simi-
lar to the facial profile of the patient.
For example, the labial form should be straight for
patients with a straight profile and convex for a
patient with a convex profile.
3. Dentogenic concept and dynesthetics (Sex, Personality,
Age, or SPA factor)
• It was described by Frush and Fisher.
• This states that sex, personality, and age of the pa-
tient determine the form of the anterior teeth.
Sex
The form or shape of the teeth differs in males and females
as follows:
i. In females, the incisal angles are more rounded and the
teeth have a lesser angulation.
ii. In males, the incisal angles are rounded to a lesser
degree and the teeth are more angular.
• The incisal edge of the central incisors is parallel to
the lips and the laterals are above the occlusal plane
in males. But, the incisal edges of the central and
lateral incisors follow the curve of the lower lip in
females.
• The distal surface of the centrals is rotated posteri-
orly for females.
• The mesial surface of the lateral incisors is rotated
anteriorly in relation to the centrals in females.
• In males the mesial end of the laterals are hidden by
the centrals. This makes the canine very prominent in
males.
• Only the mesial thirds of the canines are visible in
females, because they are rotated anteriorly, whereas
even the middle two-thirds of the canines are visible
in males.
• The cervical regions are prominent in males than in
females.
• Females on smiling expose more anterior teeth.
Hence, the premolars should be arranged based on
aesthetics for females.
Age
• It is important in teeth selection because of the physi-
ological and functional changes that occur in the oral
tissues. The patient can be young, middle-aged, or old-
aged.
Quick Review Series for BOS 4th Year: Prosthodontics
The following changes are observed with an advance in
age of the patient:
• Due to decrease in muscle tone, sagging of the cheeks
and the lower lips occur. To prevent cheek biting (due to
sagging), the horizontal overlap of the posterior teeth
can be increased.
• Interocclusal distance reduces with age. Hence, man-
dibular teeth are more visible than the maxillary
teeth.
• Old people usually have abraded teeth with worn out
contacts. Hence, placement of contoured teeth may look
artificial.
• Old patients have gingival recession. It can be
reproduced in the dentures to provide a natural
appearance.
• Old people show a blunt smile line and pathologic
migration of teeth.
• The colour of the teeth also changes with age. In old
people, the enamel is abraded and the dentine which
carries a yellow tinge is more visible.
Personality
The dentist should select and arrange the teeth, so that it
improves the patient's personality. The patient can be either
vigorous or delicate.
i. More squarish, large teeth-vigorous people.
ii. Anteriors in a flat plane for executives and teeth
should be relatively smaller and more symmetrically
arranged.
c. Colour/Shade of the Anterior Teeth
A single colour can be described under four parameters:
• Hue.
• Brilliance or value.
• Saturation or chroma.
• Translucency.
• Hue: It is a specific colour produced by a specific wave-
length of light.
It should be in harmony with the patient's skin colour or
else it will produce an artificial look for the denture.
• Brilliance or value
• Dependent on lightness or darkness of the object.
• Dilution of colour with either black or white to pro-
duce lighter or darker shades respectively.
• In people with light skin colour, teeth with lighter
shades should be chosen and vice versa.
• Saturation or chroma: It is the amount of colour per unit
area of an object or intensity of the colour. Objects with
highly saturated colours lack depth.
• Translucency: Property of the object to partially
allow passage of light through it. Enamel has high
brilliance and translucency; hence, artificial teeth
should also show the same properties for a natural
appearance.
Section I I Topic Wise Solved Questions of Previous Years
The hue and brilliance of a tooth is influenced or deter-
mined by the following factors:
Age
• Young people have lighter teeth where the colour of the
pulp is shown through the translucent enamel.
• Old people show dark and opaque teeth due to the depo-
sition of secondary dentine and consequent reduction in
size of the pulp chamber.
• Teeth shine more in old people, as they get polished due
to regular wear of the teeth.
• Teeth of old people obtain a brownish tinge, because
exposed dentine tends to stain.
• Preserved extracted teeth are not used to select the
colour of the teeth, because they become discoloured
(as they are non-vital).
Steps in the selection of contour for anterior teeth:
For single tooth replacement, adjacent teeth are taken as
guide.
For an edentulous patient, factors like skin colour, hair
colour, and eye colour are considered.
The following reference points on the face can be used
to select the colour of the tooth:
Side of the nose: This point helps determine the basic
hue, brilliance, and saturation.
Under the lips with only the incisal edge exposed: This
reference point gives an idea of how the teeth will look
when the patient is relaxed.
Under the lips with the mouth wide open and only the
cervical third covered: This gives an idea of how the teeth
will look when the patient is smiling.
Habits
• Smokers, alcoholics, and pan chewers have discoloured teeth
due to stains. In such people, porcelain teeth are preferred
because they are not porous and do not allow percolation.
Complexion
• Colour of the teeth chosen should be in harmony with
complexion of patient.
• Colour of the face is more important, because the teeth
fall into the framework of the face.
Colour of the eyes
Colour of the iris is considered unreliable, because the eyes
are too small and far away from the teeth to significantly
influence the choice of colour.
Colour of the patient's hair
It is very unreliable, because of factors like cosmetics, etc.
Also, hair colour changes with age.
Squint test
It is used to check and compare the colour of the teeth with
the colour of the face.
The dentist should partially close his eyes to reduce
light and compare artificial teeth of different shades with
the colour of the face. The colour of the teeth that fades first
from view is least conspicuous ( contrasting) to the colour
of the face.
Q. 4. Types of posterior teeth.
Or
Discuss selection of posterior teeth for complete denture.
Ans.
Posterior Teeth Selection
It is classified under two divisions, namely:
1. Size of the teeth.
2. Form of the teeth.
1. Size of the Posterior Teeth
Buccolingual width: It should decrease for artificial teeth,
so that the buccal and the lingual surfaces slope out from
the occlusal surface to provide a proper path of escapement
of food during mastication.
It should be such that the forces from the tongue neu-
tralize the forces of the cheek. If the buccolingual width
increases, the forces acting on the denture will also in-
crease, leading to increase in the rate of ridge resorption.
Broader teeth encroach into the tongue space leading to
instability of the denture. Also, the teeth should not en-
croach into the buccal corridor space to avoid cheek biting.
Mesiodistal length
• MD width of each tooth should be selected such that the
combined length of all posterior teeth on that side of the
arch does not exceed the distance between the canine
and the retromolar pad.
• Posterior teeth should not be placed over steep antero-
posterior ridge slope, as this would lead to forward
displacement of the denture.
• Similarly, the teeth should not be placed over displace-
able tissues like the retromolar pad as it will cause tipping
of the denture during function.
• In cases with inadequate mesiodistal length, the premolar
can be omitted.
Occlusogingival height
This should be determined by the available interarch
distance.
• The occlusal plane should be located at the midpoint of
interocclusal distance.
• Large teeth selected for cases with inadequate interoc-
clusal distance appear artificial and require modification
before arrangement.
• Measures like altering the thickness of the denture base
can also be done to accommodate large teeth.

2. Form of the Posterior Teeth
Posterior teeth are available in different forms. Factors that
control the selection of the form of a tooth are:
• Condylar inclination: Teeth with a high cuspal height
are required for patients with steep condylar guidance.
This is because the jaw separation will increase for pa-
tients with acute condylar guidance during protrusion.
• Height of the residual ridge: Shallow cusped teeth go
better with shallow ridges.
• Patient's age: Teeth with shallow cusps are preferred in
older people.
• Ridge relationship: Monoplane teeth are preferred for cases
with posterior crossbite or severe class II relationship.
• Hanau's quint.
Morphologically teeth can be classified as:
i. Cusp teeth: They have cusps and fossae-like natural
teeth. They are of two types:
a. Anatomic teeth: These teeth resemble normal newly
erupted teeth.
• They provide best aesthetics and are most com-
monly used type of artificial teeth.
• Cusps resemble normal dentition with an angle of
33°. Anatomic teeth with 30° cuspal angulation are
also available and are called Pilkington-Turner teeth.
b. Semi-anatomic teeth: They are also known as modi-
fied-cusp or low-cusp teeth.
• They may have 20° or 10° cuspal angulation.
• 10° semi-anatomic teeth are known as functional
or anatoline teeth.
• They are used in cases with mild discrepancies
in jaw relation. They are more flexible to arrange
than anatomic teeth, but they are not as flexible
as non-anatomic teeth.
ii. Cuspless teeth.They are also known as 0°, flat, or
monoplane teeth. They have no cuspal angulation.
Hence are very flexible to set. It is easy to set non-ana-
tomic teeth in balanced occlusion.
iii. Special forms: Include French's posteriors, cutter bars,
masticators, VO posteriors, Sosin-bladed teeth, etc.
Q. 5. Principles of teeth arrangement for complete eden-
tulous patient.
Ans.
An artificial tooth is set by softening the wax in that portion
of the occlusal rim and positioning the tooth on it.
The arrangement of teeth should satisfy the following
concepts:
a. Key of occlusion: It denotes the relationship of the upper
and the lower teeth during function.
i. Canine key of occlusion: According to this principle,
usually the distal arm of the lower canine should
align with the mesial arm of the upper canine. The
Quick Review Series for BOS 4th Year: Prosthodontics
artificial teeth should be arranged according to this
rule.
ii. Molar key of occlusion: According to this principle,
the mesiobuccal cusp of the maxillary permanent
molars should coincide with the mesiobuccal groove
( also called buccal groove) of the mandibular perma-
nent molars.
This is class I molar relationship. Artificial
teeth should be set according to this principle.
Even if there is an abnormal jaw relation the mo-
lar relationship is always maintained, as it is the
most efficient relationship.
b. Arch form: The maxillary arch is usually 'U' -shaped
and the mandibular arch is 'V' -shaped. But it is not
mandatory for anyone to follow a fixed arch form.
Whatever is the shape of the arch, the symmetry should
never be lost.
The maxillary arch should have a smooth curve
formed by the incisal edge of the anteriors. The canine
will mark the turn of the arch and is the most prominent
tooth among the anteriors.
Regarding the posteriors, there are two concepts
followed:
i. Aligned occlusal groove concept: The central
grooves of all the maxillary posteriors should lie on
the straight line joining the tip or distal arm of the
canine anteriorly and the midpoint of the occlusal
rim posteriorly.
ii. Aligned buccal ridge concept: According to this
concept the line formed by the central grooves
should pass lingual to the canine, and the buccal
ridges of the maxillary canine, maxillary first premo-
lar, maxillary second premolar, and the mesiobuccal
line angle of the maxillary first molar should lie in a
straight line. According to this concept, the arch
makes a slight medial curvature at the first molar
region.
c. Overjet and Overbite
• Overjet denotes the distance between the upper
and lower incisors measured in the horizontal
plane. It should be at least 2 mm in a normal indi-
vidual. Overjet is increased in cases with class II
malocclusion and decreased in cases with class III
malocclusion.
• Overbite denotes the vertical overlap of the maxillary
and mandibular anteriors. It is usually 0.5 mm in a
normal individual. Increase in overjet or overbite can
alter the incisal guidance of the occlusion.
d. Compensating curves: The compensating curve for
curve of Spee, Wilson's curve, and Manson's curve
are normally incorporated to obtain a balanced occlu-
sion. Arranging the teeth according to the previously
mentioned setting principles will automatically incor-
porate the compensating curves.
Section I I Topic Wise Solved Questions of Previous Years
e. Neutral zone: Teeth should be arranged in the neutral
zone where the forces of the buccal musculature are
compensated by the lingual musculature.
• If the teeth are arranged buccally, the buccinator will
destabilize the denture.
• Similarly, if the teeth are arranged lingually, then
there will be reduction of the tongue space and the
tongue will destabilize the denture.
f. Tooth to ridge relation
The following factors should be considered:
• The mandibular posterior teeth should be arranged
on the ridge for more stability.
• The mandibular anteriors should be inclined such
that the incisive forces are transferred to the crest of
the ridge.
• Generally all posterior teeth should have their long
axis coinciding with the long axis of the residual
ridge.
g. Characterization of dentures
• Artificial teeth have ideal morphology. This fre-
quently imparts an artificial appearance to the den-
ture, because it is almost impossible for anyone to
have a perfect set of teeth in the perfect arrangement,
especially in old age.
• Hence, the dentist can add his personal touch and
produce small imperfections, which make the
teeth look natural. These imperfections should not
compromise the functions of the denture.
• Methods of characterization include mild chipping,
occlusal wear facets, small restorations on the
teeth, staining to depict the endemic conditions,
mild rotations, and alteration in anterior teeth
arrangement.
• Though these characterizations produce a striking
resemblance to natural teeth, patient prefers to have
white, unaltered artificial looking teeth.
Q. 6. Define articulator and discuss its advantages and
disadvantages.
Or
Mention the uses and requirements of an articulator.
Ans.
Articulator
Articulator is 'A mechanical device which represents the
temporomandibular joints and the jaw members to which
maxillary and mandibular casts may be attached to simulate
jaw movements' (GPT).
Uses of an Articulator
To diagnose the state of occlusion in both the natural and
artificial dentitions.
• To plan dental procedures based on the relationship be-
tween opposing natural and artificial teeth, e.g., in the
evaluation of the possibility of balanced occlusion.
• To aid in the fabrication of restorations and prosthodon-
tic replacements.
• To correct and modify completed restorations.
• To arrange artificial teeth.
Requirements of an Articulator
Minimal requirements
• It should hold casts in the correct horizontal relationship.
• It should hold casts in the correct vertical relationship.
• The cast should be easily removable and reattachable.
• It should provide a positive anterior vertical stop
(incisal pin).
• It should accept face-bow transfer record using an
anterior reference point.
• It should open and close in a hinge movement.
• It should be made of non-corrosive and rigid materials
that resist wear and tear.
• It should not be bulky or heavy.
• There should be adequate space present between the
upper and lower members.
• The moving parts should move freely without any friction.
• The non-moving parts should be of a rigid articulator.
Additional requirements
• The condylar guides should allow protrusive and lateral
jaw motion.
• The condylar guide should be adjustable in a horizontal
direction.
• The articulator should be adjustable to accept and alter
the Bennett movement.
• The incisal guide table should be customizable (allow
modification).
Advantages of Articulators
• Properly mounted casts allow the operator to visualize
the patient's occlusion, especially from the lingual view.
• Patient cooperation is not a factor when using an articu-
lator once the appropriate interocclusal records are ob-
tained from the patient.
• The refinement of complete denture occlusion in the
mouth is extremely difficult because of shifting denture
bases and resiliency of the supporting tissues. This dif-
ficulty is eliminated when articulators are used.

• Reduced chair time and patient's appointment time.
• The patient's saliva, tongue, and cheeks are not factors
when using an articulator.
Disadvantages of Articulators
• Metal articulators show errors in tooling (manufacture)/
errors resulting from metal fatigue.
• The articulator may not exactly simulate the intraborder
and functional movements of the mandible.
• Errors in jaw relation procedures are reproduced as
errors in denture occlusion. Articulators do not have any
provision to correct these errors.
Q. 7. Condylar and incisal guidance.
Ans.
Condylar Guidance
• It is the first factor of occlusion.
• It is the only factor which can be recorded from the
patient.
• Registered using protrusive registration: The patient is
asked to protrude with the occlusal rims. lnterocclusal
record material is injected between the occlusal rims in
this position. The occlusal rims with interocclusal record
are transferred to the articulator. Since the occlusal rims
are in a protrusive relation, the upper member of the ar-
ticulator is moved back to accommodate them. lnteroc-
clusal record is carefully removed and the upper member
is allowed to slide forward to its original position. The
condylar guidance should be adjusted (rotated) till the
upper member slides freely into position. It is transferred
to the articulator as the condylar guidance.
• Increase in the condylar guidance increases the jaw
separation during protrusion.
• This factor cannot be modified. All the other four fac-
tors of occlusion should be modified to compensate the
effects of this factor.
• In patients with steep condylar guidance, the incisal
guidance should be decreased to reduce the amount of
jaw separation produced during protrusion and vice
versa. But, it should be remembered that the incisal
guidance cannot be made very steep, because it has its
own ill effects.
lncisal Guidance
It is 'The influence of the contacting surfaces of the man-
dibular and maxillary anterior teeth on mandibular
movements' (OPT).
• It is the second factor of occlusion.
• It is determined by the dentist and customized for
patient during anterior try-in.
Quick Review Series for BOS 4th Year: Prosthodontics
• It acts as a controlling path for the movement of casts in
an articulator.
• It should be set depending upon the desired overjet and
overbite planned for the patient. If the overjet is in-
creased, the inclination of the incisal guidance is de-
creased. If the overbite is increased, then the incisal in-
clination increases.
• The incisal guidance has more influence on the poste-
rior teeth than the condylar guidance, because the action
of the incisal inclination is closer to the teeth than the
action of the condylar guidance.
• During protrusive movements, the incisal edge of the
mandibular anterior teeth move in a downward and for-
ward path corresponding to the palatal surfaces of the
upper incisors. This is known as the protrusive incisal
path or incisal guidance. The angle formed by this pro-
trusive path to the horizontal plane is called as the protru-
sive incisal path inclination or the incisal guide angle.
• It influences the shape of the posterior teeth. If the inci-
sal guidance is steep, steep cusps or a steep occlusal
plane or a steep compensatory curve is needed to pro-
duce balanced occlusion.
• In a complete denture, the incisal guide angle should be
as flat (more acute) as possible.
• The incisal guidance cannot be altered beyond limits. The
location and angulation of the incisors are governed by
various factors like aesthetics, function, and phonetics etc.
Q. 8. Non-anatomic teeth.
Ans.
Non-anatomic Teeth or Cuspless Teeth
They are also known as 0°, flat, or monoplane teeth. They
have no cuspal angulation, hence are very flexible to set. It
is easy to set non-anatomic teeth in balanced occlusion.
Cuspless teeth can be used for the following occlusal
schemes:
• Bilateral balance with a compensating curve.
• Three-point balance with a balancing ramp.
• Flat plane-balance in centric only.
• Reverse-pitch (anti-Monson) curve.
Advantages of Cuspless Occlusal Schemes
• More stable lower denture during mastication.
• More vertical chewing stroke.
• More shear in chewing stroke.
• More tongue room.
Disadvantages of Cuspless Occlusal Schemes
• Less stable upper denture.
• No balance during excursive guides-pleasure curve
needs to be added.
Section I I Topic Wise Solved Questions of Previous Years
Advantages of Zero Degree Teeth
• Easy to set up.
• Less lateral stress.
• Least anteroposterior interferences after settling.
• Best for patients with poor neuromuscular control and
poor ridge relationships.
• Reduced buccolingual width.
• Sharp grooves and sluiceways compensate for cusps in
getting equal chewing efficiency.
Disadvantages of Zero Degree Teeth
• Difficult to obtain balanced occlusion in excursive
movements.
• Less chewing efficiency for fibrous and tough food.
• Poor aesthetics.
• When set on flat plane, a space develops posteriorly when
excursions occur, called Christenson's phenomena causing
excessive pressure and resorption in the anterior region.
Q. 9. Compensating curves.
Ans.
Compensating Curve
Compensating curve is defined as 'The anteroposterior and
lateral curvatures in the alignment of the occluding surfaces
and incisal edges of artificial teeth, which are used to de-
velop balanced occlusion' (GPT).
• This curve is an important factor for establishing bal-
anced occlusion and it can determined by the inclination
of the posterior teeth and their vertical relationship to
the occlusal plane.
• The posterior teeth should be arranged such that their
occlusal surfaces form a curve which should be in har-
mony with the movements of the mandible guided pos-
teriorly by the condylar path.
• A steep condylar path requires a steep compensatory
curve to produce balanced occlusion otherwise there will
be loss of balancing molar contacts during protrusion.
There are two types of compensating curves, namely:
i. Anteroposterior compensating curves.
ii. Lateral compensating curves.
Curve of Spee, Wilson's curve, and Manson's curve are as-
sociated with natural dentition. In complete dentures, com-
pensating curves similar to these curves should be incorpo-
rated to produce balanced occlusion.
Anteroposterior Compensating Curves
Compensatory curves running in an anteroposterior direc-
tion. They compensate for the curve of Spee seen in natural
dentition.
Compensating Curve for Curve of Spee
Curve of Spee is defined as 'Anatomic curvature of the
occlusal alignment of teeth beginning at the tip of the lower
canine and following the buccal cusps of the natural premo-
lars and molars, continuing to the anterior border of the
ramus as described by Graf von Spee' (GPT).
• It is an imaginary curve joining the buccal cusps of the
mandibular posterior teeth starting from the canine
passing through the head of the condyle.
• It is seen in the natural dentition and should be repro-
duced in a CD.
• The significance of this curve is that, when the patient
moves his mandible forward, the posterior teeth set on
this curve will continue to remain in contact. If the
teeth are not arranged according to this curve, there
will be disocclusion during protrusion of the mandible
(Christensen's phenomenon).
Lateral Compensating Curves
These curves run transversely from one side of the arch to
the other. The following curves fall in this category:
Compensating curve for Monson curve
It is defined as 'The curve of occlusion in which each cusp
and incisal edge touches or conforms to a segment of a
sphere of 8 inches in diameter with its centre in the region
of the Glabella' (GPT).
• This curve runs across the palatal and buccal cusps of
the maxillary molars.
• During lateral movement, the mandibular lingual cusps
on the working side should slide along the inner inclines
of the maxillary buccal cusp. In the balancing side, the
mandibular buccal cusps should contact the inner in-
clines of the maxillary palatal cusp. This relationship
forms a balance.
• Only if the teeth are set following the Manson's curve
there will be lateral balance of occlusion.
Compensating curve for Anti-Monson or Wilson's
curve
It is defined as 'A curve of occlusion which is convex
upwards' (GPT).
• This curve runs opposite to the direction of the
Manson's curve.
• It is followed when the first premolars are arranged, so
that they do not produce any interference to lateral
movements.
Reverse curve
It is defined as 'A curve of occlusion which in transverse
cross-section conforms to a line which is convex upward'
(GPT).

• It improves the stability of the denture.
• It is explained in relation to mandibular posterior
teeth.
• The reverse curve was modified by Max. Pleasure to
form the pleasure curve.
Pleasure curve
It is defined as 'A curve of occlusion which in transverse
cross-section conforms to a line which is convex upward
except for the last molars' (GPT).
• It was proposed by Max. Pleasure to balance the occlusion
and increase the stability of the denture.
• Here, the first molar is horizontal and the second premolar
is buccally tilted.
• The second molar independently follows the anteropos-
terior compensating curve and lingually tilted.
• This curve runs from the palatal cusp of the first premolar
to the distobuccal cusp of the second molar.
• The second molar gives occlusal balance and the second
premolar gives lever balance.
Q. 10. Bennet's movement and Bennet angle.
Ans.
Bennett's Movement or Mandibular Lateral
Translation
It is also known as Bennett's shift, direct lateral side shift,
side shift, or laterotrusion, described by
Dr Norman Godfrey Bennett in I 908.
It is described as follows:
• When the mandible is moved to one side, there occurs
an outward bodily shift of the working side condyle
(also known as rotating condyle).
• This lateral or outward side shift of the condyle on one
side corresponds with a medial or inward movement of
the condyle on the other side (also known as orbiting
condyle).
• As the mandible is moved further to the side, after the
initial immediate medial movement or simultane-
ously with it, there occurs a progressive downward
and forward movement of the orbiting (balancing
side) condyle.
Significance
• Bennett's movement is incorporated in many articulator
designs and is significant while restoring the occlusion
in dentulous individuals.
• According to GYSI, it averages around 1.5 mm per side,
but in rare instances can measure up to 4 mm.
• The attributes of Bennett's movement determines cusp
height and morphology.
Quick Review Series for BOS 4th Year: Prosthodontics
Bennet Angle
It is formed between the path of non-working condyle and
the sagittal plane.
It is about I 5° according to GYSI.
It is given by the following formula:
Bennet angle (L) = H/8 + I 2, where H = horizontal
condylar inclination.
Q. 11. Define and classify articulators.
Ans.
Definition
Articulator is defined as 'A mechanical device which repre-
sents the temporomandibular joints and the jaw members to
which maxillary and mandibular casts may be attached to
simulate jaw movements' (GPT-8).
Classification of Articulators
The most popular methods of classifying are:
A. Based on the Theories of Occlusion
i. Bonwill theory articulator.
ii. Conical theory articulators (proposed by RE Hall).
iii. Spherical theory articulators.
8. Based on the Type of Record Used for their
Adjustment
i. lnterocclusal record adjustment.
ii. Graphic record adjustment.
C. Based on the Ability to Simulate Jaw Movements
Class I: Simple articulators capable of accepting a single static
registration. E.g. Slab articulator and Bamdoor articulator.
Class II: Permits horizontal and vertical movements, but
they do not orient the movement to TMJ with a face-bow.
• Type A: Limited eccentric motion is possible based on
the average values, e.g., Mean-Value articulator.
• Type B: Limited eccentric motion is possible based on
theories of arbitrary motion, e.g., Manson's articulator
and Hall articulator.
• Type C: Limited eccentric motion is possible based on
engraving records obtained from the patient, e.g.,
House's articulator.
Class III: These articulators permit horizontal and vertical
movements.
They do accept face-bow transfer, but this facility is limited.
• Type A: It accepts static protrusive registration and uses
equivalents for other types of motion, e.g., Hanau H,
Hanau II, and Bergstorm articulator.
Section I I Topic Wise Solved Questions of Previous Years

• Type B: It accepts static lateral protrusive registration • Type B: They are similar to type A, but they allow an-
and uses equivalents for other type of motion, e.g., gulations and customization of the condylar path, e.g.,
Panadent, trubite, and Teledyne Hanau university series. Stuart instrument gnathoscope.
Class IV: These articulators accept three-dimensional dy-
namic registrations. D. Based on the Adjustability of the
They are capable of accurately reproducing the condylar Articulator
pathways for each patient.
• Non-adjustable.
• Type A: The condylar path is determined by the engrav-
• Semi-adjustable.
ing registrations produced by the patient. This path can-
• Fully-adjustable.
not be modified, e.g., TMJ articulator.

SHORT NOTES
Q. 1. Define articulator. Contraindications
Ans. • Poor mandibular ridges.
• When opposing natural teeth are present, as it can cause
their chipping and wear.
Articulator
• When opposed by gold crowns and bridges, as it causes
Articulator is defined as 'A mechanical device which repre- their significant wear.
sents the temporomandibular joints and the jaw members to
Q. 4. Differences between natural and artificial dentition.
which maxillary and mandibular casts may be attached to
simulate jaw movements' (GPT). Ans.
Q. 2. Discuss in short, neutral zone. Differences between natural and artificial dentition is as
follows:
Ans.

Neutral Zone Natural dentition Artificial dentition

Functions independently and
• In neutral zone, the forces of the buccal musculature are
each individual tooth disperses
compensated by the lingual musculature. the occlusal load.
• Teeth should be arranged in the neutral zone.
Malocclusion does not pose a
• If the teeth are arranged buccally, the buccinator will problem for long time.
destabilize the denture.
Non-vertical forces are well
• Similarly, if the teeth are arranged lingually, there will
tolerated.
be reduction of the tongue space and the tongue will
destabilize the denture. Incising does not affect the
posterior teeth.
Q. 3. Porcelain denture teeth. Its indications and contra-
Second molar is the favoured
indications. area for heavy mastication for
better leverage and power.
Ans.
Bilateral balance is not important
and considered as hindrance.
Porcelain Denture Teeth
Proprioceptive impulses give
Porcelain denture teeth are one of the artificial teeth which feedback to avoid occlusal
do not bond chemically to the denture base, but are me- prematurities, which helps the
chanically retained to it with the help of pins or channels patient to have a habitual occlu-
sion away from centric relation.
within the teeth in which acrylic enters and locks the teeth
mechanically to the denture base.
Q. 5. Describe the various dimensions of colour.
Functions as group and occlusal
loads are not individually
managed.
Malocclusion poses immediate
drastic problems.
Non-vertical forces damage the
supporting tissues.
Incising will lift the posterior
part of denture.
Heavy mastication over second
molar can tilt or shift the den-
ture base.
Bilateral balance is mandatory
to produce stability of denture.
No feedback present and den-
ture rests in centric relation
and any prematurities in this
relation can cause shifting of
denture base.

Or
Indications
Write the methods of selecting the colour shade of arti-
• Inter-ridge space is sufficient.
ficial teeth.
• Well formed ridges.
• When superior aesthetics is required. Ans.

A single colour can be described under four parameters:
• Hue.
• Saturation or chroma.
• Brilliance or value.
• Translucency.
• Hue: It is a specific colour produced by a specific wave-
length of light.
• It should be in harmony with the patient's skin co-
lour or else it will produce an artificial look for the
denture.
• Brilliance or value: It depends on lightness or darkness
of the object.
• Dilution of colour with either black or white pro-
duces lighter or darker shades respectively.
• In people with light skin colour, teeth with lighter
shades should be chosen and vice versa.
• Saturation or chroma: It is the amount of colour per
unit area of an object or intensity of the colour. Objects
with highly saturated colours lack depth.
• Translucency: It is the property of the object to par-
tially allow passage of light through it. Enamel has high
brilliance and translucency; hence, artificial teeth should
also show the same properties for a natural appearance.
Q. 6. SPA factor in complete denture.
Or
Dentogenic concept and dynesthetics: Sex, Personality,
Age, or SPA factor.
Ans.
Dentogenic concept and Dynesthetics: Sex,
Personality, Age, or SPA factor.
Sex
• The incisal edge of the central incisors is parallel to the
lips and the laterals are above the occlusal plane in
males. But the incisal edges of the central and lateral
incisors follow the curve of the lower lip in females.
• The distal surface of the centrals is rotated posteriorly
for females.
• The mesial surface of the lateral incisors is rotated ante-
riorly in relation to the centrals in females.
• In males, the mesial end of the laterals is hidden by the
centrals. This makes the canine very prominent in
males.
• Only the mesial thirds of the canines are visible in
females, because they are rotated anteriorly, whereas even
the middle two-thirds of the canines are visible in males.
• The cervical regions are prominent in males than in
females.
• Females on smiling expose more anterior teeth. Hence,
the premolars should be arranged based on aesthetics
for females.
Quick Review Series for BOS 4th Year: Prosthodontics
Personality
• The dentist should select and arrange the teeth, so that
it improves the patient's personality. The patient can be
either vigorous or delicate.
• More squarish, large teeth-vigorous people. Anteriors
in a flat plane for executives and teeth should be rela-
tively smaller and more symmetrically arranged.
Age
• It is important in teeth selection, because of the physi-
ological and functional changes that occur in the oral
tissues.
• The patient can be young, middle-aged, or old-aged.
The following changes are observed with an advance in age
of the patient:
• Due to decrease in muscle tone, sagging of the cheeks
and the lower lips occur. To prevent cheek biting (due to
sagging), the horizontal overlap of the posterior teeth
can be increased.
• Interocclusal distance reduces with age. Hence, man-
dibular teeth are more visible than the maxillary
teeth.
• Old people usually have abraded teeth with worn out
contacts. Hence, placement of contoured teeth may look
artificial.
• Old patients have gingival recession. It can be
reproduced in the dentures to provide a natural
appearance.
• The colour of the teeth also changes with age. In old
people, the enamel is abraded and the dentine which
carries a yellow tinge is more visible.
Q. 7. Canine-guided occlusion.
Ans.
• Canine-guided occlusion also known as canine-
protected articulation or anterior-protected articu-
lation.
• A form of mutually protected articulation in which the
vertical and horizontal overlap of the canine teeth disen-
gage the posterior teeth in the excursive movements of
the mandible (GPT-8).
Q. 8. Importance of try-in in complete denture.
Ans.
Try-in in Complete Denture
It is a preliminary insertion ofremovable denture wax-up or
a partial denture casting or a finished restoration to deter-
mine the fit, aesthetics, and maxillomandibular relations
(OPT).
Section I I Topic Wise Solved Questions of Previous Years

Procedure Q. 11. Compensatory curve importance.

a. Primary evaluation. Ans.

b. Preliminary evaluation in articulator.
c. Evaluation of mouth. Compensating Curve
d. Evaluation of preliminary trial denture (maxillary and
mandibular in mouth). It is defined as 'The anteroposterior and lateral curvatures
e. Evaluation of cheek support. in the alignment of the occluding surfaces and incisal
f. Occlusal plane evaluation. edges of artificial teeth which are used to develop balanced
g. Evaluation of vertical height.
occlusion' (GPT).
h. Evaluation of centric relation. • It is the important factor for establishing balanced oc-
i. Eccentric relation evaluation. clusion and it can be determined by the inclination of
j. Incorporation of posterior palatal seal area. the posterior teeth and their vertical relationship to the
occlusal plane.
Q. 9. Selection of teeth for geriatric patient. • The posterior teeth should be arranged such that their
occlusal surfaces form a curve which should be in
Or harmony with the movements of the mandible guided
Selection of anterior teeth. posteriorly by the condylar path.
• A steep condylar path requires a steep compensatory
Or curve to produce balanced occlusion otherwise there will
What are the criteria for selection of anterior teeth for be loss of balancing molar contacts during protrusion.
complete denture patient? There are two types of compensating curves, namely:
i. Anteroposterior curves.
Ans. ii. Lateral curves.

Curve of Spee, Wilson's curve, and Manson's curve are

Anterior Teeth Selection for Geriatric Patient associated with natural dentition. In complete dentures,
compensating curves similar to these curves should be in-
• Aesthetics and phonetics are important. corporated to produce balanced occlusion.
• Pre-extraction guides available are:
i. Photographs. Q. 12. Squint test.
ii. Diagnostic casts. Ans.
iii. Radiographs.
iv. Observation of teeth of close relative. Squint test is used to check and compare the colour of the
v. Extracted teeth of patient. teeth with the colour of the face.
• Criteria of selection of anterior teeth: The dentist should partially close his eyes to reduce light
i. Size of the tooth. and compare artificial teeth of different shades with the colour
ii. Form of the tooth. of the face. The colour of the teeth that fades first from view
iii. Colour of the tooth. is least conspicuous (contrasting) to the colour of the face.
iv. Material of the tooth.
Q. 13. Balanced occlusion.

Q. 10. Indications of non-anatomic teeth in complete Ans.

denture.
Ans.
• Non-anatomic teeth are also known as 0°, flat, or mono-
plane teeth.
• They have no cuspal angulation, hence are very flexible
to set. It is easy to set non-anatomic teeth in balanced
occlusion.
Cuspless teeth can be used for the following occlusal
schemes:
• Bilateral balance with a compensating curve.
• Three-point balance with a balancing ramp.
• Flat plane balance in centric only.
• Reverse-pitch (anti-Monson) curve.
Balanced Occlusion
Balanced occlusion is the 'The simultaneous contacting of
the maxillary and mandibular teeth on the right and the left
and in the posterior and anterior occlusal areas in centric
and eccentric positions, developed to lessen or limit tipping
or rotating of the denture bases in relation to the supporting
structures' (GPT).
Importance/Rationale
• It is one of the most important factors that affects
denture stability.

• Absence of it will result in leverage of the denture dur-
ing mandibular movement.
• It is more important during parafunctional movements
to maintain denture stability.
Laws of Articulation of Developing Balanced
Occlusion
Five factors which govern balanced articulation are as
follows:
i. Condylar guidance.
ii. Incisal guidance.
iii. Compensating curves.
iv. Relative cusp height.
v. Plane of orientation of the occlusal plane.
Q. 14. Cuspless teeth.
Ans.
Cuspless Teeth
• Cuspless teeth are also known as 0°, flat, or monoplane
teeth. They have no cuspal angulation, hence are very
flexible to set.
• It is easy to set non-anatomic teeth in balanced
occlusion.
Cuspless teeth can be used for the following occlusal
schemes:
• Bilateral balance with a compensating curve.
• Three-point balance with a balancing ramp.
• Flat plane balance in centric only.
• Reverse-pitch (anti-Monson) curve.
Advantages of Zero Degree Teeth
• Easy to set up.
• Less lateral stress.
• Least anteroposterior interferences after setting.
• Best for patients with poor neuromuscular control and
poor ridge relationships.
• Reduced buccolingual width.
• Sharp grooves and sluiceways compensate for cusps in
getting equal chewing efficiency.
Disadvantages of Zero Degree Teeth
• It is difficult to obtain balanced occlusion in excursive
movements.
• Less chewing efficiency for fibrous and tough food.
• Poor aesthetics.
• When set on flat plane, a space develops posteriorly
when excursions occur, called Christenson's phenom-
ena causing excessive pressure and resorption in the
anterior region.
Quick Review Series for BOS 4th Year: Prosthodontics
Q. 15. Neutrocentric occlusion.
Ans.
Neutrocentric concept of occlusion states that plane of oc-
clusion should be flat and parallel to the residual alveolar
ridge.
This concept is similar to the monoplane occlusion used
to set non-anatomic teeth.
The term neutrocentric denotes an occlusion that elimi-
nates the anteroposterior and buccolingual inclines in order
to direct the forces to the posterior teeth.
Q. 16. Group function occlusion.
Ans.
Group function occlusion refers to multiple contact
relations between the maxillary and mandibular teeth in
lateral movements on the working side, whereby simultane-
ous contact of several teeth acts as a group to distribute
occlusal forces (GPT-8).
Q. 17. Lingualized occlusion.
Ans.
Lingualized Occlusion
• Lingualized occlusion was first proposed by Alfred
Gysi (1927).
• It involves the use of a large upper palatal cusp against
a wide lower central fossa. Here, the buccal cusps of the
upper and lower teeth do not contact each other. It has
superior chewing efficiency.
• Payne used 30° anatomical teeth which are reshaped
to obtain lingual occlusion. This scheme had com-
plete intercuspation without any deflective occlusal
contacts.
Myerson's Lingualized Integration
Myerson proposed specialized tooth moulds for arranging
teeth in lingualized occlusion. These are as follows:
• Two different moulds for the maxillary posteriors---con-
trol contact (CC) mould for patients with variations in
centric position and maximum contact (MC) mould for
patients who can reproduce accurate centric position. The
remaining teeth are common for both these moulds.
• These teeth provide maximal intercuspation, good cus-
pal height to perform occlusal reshaping, and a natural
and a pleasing appearance.
• The 'MC' mould maxillary posteriors have taller
cusps with a more anatomical appearance and also
offers a more 'exacting occlusion' compared to the
'CC'mould.
Section I I Topic Wise Solved Questions of Previous Years

Q. 18. Christenson's phenomenon. Porcelain Teeth

Ans.
Christenson's Phenomenon
• This phenomenon is given by Christensen.
• The protrusive movement is not a simple straight for-
ward movement of the mandible.
• As the mandible moves forward, the occlusion rims
separate in the posterior region even as it remains in
contact anteriorly.
• Thus during protrusion, a wedge-shaped opening is
formed in the posterior part of the occlusion rims. This
is termed as Christensen's phenomenon.
• The posterior separation is due to the downward
displacement of the condyles, as it travels along the
articular slope.
• By recording this gap and transferring the record, the
articulator can be programmed to simulate some of the
patient's mandibular movements.
Advantages
• Superior aesthetic as compared to acrylic teeth.
• Do not stain and discolour easily.
• Do not wear easily.
• Maintain vertical dimension and mastication efficiency
for long periods.
• They can be reused through rebasing.
Disadvantages
• Clicking sound on impact.
• Difficult to grind and adjust.
• Requires adequate inter-ridge distance.
• Abrades or chips opposing natural teeth and gold
crowns.
• Do not form chemical bond to denture base.
• Do not self-adjust.
• Being brittle, may fracture or chip.

Q. 19. Advantages and disadvantages of porcelain

teeth.

Ans.

------------------- i( Topic 8)
Lab Procedures Prior to Insertion
and Complete Denture Insertion

LONG ESSAYS
Q. 1. Discuss in brief the various post-insertion prob- What are the post-insertion problems in complete den-
lems in edentulous patient using complete dentures. tures? Discuss the methods of rectifying the same.
Or Ans.
What are the various post-insertion problems and their
management? Post-insertion Problems in Complete
Or Dentures

Discuss in brief the post-insertion management in com- Post-insertion problems can be divided into three broad
plete denture prosthodontics. categories:
a. Decrease in denture retention.
Or b. Decrease in denture stability.
c. Decrease in denture support.
 Quick Review Series for BOS 4th Year: Prosthodontics

Management of Post-insertion Problems iv. Neuromuscular control

Following are the various post-insertion problems and their • Forces generated during mastication are sufficient to
management: destabilize the denture.

Correction
a. Decrease in Denture Retention
• Temporary use of denture adhesives may help the
i. Lack of seal patient to learn necessary skills.
Causes
• Border underextension in depth and width. b. Decrease in Denture Stability
• Underextension of posterior border.
i. Overextension of denture borders in depth and
• Residual ridge resorption.
width.
• Inelasticity of cheeks-ageing, scleroderma, and sub-
Correction: Use pressure indicating paste and correct
mucous fibrosis.
the borders.
Correction ii. Poor fit of supporting tissues (recoil of displaced tissues
• Addition of tracing compound to the required extension lifts dentures).
and processing it with acrylic resin. Correction:Reline/rebase using minimal pressure
• Relining of denture. technique.
• Slight reduction in the depth and width of border. iii. Denture not in optimal space (denture borders are not in
neutral zone).
ii. Air beneath the impression surface of denture/ Correction:Reshape overextended regions, so that it
lack of seal does not interfere with muscular movement.
Causes iv. Occlusion: Uneven initial contact can cause displace-
i. Poor fit of the supporting tissues due to
ment.
• Deficient impression. Correction: Adjust occlusion by selective grinding
• Damaged cast. either in the mouth or in the articulator after remount
• Warped denture. procedure.
• Overadjustment of impression surface.
ii. Resorption of the residual ridge. c. Decrease in Denture Support
iii. Change in the fluid content of supporting tissues due to
i. Lack of ridge support: Due to progressive residual ridge
• Lack of recovery of tissues from the pressure of old
resorption.
dentures.
Correction: Optimal denture border extension in depth
• Effect of medication, e.g., diuretics.
and width and extend the lingual flange.
• Effect of change in posture of patient with high vol-
ii. Fibrous displaceable tissue: Due to which, during mas-
ume of tissue fluid.
tication, the denture tends to sink in.
iv. Undercut residual ridges, e.g., bimaxillary tuberosities.
Correction: Rebase/reline and optimize occlusal
v. Excessive relief over areas of reduced tissue displace-
balance.
ability.
iii. Bony prominences covered with thin mucosa, e.g.,
Correction prominent maxillary midline suture, tori, and posterior
• Relining and rebasing of denture with minimum pres- nasal spine.
sure technique. Correction: Relive the denture in these areas.
• Addition of tissue conditioners restores retentive forces. iv. Non-resilient soft tissue: Which do not adapt the tissue
• Ensure old dentures are not worn for at least 72 h prior surface of denture.
to making impression. Correction: Rebase/reline and optimal border exten-
• Add softened tracing compound and extend it up to the sion can be produced using low viscosity impression
depth of undercut area and replace it with acrylic. material.
Q. 2. Discuss in detail about the insertion instructions
iii. Xerostornia
and aftercare of the complete dentures.
• Reduced ability to form along the borders and the
polished surfaces of the dentures. Or

Correction Give your method of fitting complete denture prosthesis

and instruction and aftercare to patients.
• Supplement with artificial saliva and modify dentures to
maximize retentive forces and minimize displacing forces. Or
Section I I Topic Wise Solved Questions of Previous Years
What is the importance of patient education? What
insertion instructions you will give to a patient receiving
complete denture prosthesis?
Ans.
When giving fabricated complete denture, following are
checked to ensure proper fit of denture:
i. Evaluation of processing.
ii. Evaluation of polished surfaces.
iii. Evaluation of tissue fit and comfort.
iv. Evaluation of retention, stability, and support.
v. Evaluation of jaw relation.
vi. Evaluation of occlusion.
vii. Evaluation of aesthetics.
viii. Evaluation of speech function.
Importance of post-insertion instructions:
• It is crucial part of denture insertion and delivery.
• If proper instructions are not followed, then there is
great harm to supporting tissues resulting in failure of
denture itself even if how well it is fabricated.
• Instruction is either given verbally or by using visual
aids and model demonstrations.
• Also printed instructions on paper can be provided, so
that patient can refer to that at home.
Post-insertion Instructions to the Patient
A. Insertion and Removal of Prosthesis
• Patient is taught to insert and remove the denture
repeatedly.
• Prosthesis should be inserted along the path of insertion.
• If unilateral undercut is present, then patient is taught to
insert the denture into undercut first, and then rotate the
prosthesis into its final position.
• If the denture is very retentive and difficult to remove,
then patient is asked to blow with lips closed, to break
the peripheral seal and remove the denture.
B. Prosthesis Maintenance
Denture should be cleaned using a denture brush and tooth
paste/soap water ( or any cleansing agent) as follows:
i. Chemical cleansers: Dilute solutions of chlorhexidine,
sodium perborate, or nystatin can be used to store
the dentures. Mineral acids should not be used, as it cor-
rodes the metallic part.
ii. Ultrasonic cleaner: It is a sonic cleaner in which bub-
bles (which help to clear away the food particles) are
bombarded against the denture.
C. Prosthesis Nightwear
• Patient is advised not to wear the denture at night and
store it in water or any dilute medicinal solution.
• This is done to provide rest to mucosa to improve the
blood supply and prevent mucosa] degeneration and
bone resorption.
Nightwear is allowed in following conditions:
• Bruxism patients: In these patients, the damage to oral
tissues is more, if denture is not worn at night.
• Cases of maxillary complete denture and mandibular
partial denture.
D. Periodic Recall
• Regular recall to check for proper denture extension and
occlusion.
• Patient is recalled after 24 h of insertion to correct oc-
clusal disharmony and to check for immediate tissue
reaction.
• Next, patient is called after 1 week to check for tissue
reaction and his/her comfort enquiry done and problems
corrected.
• Next, patient is recalled after 3-6 months to determine
tissue reaction and see the amount of residual ridge
resorption.
• Post-insertion instructions should be reinforced during
recall appointments.
• In case of any tissue reactions like ulcers, soreness, etc.,
the patient is advised to stop wearing the prosthesis and
report immediately to the dentist.
• Yearly recall visit to check the need for relining/
rebasing.
Q. 3. Write an essay on sequelae of complete denture
wearing.
Ans.
Sequelae of Wearing Complete Dentures
The dentures can produce severe side effects, which if left
unchecked, will produce:
• Destabilization of occlusion.
• Loss of retention.
• Decreased masticatory efficiency.
• Poor aesthetics.
• Increased ridge resorption.
• Tissue injury.
These problems will progress making patient 'prostheti-
cally maladaptive' and cannot wear dentures any more.
The interaction of prosthesis and oral environment has
several aspects. The surface properties of the prosthesis
may affect plaque formation. Surface irregularities and
microporosities can enhance microbial colonization.
Plaque formation is also influenced by:
• Design of prosthesis.
• Health of adjacent mucosa.
• Composition of saliva.

• Salivary secretion rate.
• Oral hygiene.
• Denture wearing habits.
Thus, prosthesis may promote infection of the underlying
mucosa; there may be caries, and periodontal diseases of
the overdenture abutments, peri-implantitis (inflammation
of the peri-implantal membrane), and chemical degradation
or corrosion of prosthesis.
All these disorders produced are accelerated in the oral
tissues due to the presence of a denture and are grouped as
sequelae of wearing complete dentures.
Sequelae of complete denture wear are divided into
direct and indirect types depending on the effect of the
prosthesis on the tissues.
a. Direct Sequelae of Wearing Complete
Dentures
1. Denture stomatitis
• Pathological reaction of the palatal portion of the
denture-bearing mucosa.
• It is commonly known as 'Denture-induced stomatitis',
'Denture sore mouth', 'Denture stomatitis', 'Inflammatory
papillary hyperplasia', or 'Chronic atrophic candidiasis'.
• It is seen in 50% of the complete denture wearers.
Classification by Newton
• Type I: Localized simple infection with pinpoint
hyperaemia.
• Type II (Erythematous type): Generalized simple type
presenting a more diffuse erythema involving a part or
the entire denture covered mucosa.
• Type III: Granular type involving the central part of the
hard palate and alveolar ridge. Often seen in association
with type I and II.
Type I is usually trauma-induced, types II and III
are associated with microbial plaque accumulation.
Candida-associated denture stomatitis is often seen along
with angular cheilitis or glossitis.
Diagnosis
Candida-associated denture stomatitis (CADS) is con-
firmed by:
• The presence of mycelia or the pseudohyphae in a direct
smear.
• The isolation of more than 50 candidial colonies from
the lesions.
• The Candida usually resides on the fitting surface of the
denture.
Aetiology
• Direct factor that produces denture stomatrus is the
presence of the denture in the oral cavity.
Quick Review Series for BOS 4 th Year: Prosthodontics
• It is usually seen in patients who wear their dentures
both day and night.
• Trauma from the denture in addition to plaque accumu-
lation can stimulate the turnover of palatal epithelial
cells, thereby reducing the degree of keratinization and
barrier function.
• 'CADS' is also correlated with angular cheilitis. The
infection may start beneath the maxillary denture and
later spread to the angle of the mouth.
Predisposing factors
These factors do not directly produce denture stomatitis,
but they favour the progress or initiation of the lesion.
Systemic factors
i. Old age.
ii. Diabetes mellitus.
iii. Nutritional deficiency: Iron, folate, vitamin B2• etc.
iv. Malignancy: Acute leukaemia, agranulocytosis, etc.
v. Immune defects: Due to the use of corticosteroids and
other immune suppressants.
Local factors
• Dentures
• Environmental changes due to dentures.
• Trauma.
• Denture usage, nightwear.
• Denture cleanliness.
• Xerostomia
• Sjogren's syndrome.
• Irradiation.
• Drug therapy.
• High carbohydrate diet: Increases plaque accumulation.
• Use of broad-spectrum antibiotics: They destroy normal
symbiotic colonies leading to the formation of patho-
logical colonies.
• Smoking tobacco: Affects oral hygiene and also pro-
duces other effects.
Management and Preventive Measures
Supportive measures
• Institution of efficient oral and denture hygiene habits.
Correction of denture wearing habits. The patient is
advised to store the dentures in 0.2-2% chlorhexidine
during night.
• The patient should be instructed to remove the denture
after meals and scrub before reinserting it. The mucosa
in contact with the denture should be hygienically main-
tained and massaged with a soft toothbrush.
• Patient is advised not to use the dentures at night or
leave it exposed to air. Rough areas in the tissue surface
of the denture should be smoothened or relined using a
soft tissue conditioner.
Section I I Topic Wise Solved Questions of Previous Years
• Polishing of the external surface of the dentures should
be done routinely in order to facilitate denture cleansing.
Drug therapy
• Local therapy with Nystatin, Amphotericin B,
Miconazole, and Clotrimazole are usually preferred to
systemic therapy.
• Antifungal drugs that remove Candida albicans are
given mainly,
• After the clinical diagnosis has been confirmed by
mycological examination.
• In patients with associated burning sensation in the
mucosa.
• In patients where the infection has spread to other
sites of the oral cavity and the pharynx.
• In patients at increased risk of systemic mycotic in-
fections due to systemic diseases.
• To reduce the risk of relapse, the following precautions
are followed:
• Antifungal treatment should continue for four weeks.
• When lozenges are prescribed, patient should be
instructed to retain the dentures during its use.
Surgical management
• Elimination of deep crypts in type III denture stomaitits
by cryosurgery.
2. Flabby ridge
• Due to replacement of bone by fibrous tissue, the
residual ridge becomes extremely mobile and resilient
• It is most commonly seen in anterior maxilla oppos-
ing natural mandibular anterior teeth due to presence
of excessive load on the ridge and unstable occlusal
conditions.
Histopathology
• Marked fibrosis, inflammation, and resorption of under-
lying bone.
Treatment
As they provide poor denture support, they should be sur-
gically removed. If there is extreme ridge atrophy, then
complete removal of the flabby ridge will eliminate the
vestibule. In such cases, flabby tissue is preserved, so that
the resilient ridge may help to provide some retention to
the denture.
3. Traumatic ulcers
They are commonly known as 'sore spots'.
• They usually develop within 1-2 days after placement
of new dentures.
• They are characterized by small, painful lesions covered
with a grey necrotic membrane and surrounded by an
inflammatory halo with firm, elevated borders.
Aetiology
• Direct cause for this lesion includes overextended
denture flanges (and/or) unbalanced occlusion.
• Predisposing factors like use of immune-compromised
drugs, etc., suppress the resistance of mucosa to the
mechanical irritation.
Treatment
Normally, after denture correction ulcers heal within few
days.
If no treatment is done, then it progresses to denture
irritational hyperplasia.
4. Denture irritation hyperplasia (Epulis fissuratum)
• Hyperplastic reaction of the mucosa occurring along the
borders of the denture.
• Lesions result from trauma due to unstable dentures
with thin denture flanges.
• Symptoms: Mild with single or numerous lesions
showing flaps of hyperplastic connective tissue. Deep
ulcerations, fissuring, and inflammation may occur at
the depth of the sulcus.
• The lesions usually subside after surgical excision
of the tissues and correction of the dentures. Recur-
rence is rare. These lesions produce marked discom-
fort under pressure and microbial irritation. They
may produce severe lymphadenopathy mimicking a
neoplasm.
5. Oral cancer in denture wearers
• It usually manifests as non-healing ulcers or as infected
aberrant hyperplastic tissues.
• Carcinomas in the floor of the mouth have very poor
prognosis.
• Predisposing factors include heavy use of alcohol,
tobacco smoking/chewing, illiteracy and poverty, etc.
• Patients should be recalled every six months for a com-
prehensive oral examination. If denture sore spots do
not heal after correcting the dentures, then malignancy
should be suspected. Large lesions of denture irritation
hyperplasia should be referred to the pathologist.
6. Burning mouth syndrome (BMS)
• It is characterized by burning sensation in the structures
in contact with dentures without any visible changes in
the mucosa.
• In burning mouth sensation, mucosa is often inflamed
due to mechanical irritation, infection or an allergic re-
action whereas in BMS the mucosa is clinically healthy.
Epidemiology
• It is common in post-menopausal women above 50
years of age.

• The general complaint includes burning sensation of the
supporting structures of the denture and the tongue.
• The syndrome is aggravated by fatigue, tension, and
intake of hot foods. The intensity of pain and burning
sensation is reduced during eating, sleeping, mental
distraction, etc.
Clinical features
• This condition does not have any overt clinical signs or
symptoms.
• Pain starts in the morning and aggravates during
the day.
• Burning sensation is usually accompanied with dry
mouth and persistent altered taste sensation.
• Other associated symptoms include headache, insomnia,
decreased libido, and irritability or depression.
Aetiology
Local factors
• Mechanical irritation caused by ill-fitting dentures.
• Prolonged period of masticatory muscle activity.
• Constant parafunctional movements of the tongue.
• Constant excessive friction on the mucosa.
• Candida! infections and allergic reactions can produce
symptoms similar to EMS.
• Myofacial pain.
Systemic factors
• Vitamin and iron deficiency.
• Xerostomia.
• Menopause.
• Diabetes
• Medication.
Psychogenic factors
• Anxiety.
• Depression.
Treatment
EMS patients are more psychologically affected. They con-
sider that their psychiatric disorders are due to poor den-
tures. These patients may need counselling to understand
the irrelevance of the dentures with regard to their mental
health and also to eliminate their fears. The patient's symp-
toms are given first priority.
7. Gagging
• Gag reflex-normal, healthy defence mechanism which
functions to prevent foreign bodies from entering the
trachea.
• It is triggered by tactile stimulation of the soft palate,
posterior part of tongue, and fauces.
• Other stimuli like sight, smell, taste, noise, and psycho-
logical factors can produce gagging.
Quick Review Series for BOS 4th Year: Prosthodontics
• In sensitive patients, new dentures may stimulate gag-
ging but this disappears as the patient adapts to the
dentures.
• Persistent gagging can occur due to overextended
denture borders, especially in the posterior part of
maxillary denture and the distolingual part of man-
dibular denture. Gagging usually produces displace-
ment of the denture.
• Gagging may occur due to unstable occlusal conditions.
For example, increase in vertical dimension of occlu-
sion, because the unbalanced occlusal contacts may
displace the denture and trigger gagging.
• It can also result from other systemic conditions like
GIT disorders, adenoids, or tumours in the upper respi-
ratory tract, alcoholism, and severe smoking
• Limiting the posterior extension of the dentures and
exercises help to decrease gagging.
8. Residual ridge resorption (RRR)
• It is most common and important sequelae of wearing
complete denture.
• There is continuous loss of bone after tooth extraction
and after placement of complete denture.
• RRR is more common in women due to osteoporotic
changes in bone.
• It is alveolar remodelling, which occurs due to change
in the functional stimulus of bone tissue.
• Ridge resorption is a chronic progressive change in the
bone structure, which results in severe impairment in
the fit and function of the prosthesis.
• It is more important in areas with thick cortical bone,
i.e., the buccal parts of the maxilla and lingual parts of
the mandible that serve as load-bearing regions.
Aetiopathogenesis
• Wherever there is pressure, bone resorbs due to activa-
tion of osteoclasts.
• This resorption due to pressure is minimal at the stress-
bearing areas of the jaws.
• Hence, excessive pressure applied to the nonstress-
bearing areas produces RRR.
• Continuous pressure is required for activation of osteo-
clasts, hence, RRR is common in patients who wear
their dentures continuously overnight.
Pattern of Resorption
• It occurs more rapidly in first six months after teeth
extraction and at a slower pace till 12 months.
• It progresses after 65 years of age.
• It is more rapid in females than males.
• It is precipitated by systemic diseases or ill-fitting den-
tures.
• All denture patients should be examined periodically
on an annual basis. Rate of osseous changes can be
Section I I Topic Wise Solved Questions of Previous Years
retarded when complete dentures are readapted by
relining/rebasing during the first signs and symptoms of
loss of adaptation.
Rate of RRR
• During first year after extraction, the amount of RRR is
2-3 mm in the maxilla and 4-5 mm in mandible.
• Later annual rate of reduction of height in mandible is
0.1-0.2 mm and it is four times less in the edentulous
maxilla.
• The degree of RRR results from a combination of
anatomical, metabolical, and mechanical determinants.
Severe RRR of mandible can be related to a small
gonial angle.
• The main factor that affects the rate of residual ridge
remodelling is the mechanical force transferred from
the denture base and the tongue to the tissues.
• The rate of RRR is increased in patients who wear their
dentures throughout the night without giving rest to the
tissues.
Clinical features
• Reduction in depth and width of sulcus due to ridge
resorption, till the level of the muscle attachment.
Hence, muscles appear to be inserted on the crest of the
ridge obliterating the sulcus.
• Decreased vertical dimension at occlusion.
• Reduction of the lower facial height (due to decreased
VDO).
• Anterior rotation of the mandible.
• Increase in relative prognathism.
• Resorption is centripetal (towards the centre) in the
maxilla, and centrifugal (away from the centre) in the
mandible. Hence, the size of the maxillary arch will
decrease with resorption and the size of the mandibular
arch will increase with resorption.
• Sharp, spiny, and uneven ridge crest due to difference in
rate of resorption from one place to another.
• Long-term resorption affects support stability and reten-
tion of dentures.
Changes in the maxilla
Resorption of the bone of the maxillae usually causes the
upper denture to move up and back in relation to its original
position. However, the occlusion also may force the maxil-
lary denture forward.
Changes in the mandible
The mandible will move to a higher position during occlu-
sion than the one it occupied before the resorption. This
will lead to a decrease in the interarch space. The mandibu-
lar movement is rotatory around a line approximately pass-
ing through the condyles.
The effect of this rotatory movement varies from patient
to patient and occurs due to several features:
• The duration and magnitude of bone resorption.
• The mandibular postural habit.
• Tooth morphology.
• The amount of material present.
The mandible's rotation may produce the following
consequences:
• Loss of centric occlusion in the dentures.
• Changes in the structures that support the upper denture.
• Movement of lower denture in a backward direction
which may lead to traumatic changes in the supporting
structures of the mandible.
• Movement of the lower jaw anteriorly, with an ensuing
prognathic appearance.
Mandibular rotation causes severe damage in the den-
ture-supporting tissues over a long period of unsupervised
denture wear. As the mandible moves anteriorly, denture
also moves along with it. But, this is prevented by the lock-
ing mechanism of the cusped teeth. Hence, the denture
shows posterior displacement in relation to the mandible.
Treatment
Preprosthetic surgery can be done to increase the height
of the ridge (ridge augmentation) or depth of the sulcus
(vestibuloplasty).
9. Overdenture abutments: caries and periodontal
diseases
Overdentures are tooth-supported complete dentures. Teeth,
which support the complete denture are called overdenture
abutments. These abutments are usually endodontically
treated and reduced in size, so that a denture can be fabri-
cated to fit over them.
Common problems associated with overdenture abut-
ments are caries and periodontal diseases, because it is
difficult to achieve good plaque control in the presence of a
denture base all around it.
Pathogenesis
Bacterial colonization may easily be left unchecked due to
the presence of an overdenture. Gingivitis is produced
within three days of colonization of Streptococcus sp. and
Actinomyces sp. Caries is initiated in the presence of a high
proportion of Lactobacilli and Streptococcus mutans.
Preventive measures and management
• Plaque control: It can be established using mechanical
methods like brushing, flossing, etc., and chemical
methods using mouthwashes, etc. The dentures should
also be cleaned effectively to provide better plaque
control.
• Fluoride application and chlorhexidine mouthwashes.

• Avoiding nightwear of dentures: This helps the saliva
(with its buffering capacity, antibodies and antibacterial
enzymes-lysozyme) to clean and guard the abutments.
• Metal copings can be placed around the teeth in order to
protect the tooth structure from caries.
• Periodontal therapy to eliminate periodontal pockets.
i. Indirect Sequelae of wearing Complete
Dentures
1. Atrophy of masticatory muscles
Masticatory function depends on skeletal muscle force and
coordination of orofunctional movements. The skeletal force
or the bite force decreases with age. Hence, most denture
wearers use less biting force and do not use their muscles to
their maximum function causing their atrophic degeneration.
• Atrophy of a muscle due to poor usage is called disuse
atrophy.
• It is more common in women and older people.
• Common muscles that undergo disuse atrophy are the
masseter and the medial pterygoids.
Diagnosis
• The patient is asked to chew a specific quantity of test
food and the time taken to chew the test food into small
particles is measured. The number of chewing cycles
taken to crush the test food is recorded. (Generally com-
plete denture patients take around seven times more
effort than dentulous patients to obtain the same result.
In other words, what a dentulous person can do with one
chewing cycle will take seven chewing cycles in a com-
plete denture wearer).
• These patients prefer soft diet and try to swallow them
as large pieces.
Preventive measures and management
• Overdentures do not produce disuse atrophy, since the
propriceptive impulses are generated from the abutment
teeth and the biting force is not decreased as much as in
a conventional complete denture patient.
• In the absence of overdenture abutments, implants can
be inserted and an implant-supported complete denture
can be fabricated in order to preserve the biting force.
2. Nutritional deficiences
Causes for malnutrition in old people
The principal causes of proteocaloric malnutrition among
elderly denture wearers are:
• Poor general health.
• Poor absorption.
• Intestinal, anabolic, and catabolic disturbances.
• Anorexia.
• Reduced rate of salivary secretion during mastication.
Quick Review Series for BOS 4 th Year: Prosthodontics
General precautions to prevent and/or control of
sequelae from complete dentures are as follows:
• Modified dietary habits wherein balanced diet is admin-
istered.
• Food particles can be mechanically broken down
before eating to reduce the burden on the oral
musculature.
• The dentist should try to preserve the remaining teeth as
much as possible and at least fabricate an overdenture
in order to reduce the sequelae. Especially for the
mandible, as destabilization occurs more easily due to
excessive ridge resorption.
• In the absence of overdenture abutments, the dentist
should try to at least plan an implant-supported com-
plete denture. Implant-supported dentures also help to
reduce the rate of resorption of the ridge.
• Regular follow-up should be conducted, so that a stable
occlusion can be maintained.
• Overdenture patients should be frequently recalled to
examine the status of the abutment.
• Patient should be motivated to follow optimum denture
wearing and maintaining habits.
• Patient's cooperation is important in the success of
treatment. This should be explained and emphasized.
Q. 4. Classify denture stomatitis and write its causative
factors.
Ans.
Denture Stomatitis
• It is the pathological reaction of the palatal portion of
the denture-bearing mucosa.
• It is commonly known as 'Denture-induced stomati-
tis', 'Denture sore mouth', 'Denture stomatitis',
'Inflammatory papillary hyperplasia', or 'Chronic
atrophic candidiasis'.
• It is seen in 50% of the complete denture wearers.
A. Classification (by Newton)
• Type I: Localized simple infection with pinpoint hyper-
aemia.
• Type II (Erythematous type): Generalized simple type
presenting a more diffuse erythema involving a part or
the entire denture covered mucosa
• Type III: Granular type involving the central part of the
hard palate and alveolar ridge. Often seen in associa-
tion with types I and II. Type I is usually trauma-
induced, types II and III are associated with microbial
plaque accumulation.
• Candida associated denture stomatitis is often seen
along with angular cheilitis or glossitis.
Section I I Topic Wise Solved Questions of Previous Years

B. Diagnosis C. Management and Preventive Measures

Candida-associated denture stomatitis (CADS) is con- Supportive measures
firmed by • Institution of efficient oral and denture hygiene habits.
• The presence of mycelia or the pseudohyphae in a direct Correction of denture wearing habits. The patient is
smear. advised to store the dentures in 0.2-2% chlorhexidine
• The isolation of more than 50 candidial colonies from during the night.
the lesions. • The patient should be instructed to remove the denture
• Candida usually resides on the fitting surface of the after meals and scrub before reinserting it. The mucosa
denture. in contact with the denture should be hygienically main-
tained and massaged with a soft toothbrush.
Aetiology • Patient is advised not to use the dentures at night or
• Direct factor that produces denture stomatitis is the leave it exposed to air. Rough areas in the tissue surface
presence of the denture in the oral cavity. of the denture should be smoothened or relined using a
• It is usually seen in patients who wear their dentures soft tissue conditioner.
both day and night. • Polishing of the external surface of the dentures should
• Trauma from the denture in addition to plaque accumu- be done routinely in order to facilitate denture cleansing.
lation can stimulate the turnover of palatal epithelial
Drug therapy
cells thereby reducing the degree of keratinization and
barrier function. • Local therapy with Nystatin, Amphotericin B,
• 'CADS' is also correlated with angular cheilitis. The Miconazole, and Clotrimazole are usually preferred to
infection may start beneath the maxillary denture and systemic therapy.
later spread to the angle of the mouth. • Antifungal drugs that remove Candida albicans are
given mainly after the clinical diagnosis has been
Predisposing factors confirmed by mycological examination.
• In patients with associated burning sensation in the
These factors do not directly produce denture stomatitis,
mucosa.
but they favour the progress or initiation of the lesion.
• In patients where the infection has spread to other
sites of the oral cavity and the pharynx.
Systemic factors
• In patients at increased risk of systemic mycotic
i. Old age. infections due to systemic diseases.
ii. Diabetes mellitus.
iii. Nutritional deficiency: Iron, folate, vitamin B2, etc. To reduce the risk of relapse, the following precautions are
iv. Malignancy: Acute leukaemia, agranulocytosis, etc. followed:
v. Immune defects: Due to the use of corticosteroids and • Antifungal treatment should continue for four weeks.
other immunesuppressants. • When lozenges are prescribed, patient should be in-
structed to retain the dentures during its use.
Local factors
Surgical management
• Dentures
• Elimination of deep crypts in type III denture stomaitits
• Environmental changes due to dentures.
by cryosurgery.
• Trauma.
• Denture usage, nightwear. Q. 5. Tissue conditioners.
• Denture cleanliness.
Or
• Xerostomia
• Sjogren's syndrome. Conditioning of abused and irritated tissues.
• Irradiation.
Ans.
• Drug therapy.
• High carbohydrate diet: Increases plaque accumula-
tion. Tissue Conditioners
• Use of broad-spectrum antibiotics: They destroy normal • Kydd and Mandley (1967): Tissue lining materials per-
symbiotic colonies leading to the formation of patho- mit wider dispersion of forces and hence, aid in decreas-
logical colonies. ing the force per unit area transmitted to the supporting
• Smoking tobacco: Affects oral hygiene and also pro- tissues. Such soft liners could serve as an analogue of the
duces other effects. mucoperiosteum with its relatively low elastic modulus.

• The prolonged contact of denture bases (rigid) with the
underlying tissues produces changes in tissues. Mucosa!
health may be promoted by hygienic and therapeutic
measures and tissue conditioning techniques done in
appropriate situations.
A. Composition
Tissue conditioners are composed of polyethylmethacrylate
and a mixture of aromatic ester and ethyl alcohol.
They are available as three component systems:
• Polymer (Powder).
• Monomer (Liquid).
• Liquid plasticizer (Flow control).
A gel is formed when these materials are mixed with
ethyl alcohol having a greater affinity for the polymer.
B. Major Uses of Tissue Conditioners
• Tissue treatment.
• Temporary obturator.
• Baseplate stabilization.
• To diagnose the outcome of resilient liners.
• Liners in surgical splints.
• Trial denture base.
• Functional impression.
A. Temporary obturator
Tissue conditioners may be added as a temporary obturator
over the existing complete or partial denture. This may be
done directly in the mouth or indirectly after an impression
of the surgical area has been made.
B. Stabilization of baseplates and surgical splints or
stents
When undercuts are present on an edentulous cast, an
acrylic temporary denture base cannot be used, as it may get
locked into the undercut and break the cast during removal.
In these cases, tissue conditioners of a stiffer consistency are
used to stabilize record bases and prevent breakage of cast.
C. Adjunct to an impression or as a final impression
material
These materials are used when it is difficult to determine
the extent of the denture base due to the presence of mov-
able oral structures. These materials record the extensions
of the denture in a dynamic form that will later help in pre-
paring an impression tray for the final impression.
D. Adjunct to determine the potential benefits of a
treatment modality
Sometimes patients with well-constructed dentures develop
chronic soreness and find it difficult to wear the dentures
Quick Review Series for BOS 4th Year: Prosthodontics
comfortably. Tissue conditioners can be used to determine
if this problem can be resolved with the use of a resilient
liner.
E. Adjuncts for tissue healing
Tissue conditioners prepare the selected oral structures to
withstand all the stress from the prosthesis. They are used
to preserve the residual ridge and to heal irritated hyperae-
mic tissues prior to denture fabrication.
C. Procedure for Applying Tissue Conditioners
i. Preparation of the dentures
• The tissue part of the denture base, which crosses an
undercut, should be reduced.
• The tissue surface of the denture, which covers the crest
of the ridge, should be reduced by 1 mm.
• Dentures should allow sufficient room for the placement
of the tissue conditioner in order to promote the recov-
ery of displaced and traumatized tissues.
ii. Mixing and placement of the tissue conditioner
• Tissue conditioners are available as three component
systems
• Polymer (Powder).
• Monomer (Liquid).
• Liquid plasticizer (Flow control).
• The mixing ratio can be changed according to the con-
sistency required.
• A ratio of 1.25 parts of polymer, 1 part of monomer, and
0.5 cc of plasticizer is usually recommended. The
plasticizer should be added to the monomer.
• The ingredients are mixed to form a gel which is
applied in sufficient thickness to the tissue surface of
the denture.
• The denture is inserted and border movements are
carried out to mould the setting material.
D. Care and Maintenance
• Tissue conditioners should not be cleaned by scrubbing
with a hard brush in order to prevent tearing of the
material.
• The use of soft brush under running water is
recommended.
• Tissue conditioners are versatile and ease to use.
• They can be easily misused and their longevity
against wear is very limited and they tend to
harden and roughen within 4-8 weeks due to the
loss of plasticizer. Hence, they require close obser-
vation.
Section I I Topic Wise Solved Questions of Previous Years
SHORT ESSAYS
Q. 1. Importance of finishing and polishing of complete
denture.
Ans.
Importance/Role of the Finished and
Polished Surfaces of Complete Dentures
i. It contributes to aesthetics by replacing lost tissue
and by giving support and fullness to the cheeks and
lips.
ii. Reproducing gingival anatomy gains more importance
when the patient has a high lip line. During talking or
smiling in such patients a large portion of the denture
base may be visible.
iii. A thick or improperly contoured palate can create
phonetic problems.
iv. By supporting the cheeks, lips, and the modiolus, it
contributes to facial expressions.
v. An excessively concave buccal flange can cause food
entrapment in the buccal sulcus.
vi. Improper contour of the gingival embrasure area can
cause food lodgement and poor oral hygiene.
vii. A properly contoured buccal and lingual flange re-
duces the destabilizing effect of the buccinator, the
modiolus, and the tongue.
viii. A proper finish and polish is essential for patient com-
fort, aesthetics, and hygiene of the denture.
ix. The denture borders should retain the shape that was
achieved during border moulding. Thinning of the
denture borders can lead to a loss of peripheral seal
and possible food entrapment. Thin sharp borders can
also cause injury to the tissues.
Q. 2. Write about the instructions given to complete
denture patient at the time of denture delivery.
Ans.
Post-insertion Instructions to the Patient
A. Insertion and Removal of Prosthesis
• Patient is taught to insert and remove the denture
repeatedly.
• Prosthesis should be inserted along the path of
insertion.
• If unilateral undercut is present, then the patient is
taught to insert the denture into undercut first, and then
rotate the prosthesis into its final position.
• If the denture is very retentive and difficult to remove,
then the patient is asked to blow with lips closed to
break the peripheral seal and remove the denture.
B. Prosthesis Maintenance
Denture should be cleaned using a denture brush and tooth
paste/soap water (or any cleansing agent) as follows:
i. Chemical cleansers: Dilute solutions of chlorhexidine,
sodium perborate, or nystatin can be used to store the
dentures. Mineral acids should not be used, as it cor-
rodes the metallic part.
ii. Ultrasonic cleaner: It is a sonic cleaner in which bubbles
(which help to clear away the food particles) are bom-
barded against the denture.
C. Prosthesis Nightwear
• Patient is advised not to wear the denture at night and
store it in water or any dilute medicinal solution.
• This is done to provide rest to mucosa to improve the
blood supply and prevent mucosa) degeneration and
bone resorption.
Nightwear is allowed in the following conditions:
• Bruxism patients, where damage to oral tissues is more
if denture is not worn at night.
• Cases of maxillary complete denture and mandibular
partial denture.
D. Periodic Recall
• Regular recall to check for proper denture extension and
occlusion.
• Patient is recalled after 24 h of insertion to correct oc-
clusal disharmony and to check for immediate tissue
reaction.
• Then patient is called after 1 week to check for tissue
reaction and his/her comfort enquiry done and problems
corrected.
• Then patient is recalled after 3-6 months to determine
tissue reaction and see the amount of residual ridge
resorption.
• Post-insertion instructions should be reinforced during
recall appointments.
• In case of any tissue reactions like ulcers, soreness, etc.,
the patient is advised to stop wearing the prosthesis and
report immediately to the dentist.
• Yearly recall visit to check the need for relining/
rebasing.
Q. 3. Problems associated with complete denture use
and methods for rectifying the same.
Or
Post-insertion problems in complete denture patient.
Ans.
 Quick Review Series for BOS 4th Year: Prosthodontics

Post-insertion problems can be divided into three broad 3. Xerostomia

categories: • Reduced ability to form along the borders and the
a. Decrease in denture retention. polished surfaces of the dentures.
b. Decrease in denture stability. • Correction: supplement with artificial saliva and modify
c. Decrease in denture support. dentures to maximize retentive forces and minimize
displacing forces.
Various Post-insertion Problems and their 4. Neuromuscular control
Management
• Forces generated during mastication are sufficient to
A. Decrease in Denture Retention destabilize the denture.
Correction: Temporary use of denture adhesives may
1. Lack of seal help patients to learn necessary skills.
Causes
• Border underextension in depth and width. B. Decrease in Denture Stability
• Underextension of posterior border. 1. Overextension of denture borders in depth and width
• Residual ridge resorption. Correction: Use pressure indicating paste and correct
• Inelasticity of cheeks-ageing, scleroderma, and sub- the borders.
mucous fibrosis. 2. Poor fit of supporting tissues (recoil of displaced tissues
Correction
lifts dentures)
Correction: Reline/rebase using minimal pressure
• Addition of tracing compound to the required extension technique.
and processing it with acrylic resin. 3. Denture not in optimal space (denture borders are not in
• Relining of denture. neutral zone)
• Slight reduction in the depth and the width of border. Correction: Reshape overextended regions, so that it
2. Air beneath the impression surface of denture/ does not interfere with muscular movement.
lack of seal 4. Occlusion: Uneven initial contact can cause displace-
ment.
Causes Correction: Adjust occlusion by selective grinding ei-
i. Poor fit of the supporting tissues due to ther in the mouth or in the articulator after remount
• Deficient impression. procedure.
• Damaged cast.
• Warped denture.
C. Decrease in Denture Support
• Overadjustment of impression surface.
ii. Resorption of the residual ridge. 1. Lack of ridge support: Due to progressive residual ridge
iii. Change in the fluid content of supporting tissues resorption.
due to Correction: Optimal denture border extension in depth
• Lack of recovery of tissues from the pressure of old and width and extend the lingual flange.
dentures. 2. Fibrous displaceable tissue: Due to which during
• Effect of medication, e.g., diuretics. mastication the denture tends to sink in.
• Effect of change in posture of patient with high Correction: Rebase/reline and optimize occlusal bal-
volume of tissue fluid. ance.
iv. Undercut residual ridges, e.g., bimaxillary tuberosities. 3. Bony prominencies covered with thin mucosa, e.g.,
v. Excessive relief over areas of reduced tissue displace- prominent maxillary midline suture, tori, and posterior
ability. nasal spine.
Correction: Relive the denture in these areas.
Correction
4. Nonresilient soft tissue: Which do not adapt the tissue
• Relining and rebasing of denture with minimum pres- surface of denture.
sure technique. Correction: Rebase/reline and optimal border extension
• Addition of tissue conditioners restores retentive forces. can be produced using low viscosity impression mate-
• Ensure old dentures are not worn for at least 72 h prior rial.
to making impression.
• Add softened tracing compound and extend it up to the Q. 4. Denture stomatitis.
depth of undercut area to replace it with acrylic. Ans.
Section I I Topic Wise Solved Questions of Previous Years
Denture Stomatitis
• It is the pathological reaction of the palatal portion of
the denture-bearing mucosa.
• It is commonly known as 'Denture-induced stomatitis',
'Denture sore mouth', 'Denture stomatitis', 'Inflamma-
tory papillary hyperplasia', or 'Chronic atrophic candi-
diasis'.
• It is seen in 50% of the complete denture wearers.
A. Classification (By Newton)
• Type I: Localized simple infection with pinpoint hyper-
aemia.
• Type II (Erythematous type): Generalized simple type
presenting a more diffuse erythema involving a part or
the entire denture covered mucosa.
• Type III: Granular type involving the central part of the
hard palate and alveolar ridge. Often seen in association
with type I and II.
Type I is usually trauma-induced, types II and III are
associated with microbial plaque accumulation. Candida-
associated denture stomatitis is often seen along with angu-
lar cheilitis or glossitis.
B. Diagnosis
Candida-associated denture stomatitis (CADS) is con-
firmed by
• The presence of mycelia or the pseudohyphae in a direct
smear.
• The isolation of more than 50 candidial colonies from
the lesions.
• Candida usually resides on the fitting surface of the
denture.
C. Aetiology
• Direct factor that produces denture stomatitis is the
presence of the denture in the oral cavity.
• It is usually seen in patients who wear their dentures
both day and night.
• Trauma from the denture in addition to plaque accumu-
lation can stimulate the turnover of palatal epithelial
cells thereby reducing the degree of keratinization and
barrier function.
• 'CADS' is also correlated with angular cheilitis. The
infection may start beneath the maxillary denture and
later spread to the angle of the mouth.
D. Predisposing Factors
These factors do not directly produce denture stomatitis,
but they favour the progress or initiation of the lesion.
Systemic factors
i. Old age.
ii. Diabetes mellitus.
iii. Nutritional deficiency: Iron, folate, vitamin B2, etc.
iv. Malignancy: Acute leukaemia, agranulocytosis, etc.
v. Immune defects: Due to the use of corticosteroids and
other immunesuppressants.
Local factors
• Dentures
• Environmental changes due to dentures.
• Trauma.
• Denture usage, nightwear.
• Denture cleanliness.
• Xerostomia
• Sjogren's syndrome.
• Irradiation.
• Drug therapy.
• High carbohydrate diet: Increases plaque accumulation.
• Use of broad-spectrum antibiotics: They destroy normal
symbiotic colonies leading to the formation of patho-
logical colonies.
• Smoking tobacco: Affects oral hygiene and also pro-
duces other effects.
E. Management and Preventive Measures
Supportive measures
• Institution of efficient oral and denture hygiene habits.
Correction of denture wearing habits. The patient is
advised to store the dentures in 0.2-2% chlorhexidine
during the night.
• The patient should be instructed to remove the denture
after meals and scrub before reinserting it. The mucosa
in contact with the denture should be hygienically main-
tained and massaged with a soft toothbrush.
• Patient is advised not to use the dentures at night or
leave it exposed to air. Rough areas in the tissue surface
of the denture should be smoothened or relined using a
soft tissue conditioner.
• Polishing of the external surface of the dentures
should be done routinely in order to facilitate denture
cleansing.
Drug therapy
• Local therapy with Nystatin, Amphotericin B,
Miconazole, and Clotrimazole are usually preferred to
systemic therapy.
• Antifungal drugs that remove Candida albicans are
given mainly
• After the clinical diagnosis has been confirmed by
mycological examination.
• In patients with associated burning sensation in the
mucosa.

• In patients where the infection has spread to other
sites of the oral cavity and the pharynx.
• In patients at increased risk of systemic mycotic in-
fections due to systemic diseases.
• To reduce the risk of relapse, the following precautions
are followed:
• Antifungal treatment should continue for four weeks.
• When lozenges are prescribed, patient should be
instructed to retain the dentures during its use.
Surgical management
• Elimination of deep crypts in type III denture stomatitis
by cryosurgery.
Q. 5. Compare the residual ridge resorption in maxil-
lary and mandibular ridges.
Or
Ridge resorption.
Ans.
Residual Ridge Resorption (RRR)
• Residual ridge resorption is the most common and im-
portant sequelae of wearing complete denture.
• There is continuous loss of bone after tooth extraction
and after placement of complete denture.
• It is more common in women due to osteoporotic
changes in bone.
• It is alveolar remodelling, which occurs due to change
in the functional stimulus of bone tissue.
• It is a chronic progressive change in the bone structure,
which results in severe impairment in the fit and func-
tion of the prosthesis.
• It is more important in areas with thick cortical bone,
i.e., the buccal parts of the maxilla and lingual parts of
the mandible that serve as load-bearing regions.
A. Aetiopathogenesis
• Wherever there is pressure, bone resorbs due to activa-
tion of osteoclasts.
• This resorption due to pressure is minimal at the stress-
bearing areas of the jaws.
• Hence, excessive pressure applied to the nonstress-
bearing areas produces RRR.
• Continuous pressure is required for activation of osteo-
clasts. Hence, RRR is common in patients who wear
their dentures continuously overnight.
B. Pattern of Resorption
• It occurs more rapidly in first 6 months after teeth ex-
traction and at a slower pace till 12 months.
Quick Review Series for BOS 4th Year: Prosthodontics
• It progresses after 65 years of age.
• It is more rapid in females than males.
• It is precipitated by systemic diseases or ill-fitting
dentures.
• All denture patients should be examined periodically on
an annual basis. Rate of osseous changes can be re-
tarded when complete dentures are readapted by relin-
ing/rebasing during the first signs and symptoms of loss
of adaptation.
C. Rate of RRR
• During first year after extraction, the amount of RRR is
2-3 mm in the maxilla and 4-5 mm in mandible.
• Later annual rate of reduction of height in mandible is
0.1-0.2 mm and it is four times less in the edentulous
maxilla.
• The degree of RRR results from a combination of
anatomical, metabolical, and mechanical determinants.
Severe RRR of mandible can be related to a small
gonial angle.
• The main factor that affects the rate of residual ridge
remodelling is the mechanical force transferred from
the denture base and the tongue to the tissues.
• The rate of RRR is increased in patients who wear their
dentures throughout the night without giving rest to the
tissues.
D. Clinical Features
• Reduction in depth and width of sulcus due to ridge
resorption, till the level of the muscle attachment.
Hence, muscles appear to be inserted on the crest of the
ridge obliterating the sulcus.
• Decreased vertical dimension at occlusion.
• Reduction of the lower facial height (due to decreased
VDO).
• Anterior rotation of the mandible.
• Increase in relative prognathism.
• Resorption is centripetal (towards the centre) in the
maxilla, and centrifugal (away from the centre) in the
mandible. Hence, the size of the maxillary arch will
decrease with resorption and the size of the mandibular
arch will increase with resorption.
• Sharp, spiny, and uneven ridge crest due to difference in
rate of resorption from one place to another.
• Long-term resorption affects support stability and reten-
tion of dentures.
Changes in the maxilla
• Resorption of the bone of the maxillae usually causes
the upper denture to move up and back in relation to its
original position. However, the occlusion also may
force the maxillary denture forward.
Section I I Topic Wise Solved Questions of Previous Years
Changes in the mandible
The mandible will move to a higher position during occlu-
sion than the one it occupied before the resorption. This
will lead to a decrease in the interarch space. The mandibu-
lar movement is rotatory around a line approximately pass-
ing through the condyles.
The effect of this rotatory movement varies from patient
to patient and occurs due to several features:
• The duration and magnitude of bone resorption.
• The mandibular postural habit.
• Tooth morphology.
• The amount of material present.
The mandible's rotation may produce the following conse-
quences:
• Loss of centric occlusion in the dentures.
• Changes in the structures that support the upper denture.
• Movement of lower denture in a backward direction
which may lead to traumatic changes in the supporting
structures of the mandible.
• Movement of the lower jaw anteriorly, with an ensuing
prognathic appearance.
Mandibular rotation causes severe damage in the denture-
supporting tissues over a long period of unsupervised denture
wear. As the mandible moves anteriorly, denture also moves
along with it. But, this is prevented by the locking mecha-
nism of the cusped teeth. Hence, the denture shows posterior
displacement in relation to the mandible.
E. Treatment
Preprosthetic surgery can be done to increase the height of
the ridge (ridge augmentation) or depth of the sulcus (ves-
tibuloplasty).
Q. 6. Denture cleansing agents.
Or
Mechanism of action of denture cleansers.
Ans.
Denture Cleansing Agents
Dentures can be cleaned manually or through chemical
cleaning agents. Usually two of them are combined.
A. Chemical Denture Cleansers
Commercial preparations
• Safe and effective.
• Most commercial solutions contain a bleaching agent
such as sodium hypochlorite.
• Some are available in the form of tablets which effer-
vesce when dropped in water releasing bubbles. The
dentures are left in this for at least 15 min or even over
night. The dentures are rinsed before use.
Removal of calculus
Overnight soaking in white vinegar is effective in removing
and controlling calculus build-up on the dentures. The ace-
tic acid in vinegar decalcifies calculus deposits.
B. Manual Cleansing
i. With denture brush
• They are used along with a mild detergent or a denture
paste (which is low in abrasive) and water.
• Regular paste use is contraindicated, as they contain
abrasives which can cause excessive wearing of
resin.
• Gentle brushing with a soft brush and a nonabrasive
cleanser combined with overnight soaking is an effec-
tive cleaning method.
Precaution
i. Stiff bristles along with abrasive cleansers can cause
severe abrasion and therefore should be avoided.
ii. Dentures should be brushed over a basin filled with
water to prevent breakage, if they are accidentally
dropped.
iii. The impression surface of the denture should not be
brushed too aggressively.
ii. Sonic cleansers
These use vibratory energy (not ultrasonic energy) to clean
the dentures.
In combination with hypochlorite solutions they are
very effective in removing calculus as well as cigarette and
coffee stains.
Formula for a homemade cleanser by The Buffalo
School of Dental Medicine:
Sodium hypochlorite (Chlorox*) - 1 Tbsp
Calgon (detergent softens and loosens - 1 tsp
food deposits)
Water - 114 cc
*(Household bleach-germicidal and mild bleach)
A 30 min soaking once a week is sufficient to remove
most stains.
Note: After chemical soaking, the patient should thor-
oughly brush and rinse the denture under running water.
This ensures that all the food deposits which have been
softened by the chemical cleaner are removed. In addition,
brushing is necessary to remove all traces of the chemical
cleanser.

Caution: Cleansers containing sodium hypochlorite are not
indicated with chrome cobalt or other metal-based den-
tures. The hypochlorite may pit or damage the metal.
Q. 7. Denture resins.
Ans.
Denture Resins
These include either heat cure or self (cold) cure acrylic
resins.
These materials are usually supplied as powder and as
liquid parts.
A. Composition
a. Powder
• Polymethylmethaacrylate: To undergo further polymer-
ization, reduce polymerisation shrinkage, and facilitate
the fabrication technique.
• Copolymers of PMMA: To increase the solubility of
polymer in monomer and improve strength and fracture
resistance.
• Benzoyl peroxide: To initiate polymerization of mono-
mer after being added to powder.
• Dibutyl phthalate: To increase the solubility of polymer
in monomer and produce soft and more resilient polymer.
• Colour pigment: To obtain various tissue-like shades.
• Opacifiers: To increase the opacity of material, so that
its translucency matches to that of oral tissues.
• Dyed synthetic fibre: To stimulate minute blood vessels
underlying oral mucosa.
• Inorganic particle: To improve stiffness of denture
base.
• Heavy metal compound: To impart radiopacity.
b. Liquid
• Methylmethacrylate: To produce PMMA on polymer-
ization.
• Comonomer higher methacrylate: To dissolve polymer
beads of powder.
• Hydroquinone inhibitor: To improve properties of
denture base and prolong shelf life of liquid.
• Dibutyl phthalate: To produce softer and resilient polymer.
• Butyl methacrylate: To improve physical properties of
denture.
• Cross-linking agent-ethylene glycol dimethacrylate:
To increase resistance of denture to crazing, fatigue
resistance.
B. Advantages
• Non-toxic, non-irritant, insoluble, and noncorrosive in
oral fluids.
Quick Review Series for BOS 4th Year: Prosthodontics
• Excellent aesthetics.
• Good colour stability.
• Easy to repair, rebase, and alter contour.
• Low density.
• Take good polish.
• Heat discolouration temperature too high.
C. Disadvantages
• Relatively low modulus of elasticity, so require greater
bulk than desirable to produce strength.
• High co-efficient of thermal expansion.
• Abrasion resistance not good enough.
• Low thermal conductivity.
• Radiolucent material.
• Nonwettable surface.
Q. 8. Importance of patient education.
Or
Importance of counselling for a complete denture
wearer.
Ans.
Patient Education and Preparation
• Before actually inserting the denture in the mouth, the
patient should be psychologically prepared.
• Previous instructions are reinforced.
• The patient should be made aware that only after the
dentist has completed evaluation and adjustment of
the denture in the mouth and is satisfied with it, will the
patient be allowed to view it.
a. First oral feelings: These are a temporary feeling of
fullness. The patient should be reassured that this
feeling will disappear over time.
b. Excessive salivation: New dentures often stimulate
excessive salivary flow, as mouth considers the new
dentures as foreign objects. The denture may appear
to float. The patient should be reassured that this is a
normal reaction to new dentures and will gradually
decrease over time. Compulsive spitting or rinsing
should be avoided, as it can cause denture dislodg-
ment. Swallowing should be encouraged to remove
the excess saliva.
c. Excessive looseness: Often the trial denture may be
loose, because of faulty tongue position or excessive
relief of denture base. Patient must be reassured that
this will disappear in final denture.
d. Final viewing: Once the dentist has finished evalua-
tion and correcting the errors, patient is allowed to
view the denture with mirror kept at normal conver-
sational distance and under natural light.
Section I I Topic Wise Solved Questions of Previous Years
e. Patient is instructed to relax, smile, talk, or count. He
must not look at the denture too closely or the teeth
alone, rather he should look at the overall effect of
denture on his face.
Q. 9. Describe the steps in complete denture delivery.
Ans.
During the insertion appointment, all the factors verified
during try-in are rechecked.
The two major characteristics that determine the suc-
cess of a denture are its fit and function.
Fit includes proper adaptation, patient comfort, ade-
quate extension, and aesthetics of the denture.
Function includes occlusal harmony, speech, accurate
jaw relation, retention, and stability during mastication, etc.
Steps in Complete Denture Delivery
A. Checking for the Fit of the Prosthesis
i. Examining the dentures
• Before inserting the denture, the clinician should feel
the borders of the denture to check for any sharp projec-
tions or rough ends.
• The tissue surface of the denture is examined for the
presence of voids or nodules.
ii. Examining the patient's mouth
• The oral mucosa is examined thoroughly to rule out
overextension of the denture.
iii. Checking for adaptation
• The denture is placed in the patient's mouth along its path
of insertion. First, the adaptation of the denture is checked
at the posterior palatal seal area using a mouth mirror.
• There should not be any space left between the posterior
border of the denture and the tissues. The patient is
asked to say 'ah' in unexaggerated short bursts and the
palatal seal reverified. Mandibular denture adaptation is
checked at distolingual extension.
iv. Checking for border extension
• The cheeks are elevated and the denture borders are
examined.
• The buccal and labial mucosa is stretched to check for
any denture displacement. If the denture has overex-
tended borders, then it will get displaced while stretch-
ing the mucosa.
v. Checking for frenal relief
• The labial frenum is thin and hence requires a deep
notch-like relief at the middle of the labial flange.
• The buccal frenum is more compressible (less sensitive
to compression than labial frenum). This frenum tends
to bend and adapt to the denture. Hence, it does not
require a critical relief.
• Secondly, there are multiple frena on either side, hence
providing a shallow notch in this region will be suffi-
cient. It should be remembered that the buccal frena are
attached to active muscle fibres and, if not relived, may
tend to displace the denture during function.
vi. Evaluating the denture aesthetics
Patient's lip support, cheek support, vertical height, low lip
line, high lip line, smile line, etc., are examined. These fac-
tors are usually examined thoroughly during try-in. Hence,
a simple verification would be sufficient.
B. Checking of the Denture Function
i. Evaluating the retention and stability of the
denture
Retention is evaluated by checking for the peripheral seal of
the denture.
First, posterior seal is checked followed by anterior seal.
• Posterior seal checked by gently pressing the anterior
teeth perpendicular to the path of insertion. This proce-
dure tends to lift the posterior part of the denture. If
there is adequate seal, the dentist can feel the resistance
offered by the denture against this force.
• Next, anterior seal is evaluated. The denture is pulled
against the path of insertion. The resistance offered by
the denture against this force gives the anterior seal.
Stability is examined by checking for any kind of
displacement during chewing cycle, speech, etc.
ii. Checking the jaw relation
The vertical and horizontal jaw relations are examined
thoroughly as done in try-in and patient's perception of
comfort is also verified.
iii. Speech
It is the most challenging functions that should be repro-
duced in a denture.
• Denture wearers have a shallow pronunciation, because
of the smooth palatal surface.
• In a natural environment, the rugae enhance speech.
• In a denture, speech is affected due to the absence of rugae.
• Use of a metal denture base improves speech, because
the metal can be fabricated thin enough to reproduce the
rugae on the external surface.
• Other factors that affect speech like injury to the exter-
nal laryngeal nerve, presence of tongue-tie, etc., should
also be ruled out.
• Dentures play different roles in the production of differ-
ent sounds:
• Bilabial sounds (b, p, and m): These are controlled
by lip support and become defective due to its

absence or alteration in vertical dimension at
occlusion.
• Labiodental sounds (f and v ): These are governed by
relation of the incisal edges of the upper anterior
teeth to the lower lip. If the teeth are set too high then
'.f'will sound like 'v '.
• Linguodental sounds ('th'): These are governed by
position of tongue between upper and lower anteri-
ors. Normally, the tongue should project 3 mm ante-
riorly between the teeth. If the tongue gets positioned
about 6 mm in front of the teeth, then, it means, the
teeth have been set very lingually.
• Linguoalveolar sounds (t, d, s, z, v, and 1): These are
made when the tongue touches the anterior part of
palate. These are the most important of all sounds in
a complete denture, because it is determined by the
thickness of the denture base. If the denture is very
thick, the patient is forced to pronounce the sounds
in a shallow blunt manner.
• 'S' sound: It is controlled by the anterior part of the
palatal plate of the denture base.
• It is considered separately because it is produced in
two tongue positions and also called as the dental
and alveolar sound.
• A narrow groove formed by the tongue in the midline
against the palate results in a space. The size of this
space determines the quality of the sound.
During the 's' sound, the following articulatory characteris-
tics are noticed.
• The tip of the tongue is near (not touching) the upper
anteriors.
• The dorsum of the tongue is flat and a groove is formed
in the midline of the tongue.
• The mandible moves forward and upward till the teeth
are almost in contact.
• The acoustic character of 's' sound is a strong high
frequency sound wave of 3-4 kHz. Auditory character
of 's' sound is a sharp loud sound.
• Linguopalatal and linguoalveolar sounds (year, she) are
not very important in a complete denture, as they are
independent of the denture base.
iv. Occlusal harmony
• If the jaw relation is accurate, errors in occlusion are
very rare.
• Usually, occlusal disharmony is not corrected during the
insertion appointment.
• The patient is asked to wear the denture continu-
ously for 24 h and then the occlusal corrections are
made.
• Occlusal disharmony can be identified using interoc-
clusal check record or an articulating paper.
i. Using interocclusal check records: When the patient
reports after 24 h, interocclusal check record is
Quick Review Series for BOS 4th Year: Prosthodontics
obtained. Interocclusal record material like ZnOE is
placed on the teeth and the patient is asked to bite.
High points are detected by the presence of perfora-
tions in interocclusal records. The high points are
reduced carefully using a bur and the occlusion is
reverified.
ii. Using articulating paper: In this, high points (pre-
mature, deflective contacts) are detected by placing
the articulating paper between the teeth and the
patient is asked to bite on it. The paper is dragged
away slowly. There should be even resistance to the
movement of the articulating paper. If the paper
slides freely, then, it means there is no contact. If the
paper does not slide away at anyone particular point,
it indicates the presence of a high point. The articu-
lating paper itself marks the high points. The high
points are reduced till the marking colour fades away
and occlusion is rechecked.
If all the above factors are satisfactory, then initial
insertion is complete.
The patient is called after 24 h to check for any soft
tissue reaction. Patient is then called after a week for
review.
Finally, periodic review is conducted once in every
3-6 months to check for soft and hard tissue changes, etc.
Q. 10. Burning mouth syndrome.
Ans.
Burning Mouth Syndrome (BMS)
• It is characterized by burning sensation in the structures
in contact with dentures without any visible changes in
the mucosa.
• In burning mouth sensation, mucosa is often inflamed
due to mechanical irritation, infection, or an allergic
reaction; whereas in BMS, the mucosa is clinically
healthy.
A. Epidemiology
• It is common in post-menopausal women above
50 years of age.
• The general complaint includes burning sensation of
the supporting structures of the denture and the tongue.
• The syndrome is aggravated by fatigue, tension, and
intake of hot foods. The intensity of pain and burning
sensation is reduced during eating, sleeping, mental
distraction, etc.
B. Clinical Features
• This condition does not have any overt clinical signs or
symptoms.
Section I I Topic Wise Solved Questions of Previous Years

• Pain starts in the morning and aggravates during the Systemic factors
day. • Vitamin and iron deficiency.
• Burning sensation is usually accompanied with dry • Xerostomia.
mouth and persistent altered taste sensation. • Menopause.
• Other associated symptoms include headache and • Diabetes.
insomnia. • Medication.
• Decreased libido and irritability or depression.
Psychogenic factors
• Anxiety.
C. Aetiology • Depression.
Local factors
D. Treatment
• Mechanical irritation caused by ill-fitting dentures.
• Prolonged period of masticatory muscle activity. • BMS patients are more psychologically affected. They con-
• Constant parafunctional movements of the tongue. sider that their psychiatric disorders are due to poor dentures.
• Constant excessive friction on the mucosa. • These patients may need counselling to understand the
• Candida! infections and allergic reactions can produce irrelevance of the dentures with regard to their mental
symptoms similar to EMS. health and also to eliminate their fears. The patient's
• Myofacial pain. symptoms are given first priority.

SHORT NOTES
Q. 1. Perleche. Symptoms
Ans. • Mild with single or numerous lesions showing flaps of
hyperplastic connective tissue.
• Deep ulcerations, fissuring, and inflammation may
Perleche
occur at the depth of the sulcus.
• It is also known as angular cheilitis. • The lesions usually subside after surgical excision of the
• It is a deep crease formed at the comer of the mouth. tissues and correction of the dentures.
Constant wetness due to saliva leads to infection and
soreness. Q. 3. Post-insertion problems of complete denture.
• Comers of mouth are moist and drooping. Ans.
• Fungal infection is seen at the folds.
• This condition is seen in cases of decreased vertical
dimension and also in cases of vitamin deficiency or Post-insertion Problems of Complete
secondary to fungal (candida) infection in the mouth. Denture
Q. 2. Epulis fissuratum. Post-insertion problems can be divided into three broad
categories:
Or
Denture irritation hyperplasia. a. Decrease in Denture Retention
Or • Lack of seal.
Denture hyperplasia.
• Air beneath the impression surface of denture/lack of seal.
• Xerostomia.
Ans. • Neuromuscular control.

Denture Irritation Hyperplasia (Epulis b. Decrease in Denture Stability

Fissuratum) • Overextension of denture borders in depth and width.
• Hyperplastic reaction of the mucosa occurring along the • Denture is not in optimal space (denture borders are not
borders of the denture. in neutral zone).
• Lesions result from trauma due to unstable dentures • Occlusion: Uneven initial contact can cause dis-
with thin denture flanges. placement.

• Poor fit of supporting tissues (recoil of displaced tissues
lifts dentures).
c. Decrease in Denture Support
• Lack of ridge support.
• Fibrous displaceable tissue: Due to which, during mas-
tication the denture tends to sink in.
• Bony prominences are covered with thin mucosa, e.g.,
prominent maxillary midline suture, tori, and posterior
nasal spine.
• Nonresilient soft tissue: This does not adapt the tissue
surface of denture.
Q. 4. Denture adhesives.
Ans.
Denture Adhesives
Denture adhesives enhance denture retention, stability, and
function.
Mode of Action
Its effectiveness depends on both physical and chemical
factors of the material.
• Water absorption: The adhesive tends to swell from 50
to 150% by volume in the presence of water. Water
absorption of the adhesive results in the formation of
anions that are attracted to cationic proteins in the
mucus membrane producing stickiness.
• Bioadhesion by carbonyl groups: Carbonyl groups in
the adhesive material provide strong bioadhesive
and biocohesive forces, which improve the retention
of the denture, e.g., polymethyl vinyl ether maleic -
anhydride or PYM/MA has a high level of these
carbonyl groups.
• PYM/MA and zinc and calcium salts with CMC have
superior retention, because of the stronger covalent
bond that develops due to its divalent interaction.
Indications for the Use of Denture Adhesives
• To improve retention and stability of the dentures (that
are poorly retained or unstable).
• To improve stability of a denture for a new or inexperi-
enced patient.
• To improve retention and stability of denture that is
poorly retained or unstable.
• To stabilize trial bases during fabrication and insertion
of the trial denture.
• For handicapped patients.
• Patients with xerostomia.
• Geriatric patients.
Quick Review Series for BOS 4th Year: Prosthodontics
• Patients with poor muscle tone (such as those with
Parkinson's disease, Tardive dyskinesia, and dysarthria).
• To provide a psychological sense of security for specific
patients (such as actors, teachers, etc.).
• To simplify the insertion for patients with tactile or
movement deficiency, e.g., cerebral trauma patients.
• As an adjunct to the maxillary prosthesis.
Q. 5. Need for periodic recall of complete denture
patients.
Ans.
• Regular recall to check for proper denture extension and
occlusion.
• Patient is recalled after 24 h of insertion to correct
occlusal disharmony and to check for immediate tissue
reaction.
• Next, patient is called after 1 week to check for tissue
reaction and his/her comfort enquiry done and problems
corrected.
• Next, patient is recalled after 3-6 months to determine
tissue reaction and see the amount of residual ridge
resorption.
• Post-insertion instructions should be reinforced during
recall appointments.
• In case of any tissue reactions like ulcers, soreness, etc.,
the patient is advised to stop wearing the prosthesis and
report immediately to the dentist.
• Yearly recall visit to check the need for relining/
rebasing.
Q. 6. Denture stomatitis.
Ans.
Denture Stomatitis
• It is the pathological reaction of the palatal portion of
the denture-bearing mucosa.
• It is commonly known as 'Denture-induced stomati-
tis', 'Denture sore mouth', 'Denture stomatitis',
'Inflammatory papillary hyperplasia', or 'Chronic
atrophic candidiasis'.
• It is seen in 50% of the complete denture wearers.
Classification (By Newton)
• Type I: Localized simple infection with pinpoint hyper-
aemia.
• Type II (Erythematous type): Generalized simple type
presenting a more diffuse erythema involving a part or
the entire denture covered mucosa.
• Type III: Granular type involving the central part of the
hard palate and alveolar ridge. It is often seen in asso-
ciation with types I and II.
Section I I Topic Wise Solved Questions of Previous Years
Q. 7. Denture cleansing agents.
Ans.
Denture Cleansing Agents
Dentures can be cleaned manually or through chemical
cleaning agents. Usually two of them are combined.
Manual Cleansing
i. Denture brush
• It is used along with a mild detergent or a denture paste
(which is low in abrasive) and water.
• Regular paste use is contraindicated, as they contain
abrasives which can cause excessive wearing of resin.
• Gentle brushing with a soft brush and a nonabrasive
cleanser combined with overnight soaking is an effec-
tive cleaning method.
ii. Sonic cleansers
These use vibratory energy (not ultrasonic energy) to clean
the dentures. In combination with hypochlorite solutions they
are very effective in removing calculus as well as cigarette
and coffee stains.
Chemical Denture Cleansers
Commercial preparations
• They are safe and effective.
• Most commercial solutions contain a bleaching agent
such as sodium hypochlorite.
• Some are available in the form of tablets which effer-
vesce when dropped in water releasing bubbles.
• The dentures are left in this for at least 15 min or even
over night. The dentures are rinsed before use.
• Caution: Cleansers containing sodium hypochlorite are
not indicated with chrome cobalt or other metal-based
dentures. The hypochlorite may pit or damage the metal.
Q. 8. Diet in complete denture.
Ans.
• There is decrease in mastication ability in complete
denture wearer, due to absence of natural teeth and pro-
prioceptive impulses and therefore decreased chewing
efficiency.
• Patient is asked to prefer soft diet and avoid biting on
hard food, as it may cause denture fracture.
• More of protein intake to counteract weakness due to
less food intake, and avoid fatty food.
• Intake of tea/coffee may cause denture discolouration.
• Avoid extremely hot food/drink, as it causes warpage
of denture.
• Avoid acidic food and drinks, as they cause abrasion of
denture and teeth.
Q. 9. Gag reflex.
Ans.
• Gag reflex is the normal, healthy defence mechanism
which functions to prevent foreign bodies from entering
the trachea.
• It is triggered by tactile stimulation of the soft palate,
posterior part of tongue, and fauces.
• Other stimuli like sight, smell, taste, noise, and psycho-
logical factors can produce gagging.
• In sensitive patients, new dentures may stimulate
gagging, but this disappears as the patient adapts to the
dentures.
• Persistent gagging can occur due to overextended
denture borders, especially in the posterior part of
maxillary denture and the distolingual part of man-
dibular denture. Gagging usually produces displace-
ment of the denture.
• Gagging may occur due to unstable occlusal conditions,
e.g., increase in vertical dimension of occlusion, be-
cause the unbalanced occlusal contacts may displace the
denture and trigger gagging.
• It can also result from other systemic conditions like
GIT disorders, adenoids, or tumours in the upper respi-
ratory tract, alcoholism, and severe smoking.
• Limiting the posterior extension of the dentures and
exercises help to decrease gagging.
Q. 10. Articulating paper.
Ans.
Articulating Paper
Articulating paper is used to detect high points in
denture ( occlusal errors) either intraorally or during lab
remounting.
Procedure
• Articulating paper is placed between the occlusal
surfaces of the upper and lower dentures bilaterally
(placing the articulating paper on one side alone may
cause the patient to deviate to or away from that
side).
• The patient is asked to occlude repeatedly through a
firm tapping motion.
• Initially, the occlusal errors in centric relation are cor-
rected by selective grinding. The marks should be
distributed widely and evenly.
• Next, working side, balancing side, protrusive errors, or
prematurities are corrected.
 Quick Review Series for BOS 4 th Year: Prosthodontics

Disadvantages Treatment
Correction using articulating paper alone is less accurate Preprosthetic surgery can be done to increase the height
when compared to clinical remounting. of the ridge (ridge augmentation) or depth of the sulcus
• Inaccurate mouth closure by the patient. (vestibuloplasty).
• It also requires a lot of patient cooperation.
• The patient should have good neuromuscular control. Q. 12. Injection moulding technique.
• Besides there is also the problem of saliva. Ans.

Q. 11. Residual ridge resorption.

Injection Moulding Technique
Ans.
This technique requires special equipment and material
(a special thermoplastic resin).
Residual Ridge Resorption
• Residual ridge resorption is the most common and Procedure
important sequelae of wearing complete denture. • A stone mould is created in a special flask and material
• There is continuous loss of bone after tooth extraction is introduced into this through a sprue.
and after placement of complete denture. • Resin is softened by heat in an injector and introduced
• It is more common in women due to osteoporotic under pressure into the mould. It is kept under pressure,
changes in bone. until it hardens.
• It is alveolar remodelling, which occurs due to change
in the functional stimulus of bone tissue.
• It is a chronic progressive change in the bone structure, Advantages
which results in severe impairment in the fit and function • Dimensional accuracy.
of the prosthesis. • Low free monomer content.
• It is more important in areas with thick cortical • Good impact strength.
bone, i.e., the buccal parts of the maxilla and lingual • No trial closures required.
parts of the mandible that serve as load-bearing
regions.
Disadvantages
• It occurs more rapidly in first 6 months after teeth
extraction and at a slower pace till 12 months. • High cost of equipment.
• Difficult mould construction.
• Less craze-resistants.
Clinical Features
Q. 13. Bilabial sounds.
• Reduction in depth and width of sulcus due to ridge
resorption, till the level of the muscle attachment oblit- Ans.
erates the sulcus.
• Decreased vertical dimension at occlusion.
Bilabial Sounds
• Reduction of the lower facial height.
• Increase in relative prognathism. Bilabial sounds (b, p, and m) are controlled by lip support
• Sharp, spiny, and uneven ridge crest due to difference in and become defective due to its absence or alteration in
rate of resorption from one place to another. vertical dimension at occlusion.
• Long-term resorption affects support stability and reten- They require both the lips for their production.
tion of dentures. Test sentence-BOBBY POPPED MY BALLOON.
Section I I Topic Wise Solved Questions of Previous Years

------------------ - <( Topic 9)

Relining and Rebasing in Complete Dentures

LONG ESSAYS
Q. 1. Patient aged 55 years, complete prosthesis wearer
for last 15 years complains of skidding of prosthesis on
examination and both maxillary and mandibular ridges
are hyperplastic. Give your method of treatment for the
patient.
Or
• Abused oral tissues (should be allowed to recover).
• TMJ problems which should be treated first.
• Poor teeth arrangement and poor aesthetics.
• Unsatisfactory jaw relationship.
• Severe bony undercuts-surgical removal should be done.
• Major speech problem with denture.

What is relining and rebasing of complete dentures?

How would you proceed to reline the maxillary com- Relining Materials and Techniques
plete denture? • Relining with auto-polymerizing acrylic resin.
Or • Relining with permanent soft liners.
• Relining with tissue conditioning material (temporary
State the clinical indication for relining and rebasing of soft liner).
complete dentures and discuss the hazards of relining
procedures.
Procedure
Ans.
It is divided into two parts:
I. Clinical procedures-same for relining and rebasing.
Relining of Complete Dentures II. Laboratory procedures-different for both.
The procedures used to resurface the tissue side of a re-
movable dental prosthesis with new base material, thus I. Clinical procedures
producing an accurate adaptation to the denture foundation Tissue preparation
area (GPT). Health of tissue is important. It includes following proce-
dures:
Indications of Relining • Surgical removal of hypertrophic tissues.
• Dentures left out of mouth before making final impression
i. Change in denture-bearing area due to resorption which for 2-3 days.
include • Daily massage of tissue.
• Loss of retention, stability, and support. • Use of tissue conditioners.
• Loss of vertical dimension.
• Incorrect occlusal relationship and reorientation of Denture preparation
occlusal plane.
ii. Immediate denture cases after 3-6 months of fabrication. • Relief of pressure areas and large undercuts.
• Tissue side of denture relieved by 1.5-2 mm.
iii. Socioeconomic condition-patient cannot afford new
dentures. • Correction of occclusal disharmony.
• Periphery of denture is shortened to obtain a flat
iv. Geriatric/chronically ill patients.
border.
v. Patient unable to come for multiple appointments for
new denture.
vi. Ill fitting of new denture at the time of denture Final Impression: Techniques
delivery.
I. Static impression techniques
a. Closed mouth technique.
Contraindications for both Relining and Rebasing b. Open mouth technique.
II. Functional impression technique
• Denture base of poor condition or quality.
• Using a tissue conditioner.
• Excessive resorption of ridge.

I. Static impression techniques
a. Closed mouth technique
Procedure
It is a two-step technique.
• Centric relation is recorded using interocclusal record
(wax or compound) which guides the dentures into
position while making reline impression.
• Borders are reduced to 1-2 mm except in posterior
region and are reformed to functional contours using
low-fusing compound.
• For large undercuts 1.5-2 mm relief should be provided.
• Palate centre portion can be removed for visibility of
maxillary denture positioning. In this case, quick setting
plaster is used as impression material.
• ZnOE is used as impression material and patient is
asked to close lightly into the newly made interocclusal
record.
Advantages
• Opening of palate allows better seating of denture and
correct recording of vertical dimension.
• It helps to orient dentures into articulator.
• Forward movement of maxillary denture is prevented
and hence reliable.
• Pre-made interocclusal record helps in positioning
denture during impression making.
Disadvantages
• Less accurate wax interocclusal record.
• Dentures cannot be relined/rebased simultaneously.
b. Open mouth technique: By Boucher (1973)
Procedure
• Dentures are used as impression trays and both upper
and lower denture relined at the same time.
• PPS is formed in modelling compound.
• Borders are shortened and 1 mm space on tissue side is
made by bur.
• To lower denture, modelling compound handle is
attached.
• Overpolished surface adhesive tapes are placed.
• Border moulding done with green stick compound.
• Final impression is taken using ZnOE/elastomers.
• Centric record made using impression as record bases.
Disadvantage
• Demanding, laborious, and require more chair and labo-
ratory time.
II. Functional impression technique with tissue
conditioner (temporary soft liner)
Tissue conditioners are used both as functional impression
material and to bring tissues back to health.
Quick Review Series for BOS 4th Year: Prosthodontics
Procedure
• Existing intercuspation is used to stabilize the denture.
• Centric record made using compound/wax.
• Denture preparation same as above technique.
• Where flanges are underextended, border moulding is
done.
• Tissue conditioner is placed, excess material trimmed
off, and patient is sent.
• After 3-5 days, denture is examined for denuded areas,
which are marked and relieved and tissue conditioner
reapplied there.
• Patient is reviewed periodically and material renewed
until the tissues regain health.
• Old material is removed and new one applied for taking
final impression and kept for 30 min.
• Once set, it is removed and cast poured.
II. Laboratory procedures for relining
i. Articulator method
• Maxillary cat mounted on a semi-adjustable articulator
using face-bow.
• Modelling clay is adapted on denture to block all sur-
faces except the occlusal teeth surfaces.
• Stone index of occlusal surface is made
• Impression material is removed along with thin resin
layer from denture inside.
• Tinfoil substitute is coated, auto-polymerizing resin
mixed, and placed on denture and cast.
• Denture is seated in stone index and articulator closed.
• Once set, fired in pressure chamber (at I 5-20 psi for
30 min).
ii. Chair-side reline technique
• Dentures relined directly in the patient's mouth.
• But it is not recommended because
• Chemical burns can occur from the monomer.
• Pporosity, poor colour stability, and poor odour.
• Difficulty in removal of material.
iii. Flask method
It is done using silicone mould material.
Rebasing of Complete Dentures
It is the laboratory process of replacing the entire denture
base material on an existing prosthesis (GPT-8).
Indications
• When denture base needs to be changed due to some pro-
cessing defects, e.g., due to discolouration, porosity, etc.
• When porcelain teeth are used.
• Observed clinical changes are mild to moderate.
Section I I Topic Wise Solved Questions of Previous Years

• Denture teeth are in good condition. • Stone index-imprint of occlusal surface of teeth is
• Clinical procedure same as relining. made.
• Teeth are separated from denture base and reassembled
Laboratory Technique for Rebasing in stone index.
• Waxing of denture is done followed by flasking and
Jig or Articulator method curing.
• Impression technique is same as relining.
• Cast poured and mounted on articulator.

SHORT ESSAYS
Q. 1. Indications, diagnosis, and contraindications for vii. Severe bony undercuts for which surgical removal
relining and rebasing. should be done.
viii. Major speech problem with denture.
Or
Relining and rebasing of complete denture.
Rebasing of Complete Denture
Or
It is the laboratory process of replacing the entire denture
Denture relining. base material on an existing prosthesis (GPT-8).
Ans.
Indications
Relining of Complete Denture i. When denture base needs to be changed due to
some processing defects, e.g., due to discolouration,
These are the procedures used to resurface the tissue side of
porosity, etc.
a removable dental prosthesis with new base material, thus
ii. When porcelain teeth are used.
producing an accurate adaptation to the denture foundation
iii. Observed clinical changes are mild to moderate.
area (GPT).
iv. Denture teeth are in good condition.
Q. 2. Open mouth relining technique.
Indications of Relining
Ans.
i. Change in denture-bearing area is due to resorption
which include
• Loss of retention, stability, and support. Open Mouth Technique: By Boucher (1973)
• Loss of vertical dimension.
• Incorrect occlusal relationship and reorientation of
Procedure
occlusal plane. • Dentures are used as impression trays and both upper
ii. Immediate denture cases after 3-6 months of fabrication and lower denture relined at the same time.
iii. Socioeconomic condition-patient cannot afford new • PPS is formed in modelling compound.
dentures. • Borders are shortened and 1 mm space on tissue side is
iv. Geriatric/chronically ill patients. made by bur.
v. Patient unable to come for multiple appointments for • To lower denture, modelling compound handle is
new denture. attached.
vi. Ill-fitting of new denture at the time of denture delivery. • Overpolished surface adhesive tapes are placed.
• Border moulding is done with green stick compound.
Contraindications for Both Relining and Rebasing • Final impression is taken using ZnOE/elastomers.
• Centric record is made using impression as record
Denture base of poor condition or quality.
i. bases.
Excessive resorption of ridge.
ii.
iii.Abused oral tissues (should be allowed to recover).
iv.TMJ problems which should be treated first.
Disadvantage
v. Poor teeth arrangement and poor aesthetics. • Demanding, laborious, and require more chair and
vi. Unsatisfactory jaw relationship. laboratory time.

Q. 3. Midline fracture of complete denture.
Or
Causes for midline fracture of maxillary complete
denture.
Ans.
Causes for Midline Fracture
i. Accidental dropping during removal or cleaning.
ii. Inability to handle denture due to poor neuromuscular
control, e.g., senility and parkinsonism.
iii. Faulty denture design resulting in areas of inadequate
thickness.
iv. Prominent median palatine raphe with inadequate relief.
v. Faulty occlusion.
vi. Excessive amounts of masticatory force applied by
some individual.
vii. Poor laboratory techniques during deflasking and
polishing procedures.
Q. 4. Complete denture repair.
Or
Repair and relining of complete denture.
Ans.
Denture Repair
Material for Denture Repair
• Self-cure/auto-polymerizing acrylic resin is simple,
quick, and accurate, but less strong.
• Heat cure not used due to chances of warpage of denture
under heat.
• Visible light cured (VLC) is new, easy to use, can be
carved, gives quick cure, and there is no warpage.
Procedure
A. Segment assembling
i. Fracture site is cleaned of debris.
ii. Pieces are accurately assembled and stabilized using a
rigid material like an old bur and sticky wax (not placed
over fracture site for better visualization) or quick
acting cyanoacrylate super glue.
B. Cast pouring
i. Undercuts blocked out.
ii. Plaster poured into denture to make cast.
C. Preparation of fracture site
i. Denture separated from cast and 2-3 mm acrylic is
removed from fracture site.
Quick Review Series for BOS 4th Year: Prosthodontics
ii. Wide bevel created on either side of fracture line.
iii. Separating media is applied followed by replacing
back the denture on cast.
D. Repairing and curing
i. Self-cure acrylic powder and liquid applied incrementally
and alternatively until the fracture site is filled in excess.
ii. Curing carried out in a pressure pot at 100°F at 30 psi
pressure for 30 min.
iii. Pressure curing increases density and strength.
iv. Once curing is completed, denture removed from cast,
trimmed, and polished.
Problems with Denture Repair
i. It may not fit well after repair.
ii. Occlusal changes might occur.
Contraindications for Denture Repair
i. Accurate assembly of fractures pieces is not possible.
ii. Poor fit and excess occlusal wear requires replacement
with new dentures.
Q. 5. Close mouth relining technique of denture repair.
Ans.
Closed Mouth Technique
Procedure
It is a two-step technique.
• Centric relation is recorded using interocclusal record
(wax or compound) which guides the dentures into posi-
tion while making reline impression.
• Borders are reduced to 1-2 mm except in posterior
region and are reformed to functional contours using
low-fusing compound.
• For large undercuts 1.5-2 mm relief should be provided.
• Palate centre portion can be removed for visibility of
maxillary denture positioning. In this case, quick setting
plaster is used as impression material.
• ZnOE is used as impression material and patient is
asked to close lightly into the newly made interocclusal
record.
Advantages
• Opening in palate allows better seating of denture and
correct recording of vertical dimension.
• It helps to orient dentures into articulator.
• Forward movement of maxillary denture is prevented
and hence reliable.
• Pre-made interocclusal record helps in positioning
denture during impression making.
Section I I Topic Wise Solved Questions of Previous Years
Disadvantages
• Less accurate wax interocclusal record.
• Dentures cannot be relined/rebased simultaneously.
Q. 6. Age changes in edentulous patients.
Or
Define the term geriodontology. What are the age
changes that occur in geriatric patients?
Ans.
Geriodontology is the branch of dentistry dealing with oral
health problems of the elderly.
Age Changes in Geriatric Patient
Physiological Changes
• Oral mucosa becomes thin, gets easily abraded, and
reacts unfavourably to pressure-form dentures.
• Skin becomes thin, dry, wrinkled, and accumulation of
melanin increases. Repair potential is depleted.
• Gross reduction in residual ridge height and width due
to long-term wear of denture.
• Tongue becomes smooth, glossy, and inflamed leading
to soreness; there is burning and abnormal taste and
nodular varicose enlargement of superficial veins is
seen on tongue undersurface.
• Decreased secretion of saliva due to atrophy of salivary
glands leading to dry mouth and decrease in denture
retention and increased functional trauma to mucosa.
• Reduced neuromuscular coordination, decrease in mas-
ticatory abitily, sagging of cheeks due to reduced
muscle tone, and decreased nerve conduction.
SHORT NOTES
Q. 1. Relining and rebasing.
Or
Denture relining.
Or
Steps in rebasing of complete dentures.
Ans.
Relining
These refer to the procedures used to resurface the tissue
side of a removable dental prosthesis with new base mate-
rial, thus producing an accurate adaptation to the denture
foundation area (GPT).
Psychological Changes
• High incidence of depression and insecurity feelings in
geriatrics.
• Tooth clenching habit which place extra stress on
tissues.
• Increased usage of drugs.
Pathological Changes
• Presence of chronic disorders, such as heart diseases,
hypertension, TB, diabetes (more bone resorption),
bone diseases, and cancer. Death may occur due to ce-
rebral haemorrhage, heart disease, and arteriosclerosis.
• Thiamine deficiency leading to accumulation of pyruvic
acid and pheripheral neuritis.
• Difficult to clean the denture due to arthritis of terminal
joints of fingers.
• Osteoarthritis of TMJ is associated difficulty in making
mandibular movements.
Age Changes in Teeth of Geriatric Patient
• Enamel: Attrition of occlusal and proximal surface,
localized increase in nitrogen and fluorine content, teeth
become darker, and there is increased resistance to
decay and reduced permeability to fluids.
• Dentine: Development of dead tracts, reparative dentine
formation, and collagen fibres appear in dentinal tubules.
• Pulp: Cell number, size, and number of organelles de-
crease; there is less perinuclear cytoplasm and presence
of long processes; there is accumulation of collagen
fibre leading to fibrosis, presence of pulp stones, and
plaque in pulpal vessels.
Rebasing
It is the laboratory process of replacing the entire denture
base material on an existing prosthesis (GPT-8).
Steps in Rebasing
Clinical procedure
a. Tissue preparation.
b. Denture preparation.
c. Final impression techniques
i. Static impression technique
• Closed mouth technique.
• Open mouth technique.
ii. Functional impression technique
• Using a tissue conditioner.
 Quick Review Series for BOS 4th Year: Prosthodontics

Q. 2. Resilient liners. Q. 3. Complete denture repair.

Or Ans.

Soft liners.
Denture Repair
Ans.
Material for Denture Repair
Resilient Liners • Self-cure/auto-polymerizing acrylic resin is simple,
quick, and accurate, but less strong.
Resilient liners are also called as tissue conditioners.
• Heat-cure not used due to chances of warpage of den-
ture under heat.
Functional Impression Technique with Tissue • Visible light cured (VLC) is new, easy to use, can be
Conditioner (Temporary Soft Liner) carved, there is quick cure, and there is no warpage.

Tissue conditioners are used both as functional impression

materials and to bring tissues back to health. Procedure
• Segment assembling.
• Cast pouring.
Procedure • Preparation of fracture site.
• Existing intercuspation is used to stabilize the • Repairing and curing.
denture.
• Centric record is made using compound/wax. Problems with Denture Repair
• Denture preparation is similar to normal procedure.
• Where flanges are underextended, border moulding is • It may not fit well after repair.
done. • Occlusal changes might occur.
• Tissue conditioner is placed, excess material trimmed
Q. 4. Tissue preparation for relining.
off, and patient is sent.
• After 3-5 days, denture is examined for denuded areas, Ans.
which are marked and relieved and tissue conditioner
reapplied there. Tissue preparation includes following procedures:
• Patient is reviewed periodically and material renewed • Surgical removal of hypertrophic tissues.
until the tissues regain health. • Dentures left out of mouth before making final impres-
• Old material is removed and new one applied for taking sion for 2-3 days.
final impression and kept for 30 min. • Daily massage of tissue.
• Once set, it is removed and cast poured. • Use of tissue conditioners.

-------------------,(Topic 10)
Special Complete Dentures and Miscellaneous

LONG ESSAYS
Q. 1. Enumerate the advantages and disadvantages of Define overdenture. Discuss in detail the following in
overdenture. treatment planning of an overdenture.
Or Selection and preparation of an abutment tooth.
Section I I Topic Wise Solved Questions of Previous Years

Objectives or goals of overdenture treatment.
Or
What are overdentures? Describe their indications, con-
traindications, advantages, and disadvantages.
Or
What is 'preventive prosthodontics'? Give the advan-
tages, disadvantages, and principle of overdentures.
Ans.
Overdentures
Overdentures are also known as tooth-supported dentures,
overlay dentures, onlay dentures, telescoped dentures, hy-
brid dentures, biologic dentures, coping prosthesis, and
superimposed dentures.
Definition
Any removable dental prosthesis that covers and rests on
one or more remaining natural teeth, the roots of natural
teeth, and/ or dental implants; a dental prosthesis that cov-
ers and is partially supported by natural teeth, natural tooth
roots, and/or dental implants (GPT-8).
Classification
Based on method of abutment preparation
i. Noncoping
• With endodontic therapy.
• Without endodontic therapy.
ii. Coping
• With endodontic therapy (short coping).
• Without endodontic therapy (long coping).
iii. Attachments.
Based on type of overdenture
i. Immediate overdenture.
ii. Transitional overdenture.
iii. Remote overdenture.
• Patients with congenital or acquired intraoral defects
i. Partial anodontia and microdontia.
ii. Cleft palate.
iii. Amelogenensis imperfecta.
• In case of severe attrition, vertical height can be restored
with an overdenture.
• Very young patients facing total extraction.
• Patients with few remaining natural teeth.
• Low caries index and good oral hygiene.
Contraindications
• High caries index and poor oral hygiene
i. When the abutments have a doubtful prognosis.
ii. When endodontic treatment is not possible.
iii. When periodontal therapy and reduction of crown-
root ratio does not improve periodontal health.
• Failure to establish a sufficient zone of attached gingiva.
• Uncooperative, terminally ill, or senile patients.
Advantages
• Preservation of the alveolar bone. Presence of the abut-
ment teeth reduces resorption.
• Preservation of the proprioception. Oral function and
feeling is improved, because of the proprioceptive feed-
back from receptors in the root.
• Improved support, because of the abutment teeth.
• Improved retention. Retention devices can be attached
to abutment teeth when better retention is needed
• Less prychological trauma, as patients are able to retain
their original teeth.
• Can be converted to a routine complete denture in case
of abutment failure.
• To preserve the alveolar bone for as long as possible.
The over denture is a logical method for use in preven-
tive prosthodontics.
• Preserving the remaining natural teeth not only pre-
serves the alveolar bone, but also gives the patient better
function and control over the dentures, because of the
presence of nerve receptors.

Indications for Overdentures Disadvantages

• Patients with few remaining teeth. • High caries risk, especially for the noncoping abutments
• Patients with poor prognosis for routine complete den- due to coverage of the teeth by the denture.
tures • Risk of periodontal problems due to improper care by
i. High palatal vault. the patient.
ii. Xerostomia. • High initial cost due to the castings, precision attach-
iii. Poor mandibular ridges. ments, preceding endodontics, periodontal therapy, and
iv. When high rate of resorption is expected. other therapies.
v. When opposing natural teeth are present. • Long bony undercuts are often found near the abutment
vi. Smaller dental arches. teeth. They cause many problems like

i. Tissue injury during insertion and removal.
ii. To avoid the undercuts, the flanges are sometimes
shortened which can reduce the peripheral
seal.
iii. Blockage of the undercuts results in a flange placed
away from the tissues. This can result in aesthetic
problems due to the bulging of the lips. Spaces
between the tissues and the flange can also create a
food trap.
• Tooth arrangement is difficult in some cases, because of
the reduced interocclusal distance.
Basic principles to be followed:
• Abutment tooth should be surrounded by healthy peri-
odontal tissue.
• Maximum reduction of coronal portion of abutment
tooth should be done to attain better crown-root
ratio and avoid interference during placement of
artificial teeth. Endodontic therapy may be done, if
required.
• A simple tooth preparation without any internal attach-
ment can be done in a single visit especially for elderly
patients and compromised patients.
• Treatment should be accompanied with fluoride gel ap-
plication and other oral hygiene measures.
• Gold copings or crowns and sleeve coping retainers can
be given for grossly destructed abutments after assess-
ing the patient's susceptibility to caries.
• Gold coping can be prepared with posts and retentive
pins depending on the amount of tooth structure above
the gingival attachment.
• Attachments may be added to cast copings for addi-
tional retention which may be resilient or nonresilient
types.
Selection and Preparation of an Abutment Tooth
Dentist should preserve the ideal teeth and extract the re-
maining to reduce the cost of the prosthesis.
Factors to be considered while selecting abutment for
overdenture are:
i. Periodontal status of the abutment teeth
• Periodontally compromised teeth with horizontal
bone loss have a better prognosis than the ones with
vertical bone loss.
• A favourable crown-root ratio should be present in
cases with slight tooth mobility.
• A circumferential band of attached gingiva is an ab-
solute necessity for an overdenture abutment.
ii. Abutment location
• Cuspids and bicuspids are frequently selected as
overdenture abutments.
• Anterior teeth are not selected, as the anterior alveo-
lar ridge resorbs easily under stress.
Quick Review Series for BOS 4 th Year: Prosthodontics
• Maxillary incisors can be used as overdenture abut-
ments, if the mandibular arch is intact.
• At least one tooth should be retained in the quadrant
to maintain the health of oral tissues.
• The number and location of the abutment teeth and
the status of the opposing one should be evaluated
during treatment planning.
iii. Endodontic and prosthodontic status
• Usually anterior teeth (canines and premolars) are
preferred as overdenture abutment, as they are easier
to prepare and economical too.
• When there is pulpal recession or calcifications
along with extensive tooth wear, endodontic therapy
can be avoided.
Rationale/Objectives/Goals of Ovedenture
Treatment
• Reduction of crown-root ratio and the resulting forces
on the abutment teeth and supporting tissues.
• Shortening the natural tooth changes the crown-root
ratio which reduces the lateral stresses and lever
action on the tooth. The load is now in a more
occlusal direction which is better tolerated by the
tooth.
• The complete denture resting on these shortened teeth
exerts largely vertical forces directed towards the bone
which are better tolerated by the teeth.
• It also forms the basis of using mobile teeth which oth-
erwise would have been indicated for extraction. Reduc-
ing the crown-root ratio reduces the mobility of these
teeth and improves their prognosis.
Q. 2. What are the indications and contraindications for
an immediate complete denture?
Or
What are the advantages and disadvantages of immedi-
ate denture service?
Ans.
Immediate Complete Denture
Immediate complete denture is 'a complete or removable
partial denture constructed for insertion immediately fol-
lowing the removal of natural tooth' (GPT-7).
Indications
• For patients with periodontally weak teeth indicated for
extraction.
• For socially active people who are very conscious about
their appearance.
Section I I Topic Wise Solved Questions of Previous Years

Contraindications Q. 3. Define interim removable denture and give indica-

tions for use.
• Patient who is not fit to undergo multiple extractions,
e.g., blood dyscrasias and cardiac disease. Ans.
• In acute periapical or periodontal infection.
• Debilitating diseases.
Interim Removable Denture
• Patient incapable of showing responsibility towards the
treatment, e.g., senile, mentally retarded, and indifferent • Interim removable denture is a temporary partial den-
patients. ture used for a short period to fulfil aesthetics, mastica-
• In cases of extensive bone loss adjacent to remaining tion, or convenience, until a more definitive form of
teeth. treatment can be rendered.

Advantages Indications for Use

• It serves as a splint, reduces pain, controls bleeding, and
protects from trauma during the healing period.
• Patient regains function faster, e.g., speech and
mastication.
• Inconvenience and stress of edentulous period is spared
and patient can learn to manipulate the denture while
recovering from surgery.
• More compatible with oral surroundings as the tongue,
lips, and cheeks have not yet changed their position.
• Natural teeth aid in vertical relation positioning and
selecting artificial teeth.
• Less change in facial appearance and more aesthetic.
• Less TMJ disturbance.
• Aids in contouring the healing residual ridge.
• Psychological benefits.
• Easy to refit by relining.
Disadvantages
• Time-consuming and precise technique.
• More appointments needed.
• More costly.
• No opportunity for try-in of anterior teeth.
• Long edentulous span: As RPD can take support from
the tissues along the ridge and helps to distribute forces
over the ridge evenly.
• Age: In cases where fixed partial denture is contraindi-
cated such as young people, because of large dental
pulps and lacks sufficient crown height and in old age
due to reduced life expectancy.
• In cases of absence of abutment tooth for support.
• In cases of reduced periodontal support of remaining
tooth: As it requires less support from remaining teeth as
compared to fixed partial denture and also splints them.
• For cross-arch stabilization: To stabilize teeth against
lateral and anteroposterior forces with the help of major
connectors.
• In cases with excessive bone loss.
• Aesthetics: Denture base gives appearance of a natural
tooth arising from the gingiva with life-like appearance
and can be arranged more easily to satisfy phonetic and
aesthetic requirements.
• For immediate tooth replacement after extraction: Later
relining can be done, as resorption occurs.
• Patient's desires: In order to avoid operative procedures
on sound healthy teeth and for economic reasons.

SHORT ESSAYS
Q. 1. Immediate complete denture. Immediate Complete Denture
Or Immediate complete denture is 'a complete or removable
partial denture constructed for insertion immediately fol-
What is immediate denture? Write about indications lowing the removal of natural tooth' (GPT- 7).
and contraindications.

Or Indications
• For patients with periodontally weak teeth indicated for
Rationale, advantages, and disadvantages of immediate
extraction.
complete dentures.
• For socially active people who are very conscious about
Ans. their appearance.

Contraindications
• Patient who is not fit to undergo multiple extractions,
e.g., blood dyscariasis and cardiac disease.
• In acute periapical or periodontal infection.
• Debilitating diseases.
• Patient incapable of showing responsibility towards the
treatment, e.g., senile, mentally retarded, and indifferent
patients.
• In cases of extensive bone loss adjacent to remaining teeth.
Advantages
• It serves as a splint, reduces pain, controls bleeding, and
protects from trauma during the healing period.
• Patient regains function faster, e.g., speech and mastication.
• Inconvenience and stress of edentulous period is spared
and patient can learn to manipulate the denture while
recovering from surgery.
• More compatible with oral surroundings as the tongue,
lips, and cheeks have not yet changed their position.
• Natural teeth aid in vertical relation positioning and se-
lecting artificial teeth.
• Less change in facial appearance and more aesthetic.
• Less TMJ disturbance.
• Aids in contouring the healing residual ridge.
• Psychological benefits.
• Easy to refit by relining.
Disadvantages
• Time-consuming and precise technique.
• More appointments needed.
• More costly.
• No opportunity for trying of anterior teeth.
Q. 2. Overdenture.
Or
What are overdentures? Write the advantages and dis-
advantages.
Or
Write the requirements (indications) of an overdenture.
Ans.
Overdentures
Overdentures are also known as tooth-supported dentures,
overlay dentures, onlay dentures, telescoped dentures, hy-
brid dentures, biologic dentures, coping prosthesis, and
superimposed dentures.
Or
Any removable dental prosthesis that covers and rests
on one or more remaining natural teeth, the roots of natural
Quick Review Series for BOS 4th Year: Prosthodontics
teeth, and/or dental implants; a dental prosthesis that covers
and is partially supported by natural teeth, natural tooth
roots, and/ or dental implants.
Indications for Overdentures
• Patients with few remaining teeth.
• Patients with poor prognosis for routine complete dentures
i. High palatal vault.
ii. Xerostomia.
iii. Poor mandibular ridges.
iv. When high rate of resorption is expected.
v. When opposing natural teeth are present.
vi. Smaller dental arches.
• Patients with congenital or acquired intraoral defects
i. Partial anodontia and microdontia.
ii. Cleft palate.
iii. Amelogenensis imperfecta.
• In case of severe attrition, vertical height can be restored
with an overdenture.
• Very young patients facing total extraction.
• Patients with few remaining natural teeth.
• Low caries index and good oral hygiene.
Advantages
• Preservation of the alveolar bone. Presence of the abut-
ment teeth reduces resorption.
• Preservation of the proprioception. Oral function and
feeling is improved, because of the proprioceptive feed-
back from receptors in the root.
• Improved support, because of the abutment teeth.
• Improved retention. Retention devices can be attached
to abutment teeth when better retention is needed.
• Less psychological trauma, as patients are able to retain
their original teeth.
• Can be converted to a routine complete denture in case
of abutment failure.
Disadvantages
• High caries risk especially for the noncoping abutments
due to coverage of the teeth by the denture.
• Risk of periodontal problems due to improper care by
the patient.
• High initial cost due to the castings, precision attach-
ments, preceding endodontics, periodontal therapy, and
other therapies.
• Long bony undercuts are often found near the abutment
teeth. They cause many problems like:
i. Tissue injury during insertion and removal.
ii. To avoid the undercuts, the flanges are sometimes
shortened which can reduce the peripheral seal.
iii. Blockage of the undercuts results in a flange placed
away from the tissues.
Section I I Topic Wise Solved Questions of Previous Years

This can result in aesthetic problems due to the bulging to eliminate the need for soaking the cast before
of the lips. Spaces between the tissues and the flange can investing.
also create a food trap. Q. 4. Implant dentures.
• Tooth arrangement is difficult in some cases because of
the reduced interocclusal distance. Or
Q. 3. What is refractory cast? Write about its fabrication. Types of implant dentures.
Ans. Ans.

Refractory Cast Implant Dentures

• Refractory cast used in RPD fabrication is made of refrac-
tory material (silica or phosphate bonded investment) to
withstand the high temperature metal framework casting.
It is not similar to master cast and has the following char-
acteristics:
• All the blocked out undercuts will be invisible in the
refractory cast.
• Spacer relief appears as an elevation on the edentulous
ridge.
• The stopper holes on the spacer will appear as a depres-
sion on the elevated saddle area.
• Gingival relief appears as an elevated band on the re-
fractory cast.
Fabrication of Refractory Cast
• Refractory or investment material is measured and
mixed according to manufacturer's instructions, so that
the expansion of the mould during burnout will match
the shrinkage of alloy.
• Gypsum bonded investments (low heat investments) are
used for casting type IV gold alloy and ticonium. This
refractory material can be burned out at 704°C without
causing breakdown of the investment.
• Investments for cobalt chromium, vitallium, etc., (high heat
investments) are burned out at temperatures of 1037°C.
These are phosphate bonded investment material and require
a special liquid to be mixed with the refractory material.
• Colloid mould in the duplicating flask is cleaned of de-
bris and poured with refractory material. The material is
introduced into moulds in small amounts to prevent air
entrapment in the area of teeth.
• Remaining refractory material is added to mould with
minimum vibration and mould kept aside covered with
wet towel to keep the colloid moist, while the refractory
material sets.
• Once it sets, the refractory cast is removed from the
mould and kept in drying oven at 93°C for 1-1.5 h.
• When dry, the cast is trimmed within 6 mm of the pro-
posed design. Trimming always should be done on dry
cast, if wet, the slurry material can accumulate on the
cast and change the contours and dimensions.
• Dried refractory cast is dipped in hot beeswax (138-
1490C for 15 sec) to ensure a smooth, dense surface
• Dentures which take support from the underlying im-
plants placed in the bone are called implant dentures.
• These increases retention, stability, and support of the
denture.
Depending on the way in which the dentures are attached
to implants, they are of two types:
i. Fully bone-anchored
• Also called as toronto denture.
• It is screwed or cemented onto implant, therefore not
meant to be removed routinely by the patient.
• It is designed in such a way that it can be cleaned
without removing convex tissue contact.
ii. Partially bone-anchored
• It is supported partly by implants and partly by mucosa.
• It can be removed by the patient for the purpose of
cleaning and oral hygiene.
• It is designed like an overdenture and can be attached
using bar and clip attachment or precision attachment.
Denture is attached to implants by:
• Screws.
• Cement.
• Precision attachment.
• Bar and clip mechanism.
• Magnets.
Q. 5. Laboratory remounting.
Or
Clinical remounting procedures.
Ans.
Laboratory Remounting
• Laboratory remounting is used to correct only process-
ing errors (e.g., mild tooth displacement).
• It cannot be used to correct errors due to faulty impres-
sion making, jaw relations, etc.
Procedure
• Remounting can be done using the same articulator
used for teeth arrangement.
• Denture should not be separated from the cast after
processing.

• Identified contacts are ground in relation to the oppos-
ing teeth.
• After grinding, dentures removed from the cast and
polished.
• New centric and eccentric records should be obtained, if
new dentures are planned.
Clinical Remount Procedure
• Clinical remounting is done in order to perfect the oc-
clusion. The dentures are remounted on to an articulator
from new interocclusal records made in the patient's
mouth. Corrections are done by selective grinding.
Advantages of Clinical Remounting
• Corrects errors made during recording of jaw relations.
• Corrects errors made while mounting the cast on the
articulator.
• Less chair-side time needed to correct occlusal errors.
• The level of patient cooperation required is minimized.
• Direct intraoral correction of occlusal errors is difficult,
because of shifting of the dentures or incorrect closures
made by the patient. Corrections on the articulator pro-
vide a stable working foundation.
• Presence of saliva makes detection by articulating paper
difficult.
• Occlusal errors (including minute errors) are more ac-
curately detected, viewed, and corrected on an articula-
tor rather than directly in the patient's mouth.
• Corrections can be made away from the patient's view,
thus preventing any objection the patient might have
when he sees his dentures being ground.
• Clinical remounting is the most commonly preferred
method of occlusal correction.
Procedure
• Dentures are inserted in mouth and the patient is trained
to close in centric relation stopping just before the teeth
make contact.
• A suitable bite registration material is selected and
placed between the occlusal surfaces bilaterally.
• Before remounting the upper denture, petroleum jelly is
applied to the tissue surface. Undercuts are blocked us-
ing tissue paper or pumice putty.
• Plaster is poured into the blocked out dentures to form
remount casts.
• The upper denture is remounted on the articulator with
the help of the face-bow index.
• The lower denture is mounted using the bite regis-
tration.
• The accuracy of the mounting is verified using a new
centric relation record.
Quick Review Series for BOS 4 th Year: Prosthodontics
• The condylar guidance angles and incisal table angles
are reset according to the previous values. New protru-
sive and lateral records may also be obtained.
• The occlusion is corrected using the selective grinding
technique.
• Initially, centric occlusion errors are corrected, followed
by protrusive, right and left lateral interferences.
Q. 7. Single complete denture.
Or
Drawbacks of single complete denture.
Or
Problems encountered in single complete denture.
Ans.
Single Complete Denture
Single complete denture is a single arch denture, either
upper or lower, sometimes opposing the natural teeth in the
other arch.
Types
i. SCD (single complete denture) opposing natural teeth.
ii. SCD opposing a (preexisting) complete denture.
iii. SCD opposing a removable partial denture.
iv. SCD opposing an overdenture.
Problems with the Single Complete Denture
Many difficulties are often encountered with the single
complete denture when it opposes remaining natural teeth
which are as follows:
• The remaining natural teeth are often tipped, suprae-
rupted, or malposed which results in an uneven occlusal
plane making it difficult to obtain a harmonious bal-
anced occlusion.
• Unfavourable occlusal forces can destabilize the den-
ture causing soreness and ultimately ridge resorption.
• Supraerupted teeth reduce the space available, making
setting of artificial teeth a laborious process.
• A mandibular SCD opposing upper natural teeth is ex-
tremely complicated.
• The reduced surface area of the lower ridge results in
excessive forces on the ridge resulting in rapid resorp-
tion. The lower SCD is therefore rarely indicated.
• The upper SCD opposing lower natural anterior teeth
often results in the combination syndrome.
• Occlusal wear-Acrylic wears quickly when opposing
natural teeth is seen. On the other hand, if one uses
porcelain teeth to counter this, the porcelain teeth re-
sults in the wear of the natural teeth.
Section I I Topic Wise Solved Questions of Previous Years
• The fixed position of lower anterior natural teeth gives
us less flexibility for aesthetic placement of upper natu-
ral teeth.
• The fixed position of lower natural teeth coupled with
the marked resorption of upper natural teeth often
places teeth in crossbite relationships as well as other
functionally compromised positions.
• Fracture of the SCD is a common problem, especially if
opposed by natural teeth, because of the forces gener-
ated by the natural teeth.
Q. 8. Granular porosity in denture.
Ans.
Granular Porosity in Denture
Porosity in denture is one of the defects of denture processing.
It is the presence of voids within the structure of resin.
It results in:
• Unaesthetic and difficult to polish denture.
• Surface porosity can trap food, making denture unhy-
gienic and foul smelling.
• Voids act as area of stress concentration and cause
warpage of denture, as the stresses relax.
• It weakens the denture and makes cleaning of denture
difficult.
It is of two types:
a. Internal Porosity: It occurs in the form of voids within
the structure of resin and found in the thicker sections of
the denture. It does not occur uniformly.
Cause: It is due to vaporization of monomer when
the temperature of resin increases above its boiling point
(100.8°C). Exothermic heat is produced during resin
curing, which dissipates easily into the palster from the
resin present near surface. However, in deep thick areas,
heat does not dissipate fast resulting in rise of tempera-
ture above the boiling point of monomer in these areas.
Prevention: Includes use of long, low temperature
curing cycle.
SHORT NOTES
Q. 1. Enumerate different types of obturator, their func-
tions, and the materials used for making them.
Or
Obturators.
Ans.
Obturators
Obturators are a prosthesis used to close a congenital or
acquired tissue opening primarily of the hard palate and/or
contiguous alveolar structures.
b. External Porosity: It occurs near the surface of dentures
and gets exposed as a result of finishing and polishing
procedures.
Cause
i. Lack of homogeneity: It causes the dough with more
monomer to shrink more than adjacent areas resulting in
voids and resin appears white.
ii. Lack of adequate pressure: Inadequate pressure during
polymerization or flask closure/packing too early results
in nonspherical voids. Mix does not have sufficient den-
sity to pack well and the resin is lighter.
Prevention
• Use proper monomer-powder ratio.
• Mix well to a homogenous mass of uniform density.
• Packing during dough stage.
• Use of hydraulic press with pressure gauge to ensure
sufficient packing.
• Use slight excess quantity of dough than required. For-
mation of flash should be there during trial closure.
Q. 9. Importance of study cast.
Ans.
Importance/uses of study cast or diagnostic cast are as
follows:
• To measure the extent and depth of undercuts.
• To determine the path of insertion of denture.
• To identify and plan the treatment for interferences like
tori.
• To perform mock surgeries for maxillofacial prosthesis.
• To determine the amount of preprosthetic surgery re-
quired.
• To evaluate the size and contour of the arch
• To get an idea about retention and stability offered by
the tissues.
• To determine the need of additional retentive features
like overdenture abutments, implant abutments, etc.
Types of Obturator
i. Surgical obturator.
ii. Treatment/temporary/transitional obturator.
iii. Definite obturator.
Materials Used for making Obturator
• Methyl methacrylate resin.
• Latex.
• Synthetic latex.
• Vinyl plastisol.
• Silicone rubber.

Functions of Obturator
• It closes the defect in hard palate.
• It provides a stable matrix for surgical packing.
• It permits speech and deglutition.
• It prevents regurgitation of food into nasal cavity by act-
ing as a barrier.
• It prevents burping of air.
• It reduces the psychological impact of surgery.
Q. 2. Immediate obturator.
Ans.
Immediate Obturator
A surgical obturator placed immediately after surgery is
known as immediate obturator.
Principle
• To give patient, the benefit of rehabilitation before he
becomes seriously debilitated.
Advantages of Immediate Obturator
• It provides a stable matrix for surgical packing.
• It reduces oral contamination and chances of infection.
• It enables the patient to speak postoperatively.
• It allows the patient to swallow and thus the nasogastric
tube may be removed early.
• It lessens the psychological impact of surgery.
• It may reduce the period of hospitalization.
Q. 3. Write in brief the treatment planning for maxil-
lary obturator prosthesis.
Ans.
Treatment planning for maxillary obturator prosthesis is as
follows:
• Diagnosis: Type of defect determines the size, location,
and extent of obturator.
• Preliminary impression using alginate: Useful for care-
ful recording of undercuts and the junction of graft and
mucosa. It is an important retentive feature.
• Custom tray fabrication: The tray is oriented properly
into the defect.
• Acrylic special trays are preferred.
• Border moulding: Velopharyngeal extension recorded
by asking the patient to swallow or doing other exer-
cises like turning the head from side to side, placing the
chin down on the chest, etc.
• Final impression with elastic impression material:
Proper positioning of tray and accurate recording of
Quick Review Series for BOS 4th Year: Prosthodontics
scar band area. Elastic recoil (purse string action) seen
in scar band tissue serves in retention of obturator.
• Jaw relation: Acrylic denture bases are preferred, as it
is difficult to position other denture bases.
• Teeth arrangement: To obtain balance occlusion.
Q. 4. Overdenture advantages.
Or
Write the concept and advantages of overdenture.
Or
Immediate overdentures.
Or
Tooth-supported overdentures.
Or
Hybrid dentures.
Ans.
Overdentures
Hybrid dentures are also known as tooth-supported den-
tures, overlay dentures, onlay dentures, overdentures, tele-
scoped dentures, hybrid dentures, biologic dentures, coping
prosthesis, and superimposed dentures.
Or
Overdentures/hybrid dentures are any removable dental
prosthesis that covers and rests on one or more remaining
natural teeth, the roots of natural teeth, and/or dental im-
plants; a dental prosthesis that covers and is partially sup-
ported by natural teeth, natural tooth roots, and/or dental
implants (GPT-8).
Advantages
i. Preservation of the alveolar bone. Presence of the abut-
ment teeth reduces resorption.
ii. Preservation of the proprioception. Oral function and
feeling is improved, because of the proprioceptive feed-
back from receptors in the root.
iii. Improved support, because of the abutment teeth.
iv. Improved retention. Retention devices can be attached
to abutment teeth when better retention is needed.
v. Less psychological trauma, as patients are able to retain
their original teeth.
vi. Overdenture can be converted to a routine complete
denture in case of abutment failure.
Q. 5. Abutment considerations of overdenture.
Ans.
Section I I Topic Wise Solved Questions of Previous Years
Selection and Preparation of an Abutment
Tooth
Dentist should preserve the ideal teeth and extract the re-
maining to reduce the cost of the prosthesis.
Factors to be considered while selecting abutment for
overdenture are:
• Periodontal status of the abutment teeth.
• Periodontally compromised teeth with horizontal bone
loss have a better prognosis than the ones with vertical
bone loss.
• A favourable crown-root ratio should be present in
cases with slight tooth mobility.
• A circumferential band of attached gingiva is an abso-
lute necessity for an overdenture abutment.
Abutment Location
• Cuspids and bicuspids are frequently selected as over-
denture abutments.
• Anterior teeth are not selected, as the anterior alveolar
ridge resorbs easily under stress.
• Maxillary incisors can be used as overdenture abut-
ments, if the mandibular arch is intact.
• At least one tooth should be retained in the quadrant to
maintain the health of oral tissues.
• The number and location of the abutment teeth and the
status of the opposing one should be evaluated during
treatment planning.
• Endodontic and prosthodontics status.
• Usually anterior teeth (canines and premolars) are pre-
ferred as overdenture abutment, as they are easier to
prepare and economical too.
• When there is pulpal recession or calcifications along
with extensive tooth wear, endodontic therapy can be
avoided.
Q. 6. Rationale of overdentures.
Ans.
Rationale/Objectives/Goals of Ovedenture
Treatment
i. To preserve the alveolar bone for as long as possible.
The overdenture is a logical method for use in preven-
tive prosthodontics. Preserving the remaining natural
teeth not only preserves the alveolar bone, but also gives
the patient better function and control over the dentures,
because of the presence of nerve receptors in the root.
ii. Reduction of crown-root ratio and the resulting forces
on the abutment teeth and supporting tissues
• Shortening the natural tooth, changes the crown-root
ratio which reduces the lateral stresses and lever ac-
tion on the tooth. The load is now in a more occlusal
direction which is better tolerated by the tooth.
• The complete denture resting on these shortened
teeth exerts largely vertical forces directed towards
the bone which are better tolerated by the teeth.
• It also forms the basis of using mobile teeth which
otherwise would have been indicated for extraction.
Reducing the crown-root ratio reduces the mobility
of these teeth and improves their prognosis.
Q. 7. Types of bar-retained overdentures.
Ans.
Bar-retained Overdentures
• One of the methods of retention of overdenture is bar
attachment.
• The typical bar attachment consists of a bar connecting
two or more abutments. Joining the two abutments en-
ables splinting.
• A metal or plastic clip fixed to the tissue side of the
denture attaches it to the bars.
The bars are attached to the abutment copings by sol-
dering.
Classification
There are two types of bar attachments. They are
i. Bar joints permits rotational movement. They are used
as a splint connecting the abutments together.
ii. Bar units (rigid fixation) permits no movement. They
are placed as a single unit on the abutment teeth like a
stud attachment.
There are many bar attachments available. Among the
famous ones are the Baker clip, the Hader bar, and the
Dolder bar, etc.
Q. 8. Advantages and disadvantages of immediate com-
plete denture.
Ans.
Advantages of Immediate Complete Denture
• It serves as a splint, reduces pain, controls bleeding, and
protects from trauma during the healing period.
• Patient regains function faster, e.g., speech and mastication.
• Inconvenience and stress of edentulous period is spared
and patient can learn to manipulate the denture while
recovering from surgery.
• It is more compatible with oral surroundings as the tongue,
lips, and cheeks have not yet changed their position.
• Natural teeth aid in vertical relation positioning and se-
lecting artificial teeth.
• Less change in facial appearance and more aesthetic.
• Less TMJ disturbance.
• Aids in contouring the healing residual ridge.

• Psychological benefits.
• Easy to refit by relining.
Disadvantages of Immediate Complete Denture
• Time-consuming and precise technique.
• More appointments needed.
• More costly.
• No opportunity for trying of anterior teeth.
Q. 15. Temporary prosthesis.
Ans.
Temporary Prosthesis
• Temporary prosthesis is also called as interim
prosthesis, provisional prosthesis, or provisional
restoration.
• It is defined as a fixed or removable dental prosthesis, or
maxillofacial prosthesis, designed to enhance aesthet-
ics, stabilization, and/or function for a limited period of
time, after which it is to be replaced by a definitive den-
tal or maxillofacial prosthesis.
• Often, such prostheses are used to assist in determina-
tion of the therapeutic effectiveness of a specific treat-
ment plan or the form and function of the planned for
definitive prosthesis.
Q. 16. Appliance versus prosthesis.
Ans.
Appliance is defined as something developed by the appli-
cation of ideas or principles that are designed to serve a
special purpose or perform a special function.
Prosthesis is defined as:
i. An artificial replacement of an absent part of the human
body.
ii. A therapeutic device to improve or alter function.
iii. A device used to aid in accomplishing a desired surgi-
cal result.
Q. 17. Kelly's combination syndrome.
Ans.
Kelly's Combination Syndrome (by Kelly in
1972)
It is seen in patients wearing maxillary complete denture
opposing a mandibular distal extension prosthesis.
Pathogenesis
i. Patient concentrates the occlusal load on remammg
natural teeth (mandibular anteriors) for proprioception
Quick Review Series for BOS 4th Year: Prosthodontics
resulting in more force acting on the anterior part of
the maxillary denture.
ii. Above leads to increased resorption of the anterior
part of maxilla replacing it with flabby tissue.
iii. Occlusal plane gets tilted anteriorly upwards and pos-
teriorly downwards due to lack of anterior support.
iv. Labial flange gets displaced irritating the labial vesti-
bule leading to formation of epulis fissuratum.
v. Posteriorly, fibrous overgrowth of tissues of maxillary
tuberosities occurs.
vi. Reduced mandibular distal extension denture-bearing
area due to shift of occlusal plane posteriorly downwards.
vii. Vertical dimension of occlusion is decreased resulting
in decreased retention and stability.
viii. Tilt of occlusal plane disoccludes the lower anteriors
causing them to supraerupt resulting in their decreased
periodontal support.
ix. These supraerupted anteriors increase the amount of
force acting on the anterior part of complete denture
and the cycle continues.
Remedy
• Combination syndrome should be identified at an early
stage and prevented.
• Overdentures and implant-supported dentures are some
of the treatment alternatives to prevent it.
Q. 18. Occlusal refining.
Or
Laboratory remounting procedures in complete denture.
Ans.
Occlusal Refining
Occlusal refining refers to correction of occlusal errors in
complete denture after processing.
It is done by remounting procedure.
Laboratory Remounting
It is used to correct only processing errors (e.g., mild tooth
displacement).
It cannot be used to correct errors due to faulty impres-
sion making, jaw relations, etc.
Procedure
• Remounting can be done using the same articulator
used for teeth arrangement.
• Denture should not be separated from the cast after
processing.
• Identified contacts are ground in relation to the oppos-
ing teeth.
Section I I Topic Wise Solved Questions of Previous Years

• After grinding, dentures are removed from the cast and Different maxillofacial prostheses are as follows:
polished. A. Extraoral prosthesis
• New centric and eccentric records should be obtained, if This restores the patient's facial aesthetics.
new dentures are planned. • Orbital and ocular prosthesis.
• Nasal prosthesis.
Q. 19. Define implants. Enumerate the various materi-
• Auricular prosthesis.
als used for implants.
• Composite prosthesis (a combination of one or more
Ans. of the above prosthesis along with adjacent tissues).
B. lntraoral prosthesis
• Obturators.
Implants
• Speech aids.
• Implant is a prosthetic device made of alloplastic material(s) • Infant feeding prosthesis.
implanted into the oral tissues beneath the mucosal or/and C. Implanted prosthesis
periosteal layer, and on/or within the bone to provide reten-
It is surgically placed within the tissues in order to
tion and support for a fixed or removable dental prosthesis;
restore its form or contour.
a substance that is placed into or/and upon the jaw bone to
• Silicone facial prosthesis.
support a fixed or removable dental prosthesis.
• Mandibular metal implants.
Materials used in fabrication of maxillofacial prosthesis are:
Various Materials Used for Dental Implants
• Methyl methacrylate resin.
• Bioactive: Ceramic and hydroxyapatite. • Latex.
• Bioinert: Titanium, carbon, and vitallium. • Synthetic latex.
Q. 20. Implant denture.
• Vinyl plastisol.
• Silicone rubber.
Or Q. 22. Occlusal pivots.
Advantages of metal denture implant.
Ans.
Ans.
Occlusal Pivot
Implant Denture
It is a concept of nonbalanced occlusion given by SEAR.
Dentures which take support from implants placed in un-
It is an elevation placed on the occlusal surface, usually in
derlying bone are called implant dentures.
the molar region, designed to act as a fulcrum, thus limiting
Depending on the way in which the dentures are at-
mandibular closure and inducing mandibular rotation (GPT-8).
tached to implants, they are of two types: It reduces injury to temporomandibular joint and also
i. Fully bone-anchored
reduces the stress in anterior region.
• It is also called as Toronto denture.
• It is screwed or cemented onto implant and is therefore Q. 23. How will you make a treatment plan for a cleft
not meant to be removed routinely by the patient.
palate patient?
• It is thus designed in such a way that it can be cleaned
without removing convex tissue contact.
Ans.
ii. Partially bone-anchored
• It is supported partly by implants and partly by mucosa. Treatment planning for maxillary obturator prosthesis is as
• It can be removed by the patient for the purpose of follows:
cleaning and oral hygiene. • Diagnosis: Type of defect determines the size, location,
• It is designed like an overdenture and can be at- and extent of obturator.
tached using bar and clip attachment or precision • Preliminary impression using alginate: Useful for care-
attachment. ful recording of undercuts and the junction of graft and
mucosa. It is an important retentive feature.
• Custom tray fabrication: The tray is oriented properly
Advantages
into the defect.
These increase retention, stability, and support of the denture. • Acrylic special trays are preferred.
• Border moulding: Velopharyngeal extension is recorded
Q. 21. Name the different maxillofacial prostheses and
by asking the patient to swallow or doing other exercises
the materials used.
like turning the head from side to side, placing the chin
Ans. down on the chest, etc.

• Final impression with elastic impression material:
Proper positioning of tray and accurate recording of
scar band area. Elastic recoil (purse string action) seen
in scar band tissue serves in retention of obturator.
• Jaw relation: Acrylic denture bases preferred, as it is
difficult to position other denture bases.
• Teeth arrangement: To obtain balance occlusion.
• Insertion and postinsertion management.
Q. 24. Transitional denture.
Ans.
Transitional Denture
It is a removable dental prosthesis serving as an interim
prosthesis to which artificial teeth will be added as natural
teeth are lost and will be replaced after postextraction tissue
changes have occurred. A transitional denture may become
an interim complete dental prosthesis, when all of the natu-
ral teeth have been removed from the dental arch.
Q. 25. Interim denture.
Ans.
Interim Denture
Interim denture or Provisional prosthesis is a temporary
denture, designed to enhance aesthetics, stabilization, and/
or function for a limited period of time, after which it is to
be replaced by a definitive denture. Often such prostheses
are used to assist in determination of the therapeutic effec-
tiveness of a specific treatment plan or the form and func-
tion of the planned for definitive prosthesis.
Q. 26. Split-cast technique.
Ans.
Split-cast Method
• It is a procedure for placing indexed casts on an articu-
lator to facilitate their removal and replacement on the
instrument.
Quick Review Series for BOS 4th Year: Prosthodontics
• It is the procedure of checking the ability of an articula-
tor to receive or be adjusted to a maxillomandibular re-
lation record (GPT-8).
Split-cast Mounting
It is a method of mounting casts, where in the dental cast's
base is sharply grooved and keyed to the mounting ring's
base. The procedure allows verifying the accuracy of the
mounting, ease of removal, and replacement of the casts.
Q. 27. Gunning splint.
Ans.
Gunning Splint
It was given by Thomas Brian Gunning.
• It is a device fabricated from casts of edentulous maxil-
lary and mandibular arches to aid in reduction and fixa-
tion of a fracture.
• This device provides an opening for saliva flow, nour-
ishment (food intake), and speech.
Q. 28. Screw-retained prosthesis.
Ans.
Screw-retained Prosthesis
• Screw-retained prosthesis is one of the methods of at-
taching the complete denture to implant placed in un-
derlying bone to enhance retention of denture.
• Screws are used when sufficient number of implant
abutments is present.
• In case of screw-retained prosthesis, patient cannot
remove the complete denture for cleaning, i.e., it is fully
bone anchored prosthesis.
• Screws may be: (i) occlusal and (ii) transverse.
The access opening for the screw may be located on the
occlusal surface or buccal/lingual flange and is filled with
composite to improve aesthetics. Sometimes, access open-
ings may interfere with development of superior occlusal
scheme.
Section I I Topic Wise Solved Questions of Previous Years

Part 11
Fixed Partial Dentures
------------------ - <( Topic 1 )
Introduction to Fixed Partial Dentures

LONG ESSAYS
Q. 1. Importance of radiographs in fixed partial denture iii. Panoramic films
treatment. • Evaluation of bone resorption, pattern of bone resorp-
tion, and quality of bone support.
Radiographs • To check for the presence of retained root tips and
impacted tooth.
Radiographs are one of the important diagnostic aids in • To determine the thickness of soft tissue on the ridge in
fixed partial denture, besides diagnostic casts. area of pantie placement.
• They do not provide a detailed view for assessing bone
support, root morphology, or caries.
Types of Radiographic Examinations
Q. 2. Discuss in detail about the advantages, disadvan-
i. Periapical radiographs.
tages, indications, and contraindications of FPO.
ii. Bitewing radiographs.
iii. Panoramic films. Or
iv. In case of TMJ disorders:
Describe the advantages and disadvantages of fixed
a. Transcranial exposure.
partial prosthodontics.
b. Serial tomography.
c. Arthrography. Or
d. CT scanning.
Discuss the indications and contraindications for a fixed
e. Magnetic resonance imaging.
partial denture.

i. Periapical radiographs
There are 14 periapical radiographs which help in complete
examination of teeth and their supporting structures.
Importance of periapical radio graphs
• To study the extent of bone support and quality of sup-
porting bone.
• Detailed root morphology of each abutment tooth.
• Width of periodontal ligament space and continuity of
lamina dura.
• Pulpal morphology and previous endodontic treatment.
• Any periapical pathology can be evaluated.
• Evaluation of crown-root ratio.
• Evaluation of the shape, length, and direction of roots.
ii. Bitewing radiographs
They help in evaluation of caries on proximal surfaces and
secondary caries on previous restorations.
Or
Indications and contraindications for fixed partial
dentures.
Ans.
Advantages, Disadvantages, Indications, and
Contraindications of Fixed Partial Dentures
Advantages of Fixed Partial Denture
i. Movements for a fixed partial denture are less com-
pared to a removable partial denture.
ii. It is psychologically better accepted than removable
partial denture.
iii. It also acts as a splint.
iv. It transmits less lateral forces to abutment tooth
compared to a partial denture abutment.

v. It can use weak abutment, if other abutments are
strong.
vi. It is aesthetically better with more comfort to the patient.
vii. It has better functioning of the prosthesis with good
perception.
viii. There is less bone resorption compared to removable
prosthesis.
Disadvantages of Fixed Partial Denture
i. It can weaken a strong abutment tooth, if the other abut-
ment support is weak.
ii. It is an irreversible treatment.
iii. Preparation of sound tooth will make the patient think
twice before agreeing to go for fixed prosthesis.
iv. Adequate preparation with good occlusal clearance is
required otherwise a fixed prosthesis can fail.
v. If restoration is over contoured, then periodontal prob-
lems can occur.
Indications for Fixed Partial Denture
The selection of prosthesis depends on biomechanical, peri-
odontal, aesthetic, and financial factors.
i. In tooth bounded situations when a single tooth is
missing.
ii. In case where the abutment tooth on either side can
support the number of tooth missing.
iii. If the abutment tooth is periodontally sound.
iv. To maintain space in orthodontic cases.
v. If the edentulous span is short and straight.
vi. To restore missing tooth in order to prevent the adja-
cent tooth from drifting into the space.
vii. To restore the mouth to complete its function free of
interferences.
viii. Cases with ridge resorption, where a removable partial
denture cannot be stable or retentive.
ix. Mentally compromised and physically handicapped
patient who cannot maintain the removable prosthesis.
Contraindications for Fixed Partial Denture
Fixed partial denture is generally avoided in following con-
ditions:
i. Unfavourable crown-root ratio.
ii. Large edentulous space.
iii. Edentulous space with no distal abutment or bilater-
ally edentulous with no distal abutment.
iv. Grossly tipped teeth (more than 22°).
v. Periodontally weak teeth.
vi. Severe bone resorption.
vii. Young age with large pulp chamber and lack of total
eruption.
viii. Large tongue.
Quick Review Series for BOS 4 th Year: Prosthodontics
ix. Extensive caries with poor oral hygiene.
x. Financially poor patients.
xi. If the patient cannot maintain oral hygiene.
xii. In case of parafunctional habits with excessive force
load on abutment tooth.
xiii. Importance of radiologic examination in crown and
bridge prosthesis.
Q. 3. Discuss the importance of diagnosis and treatment
planning in fixed partial prosthodontics.
Ans.
Diagnosis and Treatment Planning in Fixed
Partial Prosthodontics
Diagnosis and treatment planning plays an important role in
the success of any prosthetic treatment.
Diagnosis is the examination of the physical state, in
the evaluation of the mental or psychological make up,
and in understanding the needs of each patient to ensure a
predictable result.
Treatment planning means developing a course of
action that encompasses the ramifications and sequelae of
treatment to serve the patient's needs.
Diagnosis
Diagnosis in fixed partial denture includes:
I. Chief complaints.
II. History taking of the patient.
III. Examination.
a. General examination.
b. Temporomandibular joint examination.
c. Extraoral examination.
d. Intraoral examination.
e. Occlusal evaluation.
f. Abutment tooth evaluation.
IV. Making of diagnostic casts.
V. Full mouth radiographs.
I. Chief complaints
Chief complaints are mainly of four categories:
i. Comfort (pain, sensitivity, and swelling).
ii. Function (difficulty in mastication or speech).
iii. Social (bad taste or odour).
iv. Appearance (fractured or discoloured tooth).
i. Comfort
Pain
• Location, character, severity, and frequency of the pain
should be noted as well as the first time it occurred and
the factors increasing pain (e.g. hot or cold things), and
any changes in its character.
Section I I Topic Wise Solved Questions of Previous Years

Swelling iv. Dental history

• The location, size, consistency, colour change during Periodontal history
inflammation, duration, and frequency of the swelling Oral hygiene status, any previous oral hygiene prophylaxis,
should be noted. or any previous periodontal surgery is noted.
Restorative history
ii. Function All restorations of amalgam and tooth colored restoration
• Difficulties in chewing can be due to a fractured cusp or along with time of these restorations are noted.
generalized malocclusion. Endodontic history
• Speech difficulty may be due to local cause or systemic If the endodontically restored tooth is a prospective abut-
problems. ment tooth, then a radiographic evaluation of the periapical
health should be noted.
iii. Social Orthodontic history
• A bad taste or smell may be due to poor maintenance of If radiographic evaluation shows root resorption, then it can
oral hygiene or periodontal disease. be due to previous orthodontic treatment. Occlusal
adjustment with minor tooth movement can promote
iv. Appearance long-term positional stability of the teeth and reduce, or
• Missing or crowded teeth. eliminate, parafunctional activity.
• Fractured tooth or restoration. Removable prosthodontic history
• Malpositioned or discoloured teeth. Previous removable prostheses must be carefully evaluated
• Congenital anomalies of dentition. and the duration of wear needs to be noted.
Oral surgical history
II. History taking of the patient Missing teeth and period of edentulousness should be
i. Personal details (Name, age, sex, and address). noted.
ii. Medical history. Radiographic history
iii. Drug history. Previous radiographs and current diagnostic radiographic
iv. Dental history. series help to assess the progress of the disease.
a. Periodontal history. It also aids in locating impacted tooth, root tip, cyst, and
b. Restorative history. tumour.
c. Endodontic history. TMJ dysfunction history
d. Orthodontic history. Following should be noted under TMJ dysfunction
e. Removable prosthodontic history. history:
f. Oral surgical history. i. Pain or clicking in the temporomandibular joints.
g. Radiographic history. ii. Tenderness to palpation.
h. TMJ dysfunction history. iii. Difficulty in opening the mouth.
iv. Deviation while opening.
i. Personal details v. The above symptoms with any treatment done earlier
It includes name, age, sex, and address. for the dysfunction as occlusal appliances, medications,
or exercises should be noted.
ii. Medical history
Ill. Examination
• Any cardiac ailments, requiring antibiotic premedica-
tion before treatment, CNS disorders or other systemic a. General examination
diseases affecting treatment method. Hypertensive pa- • This includes general appearance, gait, weight, skin
tients and coronary disease patients should not be given colour (anaemia or jaundice). Vital signs, such as respi-
epinephrine. ration, pulse, temperature, and blood pressure are also
• Any previous radiation therapy, blood disorders, and measured and recorded.
terminal illness affecting treatment plan.
• Systemic conditions with oral manifestations. b. Temporomandibular joint examination
• Infective diseases as AIDS, hepatitis, and syphilis need • Bilateral palpation anterior to the auricular tragic, while
to be evaluated. the patient opens and closes the mouth, can locate dis-
order in the posterior attachment of the disk.
iii. Drug history • Tenderness, clicking, or pain in TMJ is noted.
Previous medication history, drug allergies, and if patient is • Jaw opening of less than 40 mm indicates restriction.
taking any medicines routinely should be noted. • Deviation from midline should also be recorded.

• Maximum lateral movement can then be measured
(normal is about 12 mm).
• Masseter and temporal muscles are palpated for signs
of tenderness and classified as mild, moderate, or
severe.
c. Extraoral examination
Extraoral examination includes:
• Facial asymmetry.
• Cervical lymph node palpation.
• TMJs and the muscles of mastication.
• Lips: Smile line, negative space between the maxillary
and mandibular teeth when the patient laughs, missing
teeth, diastema, and fractured or poorly restored teeth
are noted.
d. lntraoral examination
• Soft tissues, teeth, and supporting structures, such as
the tongue, floor of the mouth, vestibule, cheeks, and
hard and soft palates are examined and findings are
noted.
Periodontal examination
i. Oral hygiene status assessment.
ii. Examination of gingiva, periodontium, and the response
to the host tissues.
• Healthy gingiva is pink stippled and bound to the
underlying connective tissue.
• The texture, size, contour, consistency, position, and
colour are noted. Presence of any exudate or pus
should be examined.
• The width of the keratinized attached gingiva around
each tooth is assessed.
Examination of teeth
i. Absence of teeth, dental caries, any restorations, wear
facets, fractures, abrasions, malformations, and erosions
is noted.
ii. Pocket depths (usually six teeth) are recorded on a
periodontal chart.
e. Occlusal examination
• General alignment.
• Lateral and protrusive contacts.
• Centric relation.
• Jaw manoeuvrability.
General alignment
• Evaluation of the teeth for crowding, rotation, overerup-
tion, spacing, malocclusion, and vertical and horizontal
overlap should be recorded.
• The teeth can be evaluated for crowding, rotation,
overeruption, spacing, malocclusion, and vertical and
horizontal overlap.
Quick Review Series for BOS 4th Year: Prosthodontics
Lateral and protrusive contacts
Verification for presence or absence of tooth contact in
centric relation should be done using Mylar strip. Tooth
movement (fremitus) should be identified by palpation.
The presence or absence of tooth contact in eccentric
movements is verified with a thin Mylar strip. Tooth move-
ment (fremitus) should be identified by palpation.
Centric relation
• The relationship of teeth in both centric and intercuspal
position is assessed.
• If a slide from CR to IP is present, its horizontal and
vertical components can be estimated and a note made
of any lateral deviation.
Jaw manoeuvrability
• The ability and ease with which the patient moves the
jaw and the guiding movements should be assessed.
• Also check for habitual occlusion.
f. Abutment tooth evaluation
• Abutment teeth need to be strong enough to withstand
the forces directed to the missing teeth in addition to
those usually applied to the abutments.
• Abutment teeth should not exhibit mobility.
• An asymptomatic endodontically treated tooth can be
considered for an abutment provided it can withstand
the forces transmitted to it.
• The supporting tissues surrounding the abutment teeth
should be healthy and free from inflammation.
Evaluation of abutment teeth includes:
i. Crown-root ratio.
ii. Root configuration.
iii. Periodontal surface area.
iv. Vitality testing.
Crown-root ratio
An abutment tooth should have a combined pericemental
area equal to or greater than the pericemental area of the
tooth or teeth to be replaced (Ante's law).
Favourable crown-root ratio is 1: 1.
Root configuration
Root shape: Short conical roots give less support. Divergent
multiple roots give good support.
Periodontal surface area
Root surface area is evaluated. Larger teeth will have
greater surface area and will handle stress better.
Vitality testing: Prior to any restorative treatment,
pulpal health must be assessed by measuring the
response to percussion as well as thermal and electrical
stimulation.
Section I I Topic Wise Solved Questions of Previous Years

IV. Making diagnostic casts iii. To determine the thickness of soft tissue on the ridge in
• Articulated diagnostic casts aid in planning treatment area of pantie placement.
procedures. iv. They do not provide a detailed view for assessing bone
• Provide information about static and dynamic relation- support, root morphology, or caries.
ships of the teeth.
• Help in viewing several aspects of the occlusion that are
not detectable within the confines of the mouth. Treatment Planning
Advantages of diagnostic casts • Treatment planning helps to design and select the material
of choice for a particular situation.
• It helps in changing the arch relationship before orthog-
nathic procedures.
• It also helps change the tooth position prior to orth- Design and material choice
odontic procedures. It depends on:
• It modifies the occlusal scheme before attempting any i. Amount of tooth structure present.
selective occlusal adjustment. ii. Aesthetics.
• Trial tooth preparation and waxing can be done before iii. Plaque control.
fixed restorative procedures.
• Selection of an optimum path of withdrawal of a fixed Choice of restoration
partial denture can be assessed. In the following situations, fixed partial denture is contrain-
dicated and the restoration of choice is removable partial
V. Radiographic examination
denture.
i. Periapical radiographs. i. Unfavourable crown-root ratio.
ii. Bitewing radiographs. ii. Large edentulous space.
iii. Panoramic films. iii. Edentulous space with no distal abutment or bilaterally
iv. Transcranial exposure, serial tomography, arthrogra- edentulous with no distal abutment.
phy, CT scanning, or magnetic resonance imaging in iv. Grossly tipped teeth (more than 22°).
case of TMJ disorders. v. Periodontally weak teeth.
vi. Severe bone resorption.
i. Periapical radiographs
vii. Young age with large pulp chamber and lack of total
There are 14 periapical radiographs which help in complete eruption.
examination. viii. Large tongue.
Uses ix. Extensive caries with poor oral hygiene.
i. To study the extent of bone support and quality of sup- x. Financially poor patients.
porting bone. xi. If the patient cannot maintain oral hygiene.
ii. Detailed root morphology of each abutment tooth. xii. In case of parafunctional habits with excessive force
iii. Width of periodontal ligament space and continuity of load on abutment tooth.
lamina dura. xiii. Importance of radiologic examination in crown and
iv. Pulpal morphology and previous endodontic treat- bridge prosthesis.
ment.
v. Evaluation of any periapical pathology. Treatment planning must be based on the choice of
vi. Evaluation of crown-root ratio. design of the partial denture that best suits the patient.
vii. Evaluation of the shape, length, and direction of Treatment planning for fixed prosthesis includes:
root. i. Intraoral examination and selection of an appropriate
prosthesis.
ii. Bitewing radiographs ii. Evaluation of an abutment and selection of an appropri-
Used for evaluation of caries on proximal surfaces and ate prosthesis.
secondary caries on previous restorations. iii. Biomechanical considerations and fixed partial denture
design.
iii. Panoramic films iv. Patient's needs.
Uses v. Type of material/technique that best suits the
i. In the evaluation of bone resorption, pattern of bone patient.
resorption, and quality of bone support. vi. Residual ridge of the patient and treatment of ridge
ii. To check for presence of retained root tips and defects.
impacted tooth. vii. Occlusion with the opposing teeth.

SHORT ESSAYS
Q. 1. Importance of radiographs in fixed partial
dentures.
Or
Write four uses of radiographs in FPD.
Ans.
Importance of Radiographs in Fixed Partial
Dentures
i. To study the extent of bone support and quality of sup-
porting bone.
ii. Detailed root morphology of each abutment tooth.
iii. Width of periodontal ligament space and continuity of
lamina dura.
iv. Pulpal morphology and previous endodontic treat-
ment.
v. Evaluation of any periapical pathology.
vi. Evaluation of crown-root ratio.
vii. Evaluation of the shape, length, and direction of
root.
viii. To detect the presence of root stumps in edentulous
area.
ix. To know the quality of endodontic restorations.
x. To know the thicknes of soft tissues in the edentulous area.
Q. 2. Criteria for ideal abutment.
Ans.
Criteria for Ideal Abutment
• Abutment teeth need to be strong enough to withstand
the forces directed to the missing teeth in addition to
those usually applied to the abutments.
• Abutment teeth should not exhibit mobility.
• An asymptomatic endodontically treated tooth can be
considered for an abutment, provided it can withstand
the forces transmitted to it.
• The supporting tissues surrounding the abutment teeth
should be healthy and free from inflammation.
Q. 3. Indications and contraindications for fixed partial
denture.
Ans.
Quick Review Series for BOS 4 th Year: Prosthodontics
Indications for Fixed Partial
Dentures
The selection of prosthesis depends on biomechanical,
periodontal, aesthetic, and financial factors.
i. In tooth-bounded situations when a single tooth is
missing.
ii. In case where the abutment tooth on either side can
support the number of tooth missing.
iii. If the abutment tooth is periodontally sound.
iv. To maintain space in orthodontic cases.
v. If the edentulous span is short and straight.
vi. To restore missing tooth in order to prevent the adjacent
tooth from drifting into the space.
vii. To restore the mouth to complete function, free of in-
terferences.
viii. Cases with ridge resorption, where a removable partial
denture cannot be stable or retentive.
ix. Mentally compromised and physically handicapped
patient who cannot maintain the removable pros-
thesis.
Contraindications for Fixed Partial
Denture
Fixed partial denture is generally avoided in following
conditions:
i. Unfavourable crown-root ratio.
ii. Large edentulous space.
iii. Edentulous space with no distal abutment or bilater-
ally edentulous with no distal abutment.
iv. Grossly tipped teeth (more than 22°).
v. Periodontally weak teeth.
vi. Severe bone resorption.
vii. Young age with large pulp chamber and lack of total
eruption.
viii. Large tongue.
ix. Extensive caries with poor oral hygiene.
x. Financially poor patients.
xi. If the patient cannot maintain oral hygiene.
xii. In case of parafunctional habits with excessive force
load on abutment tooth.
xiii. Importance of radiologic examination in crown and
bridge prosthesis.
Section I I Topic Wise Solved Questions of Previous Years

SHORT NOTES
Q. 1. Mention indications for FPD. Contraindications for FPD
Ans. Fixed partial denture is generally avoided in following conditions:
i. Unfavourable crown-root ratio.
ii. Large edentulous space.
Indications for FPD iii. Severe bone resorption.
iv. If the patient cannot maintain oral hygiene.
The selection of prosthesis depends on biomechanical, peri-
v. In case of parafunctional habits with excessive force
odontal, aesthetic, and financial factors.
load on abutment tooth.
i. In tooth-bounded situations when a single tooth is
missing. Q. 3. Significance of radiographs in fixed partial denture.
ii. In case where the abutment tooth on either side can Importance of radiographs in crown and bridge.
support the number of tooth missing.
Ans.
iii. If the abutment tooth is periodontally sound.
iv. If the edentulous span is short and straight.
i. To study the extent of bone support and quality of
v. To restore missing tooth in order to prevent the adja-
supporting bone.
cent tooth from drifting into the space.
ii. Detailed root morphology of each abutment tooth.
vi. To restore the mouth to complete function, free of in-
iii. Width of periodontal ligament space and continuity of
terferences.
lamina dura.
Q. 2. Write few contraindications of fixed partial denture. iv. Pulpal morphology and previous endodontic treatment.
v. Evaluation of any periapical pathology.
Ans. vi. Evaluation of crown-root ratio.
vii. Evaluation of the shape, length, and direction of root.

------------------- <( Topic 2)

Parts and Design of Fixed Partial Dentures

LONG ESSAYS
Q. 1. Define and classify pontics and add a note Pontic
on selection of pontic design and requirements
of pontic. Pantie is defined as, 'An artificial tooth on a fixed partial den-
ture (FPD) that replaces a missing tooth, restores its function,
Or and usually fills the space previously filled by a natural crown'.
Define pontic. Discuss in detail about pontic designs.
Classification of Pontics
Or
Panties can be classified on the basis of mucosal contact,
Classify pontic. Discuss in detail the various pontics
type of material used, and method of fabrication. The clas-
used in FPD.
sification is as follows:
Or
I. Mucosal contact
Classify bridge pontics. Discuss in detail regarding the
A. With mucosal contact
principles of designing pontic.
i. Saddle pantie or ridge lap pantie.
Ans. ii. Modified ridge lap pantie.

iii. Ovate pantie.
iv. Conical pantie.
B. Without mucosa! contact
i. Hygienic or sanitary pantie.
ii. Modified sanitary pontic/perel pantie/bullet pantie.
II. Type of material used
Based on the type of material used, panties can be classi-
fied as:
i. All metal pantie.
ii. All ceramic pantie.
iii. Metal-ceramic pantie.
iv. Metal with resin-veneered pantie.
v. Fibre-reinforced composite pantie.
111. Method of fabrication
Based on method of fabrication, panties can be classified as:
A. Custom-made pantie.
B. Prefabricated pantie
i. Trupontic.
ii. Interchangeable facing.
iii. Sanitary pantie.
iv. Pin-facing pantie.
v. Modified pin-facing pantie.
vi. Reverse pin-facing pantie.
vii. Harmony pantie.
C. Prefabricated custom-modified pantie.
Pontic Design
• Proper designing of pantie is responsible for the success
of fixed partial denture.
• If the function and aesthetics is not restored by pantie
design, then it may result in failure of pantie.
• The objective of designing a pantie is to construct
a substitute that favourably compares to the tooth it
replaces.
• Each surface of pantie should be designed carefully to
fulfil this objective.
The three importantfactors that affect the design ofpantie are:
i. Space available for the placement of the pantie
• The spaces created by the loss of a tooth are usually
sufficient to fabricate a good pantie.
• In few cases, long period of edentulousness can cause
the adjacent teeth to tilt or drift towards this space.
In such cases, fabrication of proper pantie is difficult
as the pantie design should be compromised.
ii. Contour of the residual alveolar ridge
• Thorough examination of the diagnostic cast is im-
portant during treatment planning.
• The contour of ridge and texture of the soft tissue
should be observed carefully during intraoral
examination.
Quick Review Series for BOS 4th Year: Prosthodontics
• A smooth rounded ridge is best for the placement of
a pantie. In cases with overhanging hyperplastic tis-
sues, surgical excision of these tissues should be
carried out.
iii. Amount of occlusal load that is anticipated for the patient
• The basic requirement of a pantie is that it should be
able to restore proper function.
• The amount of occlusal load determines the selection
of material as well as the design of FPD.
General consideration
Design of each surface of the pantie contributes to the suc-
cess of the partial denture. Design of each surface of pantie
is explained as follows:
Gingival surface
• This is influenced by the material, location of space, and
degree of tissue contact.
• Highly glazed porcelain is the material of choice for this
surface.
• A pantie should have only minimum positive contact
with the ridge. Excessive pressure will cause inflamma-
tion, ulceration. or tissue proliferation. It should allow
easy cleansibility of the tissue surface.
Occlusal surface
• The most important factor in determining the design of
this surface is provision of a stable vertical stop by suit-
able placement of functional cusps.
• The functional cusp is the load-bearing cusp of the
tooth. So, functional cusp of the pantie should not be
reduced to preserve a stable vertical dimension.
• In the maxillary teeth, the buccal cusp provides aesthetics.
In lower teeth, the lingual cusps aid to protect the tongue.
lnterproximal surface
• Vertical spaces must be sufficient for interproximal tis-
sues and permit physiologic contour of pantie.
• The sizes of maxillary embrasure are reduced for the
sake of aesthetics. But, sufficient spaces are given to
avoid impingement to the interdental papilla.
• Wider embrasures provided to posterior teeth helps in
better cleansing.
Buccal and lingual surfaces
• Buccal and lingual surfaces are determined by aesthetic,
functional, and hygienic requirements.
• The facial surface should be designed with aesthetic as
primary concern. It should resemble the adjacent teeth.
• The lingual surface should meet functional and hygienic
requirements. It must harmonise with adjacent teeth from
cusp tip to height of contour, and then recedes smoothly
and convexly to facial or buccal tissue contact area.
• Embrasures on lingual areas are wider than the buccal
or facial.
Section I I Topic Wise Solved Questions of Previous Years

Q. 2. Define and classify pontics. Write in detail indica- C. Prefabricated custom-modified pontic.
tions, contraindications, and advantages of different Indications, Contraindications, and Advantages
types of pontics.
of Different Types of Pontics
Or
• Saddle/ridge lap pontic
Define and classify pontic. Discuss indications and con- Indication: Highly aesthetic demands.
traindications of various types of pontics. Contraindications: Patients with poor oral hygiene mainte-
Ans.
nance and periodontal problems.
Advantages: Aesthetically superior.
Disadvantages: Gingival surface inaccessible to patient,
Pontic thus difficult to clean.
Pantie is defined as, 'An artificial tooth on a fixed partial Pantie must be highly polished.
denture that replaces a missing tooth, restores its function, • Modified ridge lap pontic
and usually fills the space previously filled by a natural
crown'. Indications: Appearance zone.
Contraindications: Poor oral hygiene and mandibular pos-
terior teeth.
Classification of Pontics Advantages: Good aesthetics. Lingual surface is convex
Panties can be classified on the basis of mucosa! contact, and does not contact gingival tissue, thus enabling hygiene
type of material used, and method of fabrication. The clas- maintenance.
sification is as follows: Disadvantages: Oral hygiene is inferior when compared to
sanitary panties.
I. Mucosa! contact
A. With mucosa! contact • Ovate pontic
i. Saddle pantie or ridge lap pantie. Indications: Fresh extraction sockets, anterior missing
ii. Modified ridge lap pantie. teeth, or flat broad ridges.
iii. Ovate pantie. Contraindications: Posterior teeth.
iv. Conical pantie. Advantages: Most aesthetically appealing, least food en-
trapment, and thus easy to clean.
B. Without mucosa! contact Disadvantages: Surgical preparation and meticulous oral
i. Hygienic or sanitary pantie. hygiene are required.
ii. Modified sanitary pontic/perel pantie/bullet pantie.
• Conical pontic
II. Type of material used Indications: Knife-edged posterior ridges or molar
Based on the type of material used, panties can be clas- teeth.
sified as: Contraindications: Broad residual edentulous ridge and
i. All metal pantie. aesthetic zone.
ii. All ceramic pantie. Advantages: Ideal oral hygiene.
iii. Metal-ceramic pantie. Disadvantages: Compromised aesthetics.
iv. Metal with resin-veneered pantie.
• Sanitary/hygienic pontic
v. Fibre-reinforced composite pantie.
Indications: Non-aesthetic zone and ease of mainte-
111. Method of fabrication nance.
Based on method of fabrication, panties can be classi- Contraindications: Appearance zone and less vertical
fied as: dimension.
A. Custom-made pantie. Advantages: Good accessibility for oral hygiene.
B. Prefabricated pantie Disadvantages: Poor aesthetics.
i. Trupontic.
• All metal pontics
ii. Interchangeable facing.
iii. Sanitary pantie. Indications: Areas that are not of aesthetic concern.
iv. Pin-facing pantie. High stress-bearing teeth like mandibular molars.
v. Modofied pin-facing pantie. Patients with parafunctional habits like bruxism.
vi. Reverse pin-facing pantie. Contraindications: They cannot be used, if aesthetic is of
vii. Harmony pantie. prime concern.
 Quick Review Series for BOS 4th Year: Prosthodontics

Advantages Fibre-reinforced composite panties

• High strength. Indications
• Easy to fabricate and less technique sensitive. • Resin-bonded fixed prosthesis.
• They can be used, if pantie space is inadequate. • Good oral hygiene.
• Anterior single missing tooth situations.
Disadvantages
• Short-span bridges.
• Poor aesthetics.
• Used as temporary restorations in young adults, till a
• Permeable to oral fluids.
permanent prosthesis is fabricated.
• Galvanism, if two different metals are used in the
mouth. Contraindications
• Replacement of posterior missing tooth.
• All ceramic panties • Long-span bridges.
Indications • Deepbite cases.
• Areas of prime aesthetic concern like maxillary Advantages
anteriors. • Easy chair-side fabrication procedure.
• Exacting patients who are highly motivated towards • Acceptable aesthetics and shade matching.
quality dental treatment. • Minimal tooth preparation is required.
Contraindications • They can be used in young patients, where the pulp
• Patients with parafunctional habits like bruxism. chambers are big and full.
• Reduced interarchpontic space. • Crown preparation may cause pulpal damage.
• Long-span bridges. Disadvantages
Advantages: Highly aesthetic and good strength. • Less strength
Disadvantages • They cannot be used in cases of multiple missing teeth.
• High cost, as it is highly technique-sensitive. Q. 3. Describe the component parts of fixed partial denture.
• Lesser strength than porcelain fused to metal panties.
Or
• Metal-ceramic panties Describe the components of a fixed partial denture in
Indications: It is indicated in most clinical cases. detail.
It is the most commonly used pantie type.
Advantages Or
• They can be used in almost all clinical situations. Discuss the various components of partial denture and
• Good aesthetics. the functional role played by them individually.
• Adequate strength.
Ans.
• Biocompatible.
Disadvantages
• More extensive lab procedure than all metal Components of Fixed Partial Denture
panties.
Fixed partial denture is made up of three elementary com-
• Difficult to fabricate, if the retainers are not metal-
ponents:
ceramic.
I. Retainer,
II. Pantie, and
• Metal with resin-facing panties
III. Connector.
Indications: Long-term provisional restorations.
Contraindication: Definitive restorations.
Advantages Retainer
• Cost-effective procedure, as conventional gold can be • The part of a fixed dental prosthesis that unites the
used as substructure. abutment(s) to the remainder of the restoration (GPT 8).
• Easy fabrication. • This is used for the stabilization or retention of prosthesis.
• Fairly good aesthetics can be achieved. • It is cemented to the abutment.
Disadvantages • Major retainers are retainers, which cover the full oc-
• Lower strength as compared to any other restoration. cluding surface of the tooth, e.g., full veneer crowns and
• Lesser abrasion resistance. partial veneer crowns.
• Easily discoloured over a period of time. • Minor retainers are small metallic extensions that are
• Permissible to oral fluids. cemented onto the tooth, e.g., inlay and onlay.
Section I I Topic Wise Solved Questions of Previous Years

Types of retainers iii. All ceramic retainers

Retainers in FPD can be broadly classified as: • They can be fabricated as a partial veneer or full veneer
crown.
• Based on tooth coverage
• They require maximum tooth reduction, because porce-
i. Full veneer crowns. lain requires sufficient bulk for adequate strength.
ii. Partial veneer crowns.
iii. Conservative retainers. iv. All acrylic resin
• It is used for long-term temporary FPD.
• Based on the material being used • It is not indicated for permanent restorations.
i. All metal retainers.
Criteria for selecting the type of retainers
ii. Metal-ceramic retainers.
Retainers can be specifically designed to suit the condition
iii. All ceramic retainers.
of abutment.
iv. All acrylic retainers.
Various types of retainers are explained in detail below: i. Condition of the abutment
• If the abutment teeth are in good health, in terms of both
• Based on tooth coverage periodontium and caries, a partial veneer retainer can be
i. Full veneer crowns considered as a treatment option.
• In case the abutment is endodontically treated or exten-
• These retainers cover all five surfaces of the abutment.
sively damaged, a full veneer retainer is recommended.
• They are fabricated like a cap and are usually indicated
• If abutments are periodontally weak with exposure of
for extensively damaged teeth.
the root surface, conservative resin-bonded retainers are
• They are most retentive and ideal retainers, because
indicated.
their design can resist masticatory forces in all
directions.
ii. Aesthetics
ii. Partial veneer crowns • Though partial veneer retainers may not involve the fa-
• These retainers do not involve all the surfaces of the cial surface, their use in aesthetic zones can be question-
abutment. able when the teeth are thin and metal may be reflected.
• Compared to full veneer retainers, they require less • Secondary caries is also a possibility because of open
amount of tooth preparation and have superior aesthetics, margins. In such circumstances, full veneer retainers are
but are less retentive. preferred with either facing or full ceramic coverage.
• In case of inadequate pantie space, a full veneer retainer can
iii. Conservative retainers help better in managing the space to get better aesthetics.
• They require minimal tooth reduction/preparation, e.g., iii. Preservation of tooth structure
acid etching.
• Partial veneer preparations are more conservative than
• These retainers require minimal tooth preparation and
full veneer preparations.
are primarily indicated for anterior teeth.
• The buccal/facial surfaces of the teeth should be pre-
• They cannot accept heavy occlusal load, e.g., resin-
served for natural aesthetics. Choice should be made
bonded fixed partial dentures.
depending upon all the factors, so that the longevity of
• Based on the material being used
the prosthesis is not compromised.
• Even etched cast retainers can be thought of as a conser-
i. All metal retainers
vative alternative.
• All metal retainers are either partial or full veneer
crowns. iv. Retention
• These retainers needs minimal tooth preparation and are • A molar exerts more force when compared to a premo-
strong even in thin sections. lar, thus it requires more retention.
• Longer the span, greater is the retention required. In
ii. Metal ceramic retainers both cases, full coverage retainers offer better retention.
• They can be fabricated over an entire full veneer crown
or they can be fabricated as a facing, over the labial/ v. Cost
buccal surface of the full veneer crown or over partial • Full veneer all ceramic retainers are recommended in
veneer crowns. cases of anterior tooth replacements. But they are more
• These require more tooth reduction. expensive than metal-ceramic and facing retainers.

• Hence, if cost is a factor, metal-ceramic restorations
can be considered for anterior region and all metal res-
torations for posteriors.
Pontic
Pantie is defined as 'An artificial tooth on a fixed partial denture
(FPD) that replaces a missing tooth, restores its function, and
usually fills the space previously occupied by a natural crown'.
Connector
• Connector in a fixed partial denture and it can be de-
fined as, 'the portion of a fixed partial denture that
unites the retainer(s) and pontic(s)' (GPT).
Connectors can be broadly classified as:
i. Rigid connectors
a. Cast connectors.
b. Soldered connectors.
c. Loop connectors.
ii. Non-rigid connectors
a. Tenon-Mortise connectors.
b. Split pantie connectors.
c. Cross pin and wing connectors.
i. Rigid connectors
• These connectors are used to unite retainers and panties
in a fixed partial denture.
• These connectors are used when the entire load on the
pantie is to be transferred directly to the abutments.
• A rigid connector is made by casting as part of a multi-
unit wax pattern or by soldering.
• The design of rigid connector is incorporated into the
wax pattern. Connectors which are to be soldered are
sectioned in the wax pattern with a thin ribbon saw, so
that when the components are cast, they can be joined on
a flat, parallel, and at a controlled distance of 0.13 mm.
a. Cast connectors
• These are waxed on the master cast before investing the
pattern.
• It is advisable to use them on complete coverage resto-
rations, as they can be gripped buccolingually.
• One piece castings are easier to fabricate, but they tend
to create more problems, than do soldered connectors.
b. Soldered connectors
• In a soldered connector, wax patterns are sectioned at
interproximal areas using a thin saw.
• This enables the surfaces to be joined flat parallel and
accurate soldering can be done.
• A gap of 0.25 mm is recommended for proper soldering.
c. Loop connectors
• Loop connectors are used when an existing diastema is
to be maintained in a planned fixed prosthesis.
Quick Review Series for BOS 4th Year: Prosthodontics
• This connector consists of a loop on a lingual aspect of the
prosthesis that connects adjacent retainers and/or panties.
• The loop can be cast from a platinum-gold palladium
alloy wire.
• Loop should be carefully designed, such that it is easy
to maintain.
Example: Palatal connector seen in a spring cantilever fixed
partial denture is a type of loop connector.
ii. Non-rigid connectors
• These connectors are indicated in cases where a single
path of insertion cannot be achieved due to non-parallel
abutments.
• These connectors allow limited movement between the
retainer and the pantie.
a. Tenon-Mortise connectors with a male and female
component or Dove tail connectors
• This non-rigid connector consists of a Mortise (female)
prepared within the contours of the retainer and a Tenon
(male) attached to the pantie. The alignment of this
dove tail connector is critical; and it must parallel the
path of withdrawal of the other retainer.
• Paralleling is normally accomplished by means of a
dental surveyor.
• The female component may be prepared free hand in the
wax pattern or with a precision milling machine. Alter-
natively, a special mandrel can be embedded in the wax
pattern and the abutment retainer is cast.
• The female component is refined as necessary; and, the
male key is fabricated with autopolymerizing resin and
is attached to pantie. Another approach is to use a pre-
fabricated plastic component for the Mortise and Tenon
of a non-rigid connector.
b. Split pontic connector
• These connectos are used only in cases with pier
abutments.
• The connector is incorporated within the pantie.
• The pantie is split into mesial and distal segments,
where each segment is attached to its respective retainer.
• The mesial segment is fabricated with a shoe/key.
• The distal segment is fabricated with a keyway to fit
over the shoe.
• These two components are designed by aligning in a
surveyor.
c. Cross pin and wing connector
• They are similar to split pantie connector.
• A wing is attached to the distal connector.
• The wing is fabricated in such a way that it aligns with
the long axis of the mesial abutment.
• The wing along with the distal retainer is known as the
retainer wing component.
• The pantie is attached to the mesial retainer and is de-
signed to fit to the wing in the retainer wing component.
Section I I Topic Wise Solved Questions of Previous Years
The pantie along with the mesial retainer is known as
the retainer pantie component.
• After fabricating the retainer wing and retainer pantie
components, they are aligned on the working cast and a
0.7 mm pin hole is drilled across the wing and pantie
using a twist drill.
• A rigid pin of 0.7 mm diameter should be fabricated
using the same alloy.
• The pin should be seated within the pin hole created on
the wing and pantie and adjusted to its exact length.
After cementing the components, the pin is seated into
the hole using a punch and mallet.
Q. 4. Abutments for fixed partial prosthesis.
Or
Define an abutment and enumerate the criteria involved
in abutment selection.
Or
Define abutment. Describe the factors to be considered
in selection of a bridge abutment.
Or
What are questionable abutments? Give the manage-
ment of such an abutment successfully in a fixed partial
denture.
Or
Define an abutment and pier. How will you manage
abutment with compromised periodontal conditions?
Ans.
Abutment
An abutment can be defined as, 'A tooth, a portion of a
tooth or that portion of an implant used for the support of a
fixed or removable prosthesis' (GPT).
• The most important factor to be considered in the design
of a fixed prosthesis is the location and the characteris-
tics of the abutment.
• The role of an abutment is very crucial in accepting
the load acting on a fixed partial denture. The choice
of a suitable abutment is important, because the abut-
ment has to withstand both the forces acting on it and
on the pantie.
The major criteria involved in abutment selection are as follows:
Location/ Position/ and Condition of the Tooth
Teeth preferred as abutment should have the following
characteristics:
• Teeth must be adjacent to edentulous spaces.
• Teeth with grossly decayed crowns that can be restored
with a full veneer crown.
• Modifications like dowel core and pin-retained amal-
gam restoration may be needed to restore crown mor-
phology in grossly destructed teeth.
• Vital teeth are preferred, though endodontically treated
teeth can also be used.
• Pulp capped teeth should not be used as abutments, be-
cause they are always under the risk of requiring root
canal treatment.
Root Configuration
• The forces acting on tooth are transferred to the support-
ing bone through the root.
• The shape of the root will determine the ability of the
abutment to transfer the masticatory load to the support-
ing bone.
Few facts to be remembered regarding the configuration of
an abutment root are:
• Roots with greater labiolingual widths are preferred.
• Roots with irregular curvature are preferred.
• Teeth with longer roots serve as better abutments.
• Teeth with conical roots can be used for short-span fixed
partial dentures.
Crown-root Ratio
• The ratio between the length of the crown and the root
should always be less than one.
• The length of the crown in this case does not indicate
the clinical or anatomic crown. Instead, it indicates the
length of the tooth structure above the crest of the
alveolar bone.
• The teeth with alveolar defects are considered to have
very long crowns.
• Ideally, the crown-root ratios up to 1: 1 are acceptable.
Ratios above one are unacceptable.
Root Support
• The supporting alveolar bone should be healthy. It
should have good trabecular architecture and show no
signs of bone defects or bone loss.
• Intraoral radiographs should be used to evaluate the
bone architecture.
• The alveolar bone support is one of the most important
factors that aid to evaluate an abutment.
Periodontal Ligament Area
• It depends upon the size and the length of the root. The
bone support will increase with an increase in the peri-
odontal ligament area. Periodontally diseased teeth are
unsuitable to be used as abutments.
• The loss of periodontal support is almost half as impor-
tant as loss of bone support.

• The periodontal ligament area can be used as a scale or
measurement to determine the potency of an abutment.
Tylman stated that two abutment teeth can support two
panties.
• Johnson et al., improvised Tylman's statement and pro-
posed the famous Ante's Law, which states that 'the sum
of the pericemental areas of abutment teeth should be
equal to or surpass that of the teeth being replaced'.
• The pericemental area of the abutment root should be
calculated and if it is not sufficient then an additional
teeth should be used as a secondary abutment.
Assessment of Pu/pal Health
• Usually, unrestored abutments are preferred. If caries is
present, then regular preparation can be done.
• If large carious lesions are present, then they should be
scooped out and can be used for additional retention.
• Root canal treatment is advised if the abutment tooth
has a carious lesion with pulp involvement, but it is not
advised for abutments with periapical lesions.
• Special designs are considered in cases where the loca-
tion of one or all the abutments does not advocate a
conventional design.
• An abutment should be chosen according to the crown-
root ratio, biomechanical considerations, root configu-
ration, periodontal ligament area, and pulpal health.
Q. 5. What is fixed partial denture prosthesis? How do
you classify them? Discuss with reasons in the choice of
materials that you choose for construction of 3-unit
bridge for missing 26.
Ans.
Fixed Partial Denture Prosthesis
It is defined as the branch of prosthodontics with the re-
placement and/or restoration of teeth by artificial substi-
tutes that are not readily removed from the mouth.
Classification of Fixed Partial Denture
Fixed partial denture can be classified based on following
criteria:
Location of edentulous space
i. Posterior: Fixed partial denture that is confined to pos-
terior region, e.g., replacement of first missing molar.
ii. Anterior: Fixed partial denture that is confined to
anterior region, e.g., replacement of missing central
incisors.
iii. Combination: Fixed partial denture extending both an-
teriorly and posteriorly, e.g., replacement of single/
multiple teeth involving the turn of arch, as in case of
replacement of missing canine and premolars.
Quick Review Series for BOS 4th Year: Prosthodontics
Location of abutment
i. Conventional: Location of abutment is adjacent to the
edentulous space, but pantie is supported on both sides.
This is the design for majority of the fixed partial
dentures.
ii. Cantilever: Location of the abutment is adjacent to
edentulous space, but pantie is supported on one
side only.
iii. Spring cantilever: Location of the abutment is not adja-
cent to the edentulous space and pantie receives support
from one side only. Generally, premolar is used as poste-
rior abutment to replace an anterior tooth and a bar is used
to connect the abutment and pantie. The bar is rigid and
is termed 'Loop connector'. It is most often indicated in
replacing missing maxillary central incisor, when a dia-
stema is desired. Not used with mandibular replacements,
as connectors can cause tongue interference.
Type of connector
i. Fixed-fixed: Connectors on both the sides of the pantie
are rigid and there is no scope for any movement. The
connector is either soldered to the pantie and the re-
tainer or all the components are cast as a single piece.
ii. Fixed movable: One of the connectors of FPD assembly
is non-rigid. It is made of a precision or semi-precision
attachment which allows some vertical movement. This
is normally indicated in case of a pier abutment, tilted
abutments, or periodontally weak abutments.
iii. Fixed-removable: This was developed by Dr. James
Andrews and is also called as 'Andrews bridge'.
The fixed portion consists of two abutment retainers
adjacent to an edentulous space splinted by a bar. The re-
tainers attached to the bar are cemented on the abutments.
The removable portion consists of the artificial teeth and a
denture flange with a sleeve which clips onto the bar.
This technique provides flexibility in placing denture
teeth as well as the stabilizing qualities of a fixed prosthesis.
Type of material used
i. All metal: These are used only to replace posterior
teeth, as they are not aesthetic.
ii. Metal-ceramic: These are also termed as 'porcelain-
fused to metal' (PFM). These are of two types:
a) Metal with complete ceramic coverage: It has a
core of metal which fits on the abutment and is
completely covered by ceramic, both facially and
lingually/palatally.
b) Metal with ceramic facing: In this type, all surfaces
are covered by metal and ceramic. It covers the
metal in the labial/buccal surface alone.
iii. All ceramic: They are also called as metal-free ceramic
restoration, as these are fabricated using only ceramics.
iv. Metal with resin facings: This is similar to metal with
ceramic facing, except that instead of ceramic, acrylic or
Section I I Topic Wise Solved Questions of Previous Years
composite resin is used. Unlike ceramics, resin does not
bond chemically to metal. So, retention should be ob-
tained mechanically by using small wire loops or reten-
tion beads on the labial surface of metal which is then
cast. An opaque resin supplied by the manufacturer is
applied on the labial surface prior to processing the resin
to mask the metal. The other difference with metal with
ceramic facing is that the veneered resin should not cover
the incisal edge and all contacts must occur on metal.
v. All acrylic, composite, and fibre-reinforced composite:
These are only used as provisional restorations.
Duration of use
i. Provisional or temporary FPD
These are made of acrylic resins and are intended for
use for a short period of time. It is fabricated soon after
the preparation and is expected to serve the patient, till
the definitive prosthesis is fabricated. It is cemented
using temporary cements.
ii. Long-term temporary FPD
These are fabricated with special acrylic resins which have
additional strength or can be reinforced with metal inserts.
iii. Definitive FPD
These are fabricated with materials like ceramics and met-
als and are expected to serve the patient for longer time.
SHORT ESSAYS
Q. 1. Rigid and non-rigid connectors in FPD.
Or
Types of connectors used in FPDs.
Or
Connectors in fixed partial dentures.
Or
Define and classify connectors in FPD.
Ans.
Connector
• Connector in a fixed partial denture and can be defined
as, 'The portion of a fixed partial denture that unites the
retainer(s) and pontic(s)' (GPT).
Classification of Connectors
Connectors can be broadly classified as:
i. Rigid connectors
a. Cast connectors.
b. Soldered connectors.
c. Loop connectors.
Span length
i. Short-span: When the FPD replaces one or two adjacent
teeth and is confined to 3-4 units, it is called as short-
span FPD.
ii. Long-span: When the FPD replaces more than two
adjacent teeth, it is termed as long-span FPD.
Type of retention
i. Frictional resistance: All conventional fixed partial den-
tures are retained because of the frictional resistance
offered by the parallel walls of the prepared tooth and
the restoration assisted by the cement.
ii. Microretention: The retention of the resin-bonded,
etched cast restorations depend on the bonding ability
of the resin and the surface irregularities of the tissue
surface of the restoration.
Type of support
i. Tooth supported: Conventional FPDs taking support of
natural teeth only.
ii. Implant-supported: FPDs using osseointegrated im-
plants as abutments.
iii. Combination: FPDs taking support of both natural teeth
and implants.
ii. Non-rigid connectors
a. Tenon-Mortise connectors.
b. Split pantie connectors.
c. Cross pin and wing connectors.
Rigid connectors
• These connectors are used to unite retainers and panties
in a fixed-fixed partial denture.
• These connectors are used when the entire load
on the pantie is to be transferred directly to the
abutments.
• A rigid connector is made by casting a part of a multi-
unit wax pattern or by soldering.
a. Cast connectors
• One piece castings are easier to fabricate, but tend to
create more problems, than do soldered connectors.
b. Soldered connectors
• In a soldered connector, wax patterns are sectioned at
interproximal areas using a thin saw.
• This enables the surfaces to be joined flat parallel and
accurate soldering can be done.
• A gap of 0.25 mm is recommended for proper
soldering.

c. Loop connectors
• Loop connectors are used when an existing diastema is
to be maintained in a planned fixed prosthesis.
• This connector consists of a loop on a lingual aspect of
the prosthesis that connects adjacent retainers and/or
panties.
• Example: Palatal connector seen in a spring cantilever
fixed partial denture is a type of loop connector.
Non-rigid connectors
• These connectors are indicated in cases where a single
path of insertion cannot be achieved due to non-parallel
abutments.
• These connectors allow limited movement between the
retainer and the pantie.
a. Tenon-Mortise connectors with a male and female
component or Dove-tail connectors
• This non-rigid connector consists of a Mortise (female)
prepared within the contours of the retainer and a Tenon
(male) attached to the pantie. The alignment of this
dovetail connection is critical; and, it must parallel the
path of withdrawal of the other retainer.
• Paralleling is normally accomplished by means of a
dental surveyor.
• The female component may be prepared free hand in the
wax pattern or with a precision milling machine. Alter-
natively, a special mandrel can be embedded in the wax
pattern and the abutment retainer is cast.
• The female component is refined as necessary. The male
key is fabricated with auto-polymerizing resin and is
attached to pantie. Another approach is to use a prefab-
ricated plastic component for the Mortise and Tenon of
a non-rigid connector.
b. Split pontic connector
• These connectors are used only in cases with pier abut-
ments.
• The connector is incorporated within the pantie.
c. Cross pin and wing connector
• They are similar to split pantie connector.
• A wing is attached to the distal connector. The wing
along with the distal retainer is known as the retainer
wing component.
• The pantie is attached to the mesial retainer and is de-
signed to fit to the wing in the retainer wing component.
The pantie along with the mesial retainer is known as
the retainer pantie component.
Q. 2. Ridge lap and modified ridge lap pontic.
Or
Quick Review Series for BOS 4 th Year: Prosthodontics
Disadvantages of ridge lap type pontic.
Ans.
Ridge Lap Pontic
Saddle/Ridge Lap Pontic
Indication: Highly aesthetic demands.
Contraindications: Patients with poor oral hygiene mainte-
nance and periodontal problems.
Advantages: Aesthetically superior.
Disadvantages
• Gingival surface inaccessible to patient, thus difficult to
clean.
• Pantie must be highly polished.
Modified Ridge Lap Pontics
Indications: Appearance zone.
Contraindications: Poor oral hygiene and mandibular pos-
terior teeth.
Advantages
• Good aesthetics.
• Lingual surface is convex and does not contact gingival
tissue, enabling hygiene maintenance.
Disadvantages: Oral hygiene inferior, when compared to
sanitary panties.
Q. 3. Sanitary pontic.
Or
Hygienic pontic.
Ans.
Sanitary Pontic
Sanitary pantie is called so, because this design allows easy
cleansing, as tissue surface of pantie remains clear of the
residual ridge.
• This design makes no contact with the residual ridge.
Thus, there are minimal chances of inflammation.
• Occlusogingival thickness of the pantie should be
greater than 3 mm and there should be adequate space
under it, to facilitate cleansing.
• It is frequently made in convex configuration both facio-
lingually and mesiodistally.
• The conventional type is called 'the fish belly' design,
where the under surface of the pantie is rounded with-
out angles for easier cleansing/flossing, because it is
difficult to get the floss to pass over a flat under surface
evenly.
Section I I Topic Wise Solved Questions of Previous Years

Advantages Aesthetics
• Good access for oral hygiene. Though partial veneer retainers may not involve the
• Minimal tissue inflammation. facial surface, their use in aesthetic zones can be ques-
tionable when the teeth are thin and metal may be re-
flected. Secondary caries is also a possibility, because
Disadvantages
of open margins. In such circumstances, full veneer re-
• Poor aesthetics. tainers are preferred with either facing or full ceramic
coverage.
Recommended Location In case of inadequate pantie space, a full veneer re-
tainer can help better in managing the space to get better
• Non-appearance zone, when occlusogingival space aesthetics.
is low.

Preservation of Tooth Structure

Contraindications
• Partial veneer preparations are more conservative than
• Appearance zone.
full veneer preparations.
• Less vertical dimension will result in connector failure.
• The buccal/facial surfaces of the teeth should be pre-
Q. 4. Selection of retainers for a fixed partial denture. served for natural aesthetics. Choice should be made
depending upon all the factors, so that the longevity of
Or
the prosthesis is not compromised.
Bridge retainer. • Even etched cast retainers can be thought of as a conser-
vative alternative.
Ans.

Selection of Retainers for a Fixed Partial Retention

Denture A molar exerts more force when compared to a premolar
Criteria for selecting the type of retainers: Retainers can
and thus it requires more retention. Longer the span, greater
be specifically designed to suit the condition of is the retention required. In both cases, full coverage retainers
abutment. offer better retention.

Abutment Angulations Cost

• In case the abutments are parallel to each other, a full
veneer retainer can be planned and a single path of
insertion can be obtained.
• If the abutments are non-parallel owing to unfavourable
tooth positions, then a partial veener retainer along with
another partial or full retainer can be used to get a single
path of prosthesis insertion.
Condition of the Abutment
• If the abutment teeth are in good health in terms of both
periodontium and caries, then a partial veneer retainer
can be considered as a treatment option.
• In case the abutment is endodontically treated or exten-
sively damaged, a full veneer retainer is recommended.
• If abutments are periodontally weak with exposure of
the root surface, then conservative resin-bonded retain-
ers are indicated.
Full veneer all ceramic retainers are recommended in cases
of anterior tooth replacements. But, they are more expen-
sive than metal-ceramic and facing retainers.
Hence, if cost is a factor, metal ceramic restorations can
be considered for anterior region and all metal restorations
for posteriors.
Q. 5. Define pontic. Describe indications of the various
types.
Ans.
Pontic
Pantie is defined as, 'An artificial tooth on a fixed partial
denture that replaces a missing tooth, restores its function,
and usually fills the space previously filled by a natural
crown'.
 Quick Review Series for BOS 4 th Year: Prosthodontics

Classification of Pontic vii. All ceramic panties

• Areas of prime aesthetic concern like maxillary
Panties can be classified on the basis of mucosa! contact,
anteriors.
type of material used, and method of fabrication as follows:
• In patients who are highly motivated towards qual-
ity dental treatment.
I. Mucosa! contact
viii. Metal-ceramic panties: In most clinical cases.
A. With mucosa! contact a. Most commonly used pantie-type.
i. Saddle pantie or ridge lap pantie. ix. Metal with resin-facing panties: Long-term provi-
ii. Modified ridge lap pantie. sional restorations.
iii. Ovate pantie. x. Fibre-reinforced composite panties
iv. Conical pantie. • Resin-bonded fixed prosthesis.
• Good oral hygiene.
B. Without mucosa! contact • Anterior single missing tooth situations.
i. Hygienic or sanitary pantie. • Short-span bridges.
ii. Modified sanitary pontic/perel pantie/bullet pantie.
Q. 6. Maryland bridges.

II. Types of material used Ans.

Based on the type of material used, panties can be clas-
sified as: Maryland Bridges
i. All metal pantie.
• Many scientists developed different designs to over-
ii. All ceramic pantie.
come the shortcomings of Rochette bridges.
iii. Metal-ceramic pantie.
• Dunn and Reisbick used electrochemical pit corrosion
iv. Metal with resin-veneered pantie.
to study ceramic bonding to base metals.
v. Fibre-reinforced composite pantie.
• Tanaka et al., studied the retention of acrylic resin on
Ill. Method of fabrication metal copings.
Based on method of fabrication, panties can be classified as: Finally, Livaditis and Thompson from University of
A. Custom-made pantie. Maryland School of Dentistry used Dunn's study and de-
B. Prefabricated pantie veloped Maryland bridges.
i. Trupontic. • Here, mechanical retention was developed by the micro-
ii. Interchangeable facing. porosities present on the tissue surface of the retainer.
iii. Sanitary pantie. Microporosities are created by etching the tissue surface
iv. Pin-facing pantie. of the retainer.
v. Modified pin-facing pantie.
vi. Reverse pin-facing pantie. Etching Techniques
vii. Harmony pantie.
C. Prefabricated custom-modified pantie. The suggested technique that can be employed while fabri-
cating Maryland bridges can be broadly divided into:
Indications of the various types of panties are as follows: A. Electrochemical etching.
B. Non-electrochemical etching.
Types of Pontics and their Indications A. Electrochemical etching
i. Sanitary/hygienic pantie: Non-aesthetic zone and ease Here, etching is done using a chemical electrolyte in the
of maintenance. presence of an electrical gradient. Before etching, the re-
ii. Saddle/ridge lap pantie: Highly aesthetic demands. tainer is coated using paraffin wax. The wax must cover the
iii. Modified ridge lap panties: Appearance zone. entire retainer except for the area to be etched.
iv. Conical pantie: Knife-edged posterior ridges or molar Commonly used electrochemical techniques includes:
teeth. i. For non-beryllium nickel chromium alloys: Etching is
v. Ovate pantie: Fresh extraction sockets. Anterior miss- done in two stages. In the first stage, the retainer is im-
ing teeth or flat broad ridges. mersed in 3.5% nitric acid under a current of 250 mA/cm2
vi. All metal panties for 5 min. Next, the retainer is cleaned by immersing it in
• Areas that are not of aesthetic concern. an ultrasonic cleaner for 10 min.
• High stress-bearing teeth like mandibular molars. ii. For beryllium containing nickel chromium alloys: It is
• Patients with parafunctional habits like bruxism. also a two-step technique. During the first step, the
Section I I Topic Wise Solved Questions of Previous Years
retainer is immersed in 10% H2S04 under a current
of 300 mA/cm2. The second step is similar to the one
described for the previous technique.
iii. Mc Laughlin technique or one-step technique: It is a
single-step technique. Here, the alloys are etched by im-
mersing the retainer in a beaker with a mixture of HCl
and H2SO4. The beaker with the retainer is directly
placed in an ultrasonic cleanser for 99 sec under an
electrical field. This technique increases the speed of
etching.
Disadvantages of electrochemical etching
• Expensive.
• Very technique-sensitive.
• Tedious procedure and difficult to control the area to be
etched.
B. Non-electrochemical etching
Commonly used non-electrochemical etching technique
includes:
i. Livaditis proposed a technique, wherein nickel-
chromium-beryllium alloys were successfully etched
in an etching solution placed in a water bath for one
hour at 70°C.
ii. Doukoudakis proposed the use of stable aquaregia gel to
etch enamel.
Advantages of non-electrochemical etching
• It does not require special equipment.
• Etching is comparable to more expensive techniques.
• The prosthesis can be fabricated and bonded in two
stages.
Q. 7. Ante's Law.
Ans.
Ante's Law
'The abutment teeth should have a combined pericemental
area equal to or greater than the pericemental area of the
tooth/teeth to be replaced' (GPT).
In fixed partial denture prosthodontics, for the observa-
tion, the combined pericemental area of all the abutment
teeth supporting a fixed partial denture should be equal to
or greater than the tooth or teeth being replaced. As formu-
lated for removable partial prosthodontics, the combined
pericemental area of the abutment teeth should be equal to
or greater than the pericemental area of the missing teeth.
The pericemental area of the abutment should be calcu-
lated and if it is not sufficient, then an additional tooth
should be used as a secondary abutment.
Explanation
• The effective root surface area or bony support avail-
able will determine whether or not a tooth will be
able to withstand the additional load imposed on it by
pantie.
• In fixed-fixed and fixed-removable bridges, a periodon-
tally sound tooth can support a pantie of equal size.
• In case of the cantilever bridge, the load imposed must
be greatly reduced for the restoration to be successful.
This is particularly true in the posterior region, where
only minimal cantilevering is permissible.
• The approximate order of strength of teeth which can be
used as bridge abutments is as follows:
Maximal > Minimal
Upper: 6 3 7 4 5 1 2
Lower: 6 3 7 5 4 2 1
However, each tooth requires individual assessment and
consideration of other factors such as size of its roots, de-
gree of eruption, angulation, etc.
If the pericemental area of the abutment teeth is less
than the tooth to be replaced, then secondary abutments are
considered.
Q. 8. Requirements of pontics.
Ans.
A pantie should fulfil the following ideal requirements:
a. Restoring the function: It should restore the function of
the tooth it replaces.
b. Adequate strength
• The facing should not be detached.
• There should not be any flexing of the alloy which is
supporting the facing.
c. Aesthetics
• The facing should be aesthetically acceptable.
• Shade and shape should match.
d. Colour stability
The colour of the pantie should match the neighbouring
tooth and it should remain for many years. In this re-
spect, acrylic is poor. Porcelain does not discolour.
e. Hygiene
The design of pantie should be self-cleansing. Patient
should be able to clean it easily by means of tapes, den-
tal floss, and interdental stimulator.
f. Non-irritant to the soft tissues
The pantie should not irritate the gingiva.
It should not overload the abutment teeth, i.e., the
periodontal health of the abutment should not be hampered
by pantie.
 Quick Review Series for BOS 4 th Year: Prosthodontics

SHORT NOTES
Q. 1. Sanitary (hygienic) pontic. Connectors can be broadly classified as:
Ans
i. Rigid Connectors
Sanitary (hygienic) Pontic a. Cast connectors.
b. Soldered connectors.
• Sanitary pantie is called so, because this design allows c. Loop connectors.
easy cleansing, as tissue surface of pantie remains clear
of the residual ridge.
ii. Non-rigid Connectors
• This design makes no contact with the residual ridge.
Thus, there are minimal chances of inflammation. a. Tenon-Mortise connectors.
• Occlusogingival thickness of the pantie should be b. Split pantie connectors.
greater than 3 mm and there should be adequate space c. Cross pin and wing connectors.
under it, to facilitate cleansing.
Q. 4. Modified ridge lap pontics.
• It is frequently made in convex configuration, both
faciolingually and mesiodistally. Ans.
• The conventional type is called 'the fish belly' design,
where the under surface of the pantie is rounded with- Modified Ridge Lap Pontics
out angles for easier cleansing/flossing, because it is
difficult to get the floss to pass over a flat under surface Indications: Appearance zone.
evenly. Contraindications: Poor oral hygiene and mandibular pos-
terior teeth.
Advantages
Advantages • Good aesthetics.
• Good access for oral hygiene. • Lingual surface is convex and does not contact gingival
• Minimal tissue inflammation. tissue, thus enabling hygienic maintenance.
Disadvantages: Oral hygiene inferior, when compared to
sanitary panties.
Disadvantage
Q. 5. Spheroidal pontic.
• Poor aesthetics.
Ans.
Q. 2. Ovate pontic.

Ans.
• Ovate panties are used in cases where the residual ridge
is defective or incompletely healed.
• They can also be used in broad and flat ridges.
• The pantie is designed such that, its cervical end ex-
tends into the defect of the edentulous ridge.
• The pantie should be reduced, as healing progresses.
• This pantie is more aesthetic, as it appears to arise from
the ridge, like a natural tooth.
Q. 3. Name the connectors in FPD.
Or
Non-rigid connectors in FPD.
Ans.
• These panties contact the tissue only at the ridge crest.
• They do not have concave gingival surfaces.
• They are indicated for cases with reduced interarch
space, where the pantie should give the appearance of
an exaggerated occlusogingival dimension.
Q. 6. Factors in selection of abutment in FPD.
Ans.
Factors in selection of abutment in FPD are as follows:
• Location, position, and condition of the tooth.
• Root configuration.
• Crown-root ratio.
• Root support.
• Periodontal ligament area.
• Assesment of pulpal health.
Q. 7. Bullet-shaped pontic.

Connectors in FPO Ans.

• Connector in a fixed partial denture can be defined as, • Bullet-shaped pantie has a convex tissue surface, which
'the portion of a fixed partial denture that unites the contacts the tissue at one single point without any pressure.
retainer(s) and pontic(s)' (GPT). • This pantie is very easy to clean and maintain.
Section I I Topic Wise Solved Questions of Previous Years

Indication: Replacement of mandibular posterior teeth, Ideal Requirements of Pontic Design

where aesthetics is not a major concern.
To restore function of the replaced tooth.
i.
Disadvantage: Poor aesthetics, which results due to wide
To provide aesthetics and comfort.
ii.
embrasures.
iii.It should be biologically acceptable.
Q. 8. Ridge lap pontics. iv.To permit effective oral hygiene.
v. To preserve the underlying residual ridge and mucosa.
Ans.
vi. To have adequate strength to withstand occlusal forces.
• Ridge lap pantie resembles a natural tooth.
Q. 11. Extracoronal retainers in fixed partial prosth-
• It is designed to adapt closely to the ridge.
odontics.
• This pantie is usually avoided, as it is difficult to main-
tain and often leads to inflammation of the tissue in Ans.
contact.
• Extracoronal retainers obtain retention from the exter-
Q. 9. Name the components of FPD. nal surface of the coronal as part the abutment teeth,
e.g., full veneer crowns and partial veneer crowns.
Ans.
Q. 12. Classify retainers in FPD.
Fixed partial denture is made up of three elementary com-
ponents: Ans.
i. Retainer,
ii. Pantie, and
Classification of Retainers
iii. Connector.
• The part of a fixed dental prosthesis that unites Retainers in FPD can be broadly classified as follows:
the abutment(s) to the remainder of the restoration.
This is used for the stabilization or retention of Based on Tooth Coverage
prosthesis.
• Pantie is defined as, 'An artificial tooth on a fixed partial • Full veneer crowns.
denture that replaces a missing tooth, restores its func- • Partial veneer crowns.
tion, and usually fills the space previously filled by a • Conservative retainers.
natural crown'.
• Connector in a fixed partial denture can be defined as,
Based on the Material Being Used
'The portion of a fixed partial denture that unites the
retainer(s) and pontic(s)'. • All metal retainers.
• Metal ceramic retainers.
Q.10. What are the ideal requirements ofpontic design?
• All ceramic retainers.
Ans. • All acrylic retainers.

------------------- <( Topic 3)

Occlusion in Fixed Partial Dentures

LONG ESSAYS
Q. 1. What is balanced occlusion? Write in brief about
the factors governing balanced occlusion. Write in de-
tail about the principles of tooth preparation for fixed
partial denture.
Ans.
Balanced Occlusion
It is defined as, 'The simultaneous contacting of the maxillary
and mandibular teeth on the right and left and in the posterior
and anterior occlusal areas in centric and eccentric positions,
developed to lessen or limit tipping or rotating of the denture
bases in relation to the supporting structures' (GPT).
 Quick Review Series for BOS 4th Year: Prosthodontics

Factors Governing Balanced Occlusion iii. Orientation of occlusal planes.

The factors governing balanced occlusion are also known iv. Compensating curves.
as Hanau's quint. They are as follows (Figs 3.1 and 3.2): v. Cuspal inclination.
i. Condylar guidance.
ii. Incisal guidance.

Fig. 3.1 Hanau's quint

i. Condylar guidance
• It is defined as the mechanical form located in the upper
posterior region of an articulator that controls move-
ment of its mobile member (GPT5).

Condylar guide inclination

• It is defined as the angle formed by the inclination of a
condylar guide control surface of an articulator and a
specified reference plane (GPT5).
• This is the mandibular guidance generated by the con-
dyles traversing the contours of the glenoid fossa.
• It is duplicated in the articulator. The extent of duplica-
(a)
?f7(b)
Fig. 3.2 (a) Shallow condylar guidance causes lesser posterior tooth sep-
tion depends on the articulator's capability, whether it is aration on protrusion. (b) Steep condylar guidance causes greater tooth
semi-adjustable or fully adjustable. separation on protrusion
Section I I Topic Wise Solved Questions of Previous Years
• Protrusive condylar guidance is obtained using protru-
sive records, while the lateral condylar guidance is ob-
tained using Hanau's formula or lateral records.
• It is designated as an inclination or angle, condylar
guidance angle or inclination, and is expressed in
degrees.
• This is the only factor that is obtained from the patient
and is not under the dentist's control.
• Shallow condylar guidance will cause less posterior
tooth separation in protrusion and requires teeth with
shorter cusps and flatter fossa to achieve balanced oc-
clusion, than a steep guidance.
ii. lncisal guidance
• It is defined as the influence of the contacting surfaces
of the mandibular and the maxillary anterior teeth on
mandibular movements (GPT8).
Fig. 3.3 (a) Vertical overlap; (b) Horizontal overlap; and (c) Incisal guid-
ance angle
lncisal guide angle
It is defined as the angle formed between the horizontal
plane of occlusion and a line drawn in the sagittal plane
between the incisal edges of the maxillary and the man-
dibular central incisors, when teeth are in maximum inter-
cuspation (Fig. 3.3).
• It is expressed in degrees.
• It is established during try-in.
• If this angle is steep, then it requires steep cusps, steep
occlusal plane, and a steep compensating curve to ob-
tain occlusal balance. This is detrimental to denture
stability.
• It should be as flat (close to zero degrees) as aesthetics
and phonetics will permit. It should never be greater
than the condylar guidance.
• When a steep vertical overlap is required for the anterior
teeth, a compensating horizontal overlap should be
given to reduce the incisal guide angle.
• If a steep vertical overlap (VO) is required for aesthet-
ics, then a corresponding increase in horizontal overlap
(HO) will help to decrease the incisal guide angle.
iii. Orientation of occlusal planes
Occlusal plane is defined as the average plane established
by the incisal and the occlusal surfaces of the teeth. It is not
a plane, but represents the planar mean of the curvature of
these surfaces (GPT8).
• It is established anteriorly by the height of the canine,
which nearly coincides with the comrnissure of the mouth.
• Posteriorly, it is established by the height of the retro-
molar pad.
• It is also related to the ala-tragus line.
• It must be oriented in the same relation as when teeth
existed.
iv. Compensating curves
• The anteroposterior and lateral curvature is the align-
ment of the occluding surfaces and incisal edges of the
artificial teeth that are used to develop a balanced occlu-
sion (GPT).
• It is determined by the inclination of the posterior teeth
and their vertical relationship to the occlusal plane.
• The curves that assist in producing balanced occlusion are:
Anteroposterior curve
This curve runs in anteroposterior direction and helps in
obtaining protrusive balance.
Mediolateral curve
These curves run in a lateral direction from one side of the
arch to the other and help in obtaining lateral balance.
Anteroposterior curve (Curve of Spee)
This curve is established by the occlusal alignment of the
teeth, as projected onto the median plane. It begins with the
cusp tip of the mandibular canine and follows the buccal
cusp tips of the premolar and molar teeth continuing through
the anterior border of the mandibular ramus and ending with
the anterior most portion of mandibular condyle.
• It was first described by Ferdinand Spee, German anato-
mist, in 1890 (GPT8).
• This curve helps in obtaining protrusive balance.
• The radius or steepness of the curve necessary to achieve
balance is dependent on the incisal and the condylar guid-
ances. It should be kept as modest or shallow as possible.

Mediolateral curve
A. Curve of Wilson (Fig. 3.4)
• It is a curve that is convex downwards.
• The name is given after George Wilson who described
it in 1911.
• It is used to arrange the molars.
• The lower teeth are inclined lingually, givmg promi-
nence to the buccal cusps and bringing them into heavy
occlusal contact with the upper buccal cusp during lat-
eral movements on the working side.
Fig. 3.4 Curve of Wilson
B. Reverse curve or anti-Monson curve (Fig. 3.6)
• It is a curve of occlusion that is convex upwards.
• It is usually used to arrange the first premolars.
Fig. 3.6 Reverse curve
Quick Review Series for BOS 4th Year: Prosthodontics
C. Curve of Monson (Fig. 3.5)
• It is the curve of occlusion in which each cusp and inci-
sal edge touches or conforms to a segment of the surface
of a sphere, which is 8 inches in diameter with its centre
in the region of the glabella (GPT8).
• It was described by George S Monson, a US dentist.
• In three dimension, this curve is a combination of 'curve
of Spee' and curve of Wilson'.
Fig. 3.5 Monson's curve
D. Pleasure curve
• This curve is a combination of Monson and anti-
Monson curves. So, it is not a single curve but a
combination of curves.
• It was used for arranging non-anatomic teeth in bal-
anced occlusion.
• The premolars and the first molars are set in a reverse
curve to prevent buccal tipping and for the denture to be
seated.
• Second molars are set in a conventional Manson's curve
to provide eccentric lateral balance.
v. Cuspal inclination
• It is defined as the angle made by the average slope of
a cusp with the cusp plane measured mesiodistally or
buccolingually. It is also called 'cusp angle' (GPT).
• It has effects on the occlusal plane and the compensating
curves.
• The closer a tooth is located to incisal or condylar guid-
ance, the more influence that guidance has on cuspal
inclination of that tooth (Fig. 3.7).
Section I I Topic Wise Solved Questions of Previous Years

Resistance: It is defined as the ability of the preparation to

prevent dislodgement of the restoration by any forces di-
rected in an apical/oblique/horizontal direction and also to
prevent any movement of the restoration under occlusive
forces.
Factors affecting retention
These include:
a. Degree of taper.
b. Total surface area of the tooth.
c. Roughness of the tooth surface.

Fig. 3.7 Cuspal angulations determined by the angle, which is formed
by the incline of a cusp with the horizontal
• In anatomic teeth, it is preferable to eliminate the me-
siodistal cusp height, as only the buccolingual inclines
need to be considered for balanced arrangement.
a. Degree of taper
The degree of taper is inversely proportional to the reten-
tion form. The preparation should have a taper of 6°, i.e.,
3° on either side and the prepared walls should not be
parallel.
A tapering fissure diamond is used to prepare the
required taper.

b. Total surface area of the tooth

Principles of Tooth Preparation for Fixed Partial It indirectly refers to the amount of tooth structure pres-
Dentures ent. Therefore, molars provide more retention than
A. Preservation of tooth structure. premolars.
B. Retention and resistance.
c. Roughness of the tooth surface
C. Structural durability.
D. Marginal integrity. The preparation should not be made rough. Only the tissue
E. Preservation of periodontium. surface of the crown should be made rough, before cemen-
tation.
A. Preservation of tooth structure Factors affecting resistance
The fixed prosthesis must replace the lost tooth structure, These include:
but at the same time care should be taken to preserve the a. Length of the preparation.
remaining tooth structure and excessive tooth preparation b. Width of the tooth preparation.
should be prevented. c. Taper.
This principle can be fulfilled/achieved by the fol- d. Rotation around vertical axis.
lowing:
a. Length of the preparation
a. By making depth orientation grooves, before actual re-
duction. Reduction should be 1.5 mm and palatally at i. The abutment tooth should be of minimum length of
45° angle. 3-3.5 mm for adequate resistance and retention.
b. Preference is given to partial veneer crowns (as labial ii. Retentive grooves can be provided
structure is not reduced). • To the surface area.
c. Damage to the pulp can be prevented by the use of ad- • To provide a single path of insertion.
equate coolant. iii. For full veneer crown, groove is prepared on the proxi-
d. For reduction of heat, use of fresh and sharp diamond mal aspect.
points is indicated. iv. For bridge, groove is prepared on buccal/lingual aspect.
e. Finish line should be given either at supra or at equigin-
b. Width of the tooth preparation
gival line for easy maintenance of hygiene.
f. Grossly decayed tooth can be retained with the help of The resistance increases as the diameter of the tooth be-
dowel cores, cast posts, and onlays. comes smaller.

B. Retention and resistance c. Taper

Retention: It is defined as the ability of the preparation to The range of 2.5-6.50 taper, falls under the range for
prevent or impede the removal of restoration along its path optimal convergence which helps in reducing stress con-
of insertion. centration.

d. Rotation around vertical axis.
In order to prevent rotation of the crown (i.e., to gain
resistance)
• Grooves,
• Retentive boxes, and
• Retentive pins can be used.
Other means of preventing rotation around vertical axis
are key and key ways.
Common factors affecting resistance and retention
a. Opposing walls have minimum convergence.
b. Surface area.
c. Number of paths of removal is limited.
d. Limiting freedom of displacement from torque or twist-
ing forces in a horizontal plane.
e. Occlusogingival length.
C. Structural durability
The preparation should be such that there is adequate bulk
of metal in the restoration to withstand occlusal forces. The
contours should be such that, no periodontal and occlusal
problems occurs.
These can be done by,
a. Adequate clearance/reduction
In case of base metal alloys, reduction should be
i. For functional cusp = 1.5 mm reduction.
ii. For non-functional cusp = 1 mm reduction.
In case of porcelain
i. For functional cusp = 1.8 mm.
ii. For non-functional cusp = 1.2 mm.
b. Maintaining the occlusal morphology
• Flattened occlusal surface should be avoided.
• Maintenance of inclined planes of the cusps.
• Adequate reduction should be done along the anatomi-
cal grooves.
• Maintenance of parallelism of prepared occlusal surface
of tooth to opposing cuspal slopes.
• Cusp tips should be rounded in order to reduce stress
concentration.
c. Functional cusp bevel
• Providing a functional cusp bevel is an integral part of
occlusal reduction.
• In order to withstand the occlusal forces, a wide bevel is
prepared on the functional cusp, to provide an adequate
bulk of metal.
If a functional cusp bevel is not placed,
• There will be weak casting.
• Contacts will be defective.
• It might result in overcutting.
Quick Review Series for BOS 4 th Year: Prosthodontics
d. Other factors for structural durability
• Preparation of occlusal shoulder.
• Offset.
• Isthmus.
• Preparation of proximal grooves and boxes.
• Type of alloy used.
D. Marginal integrity
The success of a restoration depends upon the adaptation of
the margins to the 'Finish line'.
Definition: The point on the tooth at which the preparation
terminates is called 'Finish Line'.
For a successful restoration:
i. Margin should extend up to the tooth line of preparation.
ii. The cavosurface finish line should be adapted closely to
the margin.
iii. The margin and the 'Finish line' should maintain a
continuous contact.
Indications for sub-gingival finish line
a. Fracture line which extends below the gingival margin.
b. Presence of secondary caries below the restorative margin.
c. If a sub-gingival finish line has earlier restoration done
(Even the new restoration should have a sub-gingival
finish line.)
d. In order to increase the crown length, as it helps to in-
crease the resistance.
e. Patients who have short lips and has a gummy smile.
Finish lines (According to shape)
They are as follows:
a. Chamfer.
b. Shoulder.
c. Bevelled shoulder.
d. Knife-edge.
a. Chamfer
• It is prepared mainly for gold restoration.
• It allows a slip-joint and provides adequate bulk.
• Less reduction of tooth is needed
• It is very easy to establish.
• Burnishing can be done very easily.
• It provides acceptable stress distribution and adequate
seal (El-Ebrashi's concept).
b. Shoulder
• It is done for all porcelain jacket crown and injectable
ceramics (complete porcelain crown).
• The wide ledge helps in providing resistance to occlusal
forces and also provides minimum stresses that may
fracture porcelain.
• It is a well defined finish line with a butt joint and there-
fore it cannot be used for cast restorations.
Section I I Topic Wise Solved Questions of Previous Years

• Preparing a shoulder finish line is difficult and may also

lead to/promote adverse pulpal involvement.

c. Bevelled shoulder
• It is a modified type of shoulder finish line.
• The angle of the bevel helps in improving marginal ad-
aptation. It forms an obtuse angle with the axial wall.
• The restoration margins make an acute angle with the
cavosurface.
• It is especially indicated on labial finish line of porce-
lain, which is fused to metal restorations for the follow-
ing reasons:
i. Due to high aesthetic demand.
ii. To extend the margin into gingival sulcus.
iii. It resists distortion due to the bulk of the metal.
iv. It can be used along with chamfer also.

d. Knife-edge
• It should be cut carefully, so that axial reduction is not
hampered. Fig. 3.8 Two-piece custom built clutch for ease of placement
• It can result in distortion under occlusal forces.
• A stem is attached to the centre of the labial surface of
Indications the clutch and it should be parallel to the sagittal plane
• For post and core. (Fig. 3.9).
• For radicular crowns.
• For lingual surface of mandibular posteriors.
• Teeth which has very convex surface.
• In case of younger patients.
Other types of finish lines
a. Heavy chamfer.
b. Radial shoulder.
c. Wing preparation.

E. Preservation of periodontium
• The periodontium has a considerable effect based on the
location of finish line and the overall fixed prosthesis
fabrication.
• The periodontal health is determined by the cervical
contours and finish lines.
• Generally, a 2 mm biological width of the epithelial at-
tachment is maintained.
Q. 2. Recording of jaw relation records for crown and
bridge. Fig. 3.9 Stem of the clutch parallel to the sagittal plane

Ans. • By using zinc oxide eugenol impression paste, the cast

Recording the Orientation Jaw Relation
• The face-bow is positioned on the face in such a way
Using a Kinematic Face-bow
• An accurate impression of the mandible and the maxilla
should be made.
• Stone casts are fabricated using the impressions.
• Two-piece custom-built metal clutches should be
fabricated (Fig.3.8).
of aluminium clutches (maxillary and mandibular) are
attached to the teeth.
that:
i. The mandibular clutch is attached to the U-frame of
the face-bow. The stem is passed through a provision
in the U-frame.
ii. The maxillary clutch is attached to the horizontal bar
of the face-bow. The horizontal arm is fixed, such

that the grid is placed over the area anterior to the
external acoustic meatus.
• The metal styli (rods) at the distal end of the face-bow
should be placed over the condyle (13 mm in front of
the tragus on the canthotragal line).
• The patient should be in a semi-supine position, while
positioning the styli and the styli should contact the grid
of the horizontal arm.
• The patient should be asked to slowly open his mouth to
a maximum of 20 mm inter-incisal distance. Within this
range of jaw separation, the mandibular condyles show
pure rotation.
• The mandible shows pure rotation along the hinge axis.
The patient should be trained to open and close his
mouth at the hinge axis.
• As the patient moves his mandible, the styli will first
form an arc on the grid. But once the styli reach the
hinge axis, they stop and begin to rotate at that particu-
lar point.
• The grid is gently removed and the styli arc is tatooed
on the skin for further reference.
• This completes the face-bow record, i.e., the true hinge
axis has been located.
Pantographic Tracing
• After the face-bow record is completed, jaw writing is
recorded in three planes. A pantograph is required to
record the jaw writings (mandibular movements re-
corded on flags using styli) in three planes.
• Pantographs are used to record the mandibular move-
ment and also to develop satisfactory occlusion on an
articulator.
SHORT ESSAYS
Q. 1. Achieving retention in fixed partial denture.
Ans.
Retention in Fixed Partial Denture
Retention: It is defined as the ability of the preparation to
prevent or impede the removal of restoration along its path
of insertion.
Retention can be classified as:
• Primary retention
i. Sleeve retention.
ii. Wedge-type retention.
• Secondary retention.
Following are the factors to be considered in order to
achieve retention:
Quick Review Series for BOS 4th Year: Prosthodontics
• They record the mandibular movement in relation to
an established plane in the face (a plane formed by
the hinge axis along with the anterior reference
points).
• A pantograph has two horizontal bars attached to metal-
lic clutches similar to a kinematic face-bow assembly.
The difference is that the distal end of the upper bar has
two grids (instead of one) placed perpendicular to one
another.
• Two anterior grids are placed on the lower bar. Each
grid has a separate stylus to draw the mandibular
paths. The metal styli should be oriented to the tatooed
hinge axis.
• The patient is made to rehearse hinge movement and
translatory movement like right lateral and left lateral. A
Cohen or Hitchkok trainer can be used to rehearse the
mandibular movements.
• After the patient is trained, the grids are coated with a
pressure-sensitive material (pumice-ether mix). The
stylus of each grid is made to contact the grid and the
patient is asked to perform the trained movements.
When the patient moves his mandible, the styli will
draw tracings on their respective grids. These tracings
are called as pantograms, as they are thin and delicate
lines.
• These tracings can be used to program a fully adjustable
articulator, and this is useful to develop the ideal occlu-
sion for a complicated restorative case.
• Occlusion developed by such method will exhibit
no posterior tooth contact when the mandible is in
any eccentric position. Contact is present only be-
tween the cusp tip and the ridges around the central
fossa.
i. Degree of taper
• The prepared walls should not be absolutely parallel.
• The preparation should have a taper of about 6° (3° on
either side).
ii. Total surface of the cement film
• Indirectly refers to the amount of tooth structure present.
• Therefore, molars provide more retention than premolars.
iii. Area of cement under shear force
• Compressive.
• Tensile.
• Shear.
Section I I Topic Wise Solved Questions of Previous Years

iv. Roughness of the tooth surface

• Increase in the roughness of surface area increases re-
tention (But the preparation should not be made rough.
The tissue surface of the crown should be made rough,
before cementation).
• Minimum convergence of opposing walls.
• Limiting the number of paths of removal.
• Limiting freedom of displacement from torque or twisting
forces in a horizontal plane.

v. Path of insertion Fig. 3.10 Interocclusal check wax is softened in a water bath
a. It is an imaginary line along which the restoration will
be placed onto or removed from the preparation.
b. A single path of insertion provides best retention.
• Greater height of the crown is needed for good re-
tention • The mandibular fixed partial denture is inserted and the
• Short preparations can be modified with grooves, mandible is guided into centric position. Once the man-
which can significantly decrease the arc of dis- dible is in centric relation, the patient is advised to close
placement. his mouth such that the maxillary teeth penetrate about
• Secondary retention can be obtained by retentive 1-1.5 mm deep into the wax (Fig. 3.11).
features like pins, boxes, and grooves etc.
Q. 2. Clinical remounting.
Ans.

Clinical Remounting
• Clinical remount is done using interocclusal records.
• These interocclusal records should be made in the cen-
tric and eccentric positions.
• All these procedures are done as a part of finishing the
fixed prosthesis and should be done before cementing
the fixed partial denture.
Fig. 3.11 Making interocclusal record with slight closure
Clinical Remounting Using Centric Relation
Record
Making an interocclusal record in centric position • The wax layers should not be completely perforated to
The following steps are to be followed in relation to a max- make tooth contact.
illary complete denture opposing a mandibular partial den- • The dentures should be carefully removed. The man-
ture: dibular partial denture is placed in cold water, in order
• The occlusal surface of the maxillary denture should to harden the record wax.
be lubricated with vaseline and inserted into the • The wax should have 1 mm deep occlusal imprints
mouth. without perforation.
• Two layers of aluwax should be placed over the poste- • The dentures are reinserted and the procedures are
rior teeth in a mandibular fixed partial denture. repeated. But in this case, the record is made with
• It can be sealed to the denture using a warm spatula. The complete closure.
wax should be immersed in a water bath 54 °C to soften • During complete closure, no torque or tilting force
it uniformly (Fig. 3.10). acting on the denture should be present (Fig. 3.12).
 Quick Review Series for BOS 4th Year: Prosthodontics

• The articulator is closed in centric relation.

• The articulator should be carefully opened without slid-
ing against the teeth and the articulating paper is re-
moved.
• On the occlusal surfaces against which the articulating
paper was placed, the deflective contacts will be visible
(Fig. 3.13).
• These contacts should be relieved by grinding with
Chayes stone No: 16, 11, and 5.
• Grinding should be avoided on the cusps or cuspal in-
Fig. 3.12 Making interocclusal record with tight closure clines. It should be done only on the fossa (Fig. 3.14).

Remounting Using the Centric Record

• The articulator should be programmed such that the
condylar elements are against the centric stops (centric
/
position of the articulator).
• The maxillary denture is mounted on the articulator us-
ing a remount cast or a remounting jig (occlusal index).
• The mandibular denture is placed against the articulated
maxillary denture using the centric record and articulated.

Clinical Remounting Using Eccentric Relation

Record
• Eccentric records (usually protrusive) are recorded us-
ing the same steps followed in a centric relation record. Fig. 3.13 Deflective contacts
• Before proceeding to eccentric relations, the centric re-
lationships should be reverified.
Q. 3. Selective grinding procedure.

Ans.

Selective Grinding Procedure

• Selective grinding is defined as the intentional alteration of
the occlusal surfaces of teeth to change their form (GPT).
• These procedures vary according to the teeth on which
they are carried out.

Correcting the Identified Occlusal Errors in

Anatomic Teeth
• Selective grinding for the correction of identified
occlusal interferences in the centric relation should be
done first, followed by the correction of identified
occlusal interferences in the eccentric relation.
Correcting the Identified Occlusal Errors
in Anatomic Teeth in Centric Relation
• This procedure is done on the remounted dentures.
• Minimum thickness articulating papers should be
placed between the occlusal surfaces of opposing teeth.
Fig. 3.14 Only fossae should be ground
Correcting the Identified Occlusal Errors in
Anatomic Teeth in Eccentric Relations
• After completing occlusal reshaping in centric posi-
tion, the articulating paper is placed between the
teeth and the articulator is moved to lateral position
(laterotrusion).
Section I I Topic Wise Solved Questions of Previous Years
• During the lateral movement of the articulator, if the
incisal pin rises away from the incisal table, selective
grinding is necessary on the working side.
• All the contact areas should be made visible by the
markings of the articulating paper.
• On the non-working side, there will be contacts between
the maxillary buccal and mandibular lingual cusps. The
incisors will also show contacts.
• For selective grinding on the working side, BULL rule
should be followed (buccal cusps of upper and lingual
cusps of lower teeth).
SHORT NOTES
Q. 1. Selective grinding.
Ans.
Selective Grinding
• Selective grinding is defined as the intentional alteration
of the occlusal surfaces of teeth to change their form
(GPT).
• Selective grinding for the correction of identified oc-
clusal interferences in the centric relation should be
done first, followed by the correction of identified
occlusal interferences in the eccentric relation.
Types of Abutments
LONG ESSAYS
Q. 1. Define an abutment and enumerate the criteria
involved in abutment selection.
Or
Selection of abutment for FPO.
Or
Define abutment. Explain the criteria for selection of
teeth for a fixed partial denture abutment.
Or
Define the term 'abutment' in fixed partial dentures.
Describe the factors responsible for selection of an
abutment.
Or
• Grinding should be verified and repeated, until the inci-
sal pin contacts the incisal table all along the lateral
movement.
• On the balancing side, markings of the articulator paper
will appear on the maxillary palatal cusps and mandibu-
lar lingual cusps.
• During selective grinding on the balancing side, the
lingual slope of the buccal cusps should be reduced.
• After the laterotrusive interferences are corrected, pro-
trusive interferences should be corrected in the same
manner.
Q. 2. Types of occlusion in FPO.
Ans.
Types of Occlusion in FPD
The types of occlusion in FPD are as follows:
• Centric occlusion.
• Bilateral balance.
• Unilateral balanced occlusion.
• Mutually protected occlusion.
• Canine- guided/protected occlusion.
• Optimum occlusion.
• Biological occlusion.
( Topic 4 ~
Define abutment. Describe the factors to be considered
in selection of a bridge abutment.
Ans.
Abutment
An abutment is defined as a tooth, a portion of a tooth, or
that portion of a dental implant that serves to support and/
or retain a prosthesis.
Factors/Criteria Involved in Abutment Selection
A. Location, position, and condition of the tooth.
B. Crown-root ratio.
C. Root configuration.

D. Root support.
E. Shape and number of root canal.
F. Periodontal ligament area.
G. Assessment of pulpal health.
A. Location, position, and condition of the tooth
a. It should be a vital tooth.
b. If it is non-vital
i. It should be endodontically treated and should be
asymptomatic.
ii. It should be radiographically sound. There should be
evidence of good seal.
c. The abutment tooth should not exhibit mobility.
d. If the crown used for abutment is carious/heavily filled,
first it is necessary to remove the caries and existing
restoration and then restore the tooth with amalgam
(pin-retained).
e. The degree of eruption of a tooth is also another neces-
sary factor in determining the amount of retention avail-
able. The more fully erupted is the abutment tooth. The
greater the surface area covered by the retainer, the
thicker and more rigid will be the casting.
f. Shape and surface area
g. The shape and surface area of the crown is also another
factor for retention. The greater the surface area, the
better is the retention. Shape of the crown also affects
retention, i.e., with a conical crown, the retention is
reduced.
h. Teeth adjacent to edentulous space can be used as
abutment.
B. Crown-root ratio
a. The crown-root ratio is a measure of the length of the
tooth occlusal to the alveolar crest of bone compared
with the length of root embedded in the bone.
b. Ratio between the length of crown and length of root
should be always less than 1.
c. The crown root ratio of 2:3 is considered ideal.
d. Ratios up to 1: 1 are acceptable.
C. Root configuration
a. Roots for the abutment teeth should have greater labio-
lingual widths.
b. Multi-rooted teeth with widely separated roots offer
more support.
c. Teeth with longer roots are preferred, as they serve bet-
ter abutment.
d. Conical rooted teeth can be used for short-span fixed
partial denture.
D. Root support
a. The alveolar bone supporting the abutment tooth should
be healthy. It should have good trabecular architecture
and should not exhibit any features of bone loss.
Quick Review Series for BOS 4 th Year: Prosthodontics
E. Shape and number of root canal
a. It is necessary to evaluate the shape and number of root
canal, as these will affect the adequacy of any post-
crown which may be placed.
F. Periodontal ligament area
a. The periodontal configuration (attachment status) of the
abutment tooth should be sound.
b. If the periodontal condition of the abutment tooth is
poor, then the benefits of splinting imparted by a fixed-
fixed bridge may be indicated.
c. If the tooth used as abutment has recession and bone
loss, then it will bear lesser load.
G. Assessment of pulpal health
a. Unrestored abutments are usually preferred.
b. Regular preparation can be done on the carious tooth.
c. If pulp is involved in the carious lesion of abutment
tooth, then root canal treatment is preferred.
d. Teeth which have been pulp-capped cannot be used as
bridge abutments, unless endodontic treatment is con-
templated.
Q. 2. Define an abutment and discuss the biomechanical
principles involved in abutment preparations.
Ans.
Abutment
An abutment is defined as a tooth, a portion of a tooth, or
that portion of a dental implant that serves to support and/
or retain a prosthesis.
Biomechanical Principles Involved in Abutment
Preparations
A. Preservation of tooth structure.
B. Retention and resistance.
C. Structural durability.
D. Marginal integrity.
E. Preservation of periodontium.
A. Preservation of tooth structure
The fixed prosthesis must replace the lost tooth structure,
but at the same time care should be taken to preserve the
remaining tooth structure and excessive tooth preparation
should be prevented.
This principle can be fulfilled/achieved by the following:
a. By making depth orientation grooves, before actual re-
duction. Reduction should be I .5 mm and palatally at
45° angle.
b. Preference is given to partial veneer crowns (as labial
structure is not reduced).
Section I I Topic Wise Solved Questions of Previous Years
c. Damage to the pulp can be prevented by the use of ad-
equate coolant.
d. For reduction of heat, use of fresh and sharp diamond
points is indicated.
e. Finish line should be given either at supra- or at equig-
ingival line for easy maintenance of hygiene.
f. Grossly decayed tooth can be retained with the help of
dowel cores, cast posts, and onlays.
B. Retention and resistance
Retention: It is defined as the ability of the preparation to
prevent or impede the removal of restoration along its path
of insertion.
Resistance: It is defined as the ability of the preparation to
prevent dislodgement of the restoration by any forces directed
in an apical/oblique/horizontal direction and also to prevent
any movement of the restoration under occlusive forces.
Factors affecting retention
These include:
a. Degree of taper.
b. Total surface area of the tooth.
c. Roughness of the tooth surface.
a. Degree of taper
The degree of taper is inversely proportional to the reten-
tion form. The preparation should have a taper of 6°, i.e., 3 °
on either side and the prepared walls should not be parallel.
A tapering fissure diamond is used to prepare the re-
quired taper.
b. Total surface area of the tooth
It indirectly refers to the amount of tooth structure present.
Therefore, molars provide more retention than premolars.
c. Roughness of the tooth surface
The preparation should not be made rough. Only the tissue
surface of the crown should be made rough, before cemen-
tation.
Factors affecting resistance
These include:
a. Length of the preparation.
b. Width of the tooth preparation.
c. Taper.
d. Rotation around vertical axis.
a. Length of the preparation
i. The abutment tooth should be of minimum length of
3-3.5 mm for adequate resistance and retention
ii. Retentive grooves can be provided
• To the surface area.
• To provide a single path of insertion.
iii. For full veneer crown, groove is prepared on the proximal
aspect.
iv. For Bridge, groove is prepared on buccal/lingual aspect.
b. Width of the tooth preparation
The resistance increases as the diameter of the tooth be-
comes smaller.
c. Taper
The range of 2.50--6.50 taper falls under the range for optimal
convergence, which helps in reducing stress concentration.
d. Rotation around vertical axis
In order to prevent rotation of the crown (i.e., to gain resis-
tance)
• Grooves,
• Retentive boxes, and
• Retentive pins can be used.
Other means of preventing rotation around vertical axis
are key and key ways.
Common factors affecting resistance and retention
a. Opposing walls have minimum convergence.
b. Surface area.
c. Number of paths of removal is limited.
d. Limiting freedom of displacement from torque or twisting
forces in a horizontal plane.
e. Occlusogingival length.
C. Structural durability
The preparation should be such that there is adequate bulk
of metal in the restoration to withstand occlusal forces. The
contours should be such that, no periodontal and occlusal
problems occur.
These can be done by,
a. Adequate clearance/reduction
In case of base metal alloys, reduction should be
i. For functional cusp = 1.5 mm reduction.
ii. For non-functional cusp = 1 mm reduction.
In case of porcelain,
i. For functional cusp = 1.8 mm.
ii. For non-functional cusp = 1.2 mm.
a. Maintaining the occlusal morphology
• Flattened occlusal surface should be avoided.
• Maintenance of inclined planes of the cusps.
• Adequate reduction should be done along the anatomi-
cal grooves.
• Maintenance of parallelism of prepared occlusal surface
of tooth to opposing cuspal slopes.
• Cusp tips should be rounded in order to reduce stress
concentration.
b. Functional cusp bevel
• Providing a functional cusp bevel is an integral part of
occlusal reduction.
• In order to withstand the occlusal forces, a wide bevel is
prepared on the functional cusp to provide an adequate
bulk of metal.

If a functional cusp bevel is not placed,
• There will be weak casting.
• Contacts will be defective.
• It might result in overcutting.
c. Other factors for structural durability
• Preparation of occlusal shoulder.
• Offset.
• Isthmus.
• Preparation of proximal grooves and boxes.
• Type of alloy used.
D. Marginal integrity
The success of a restoration depends upon the adaptation of
the margins to the 'Finish line'.
Definition: The point on the tooth at which the preparation
terminates is called 'Finish Line'.
For a successful restoration,
i. Margin should extend up to the tooth line of preparation.
ii. The cavosurface finish line should be adapted closely to
the margin.
iii. The margin and the finish line should maintain a con-
tinuous contact.
Indications for sub-gingival finish line
a. Fracture line which extends below the gingival margin.
b. Presence of secondary caries below the restorative
margin.
c. If a sub-gingival finish line has earlier restoration done
(Even the new restoration should have a sub-gingival
finish line).
d. In order to increase the crown length, as it helps to in-
crease the resistance.
e. Patients who have short lips and has a gummy smile.
Finish lines (According to shape)
They are as follows:
A. Chamfer.
B. Shoulder.
C. Bevelled shoulder.
D. Knife-edge.
A. Chamfer
• It is prepared mainly for gold restorations.
• It allows a slip-joint and provides adequate bulk.
• Less reduction of tooth is needed.
• It is very easy to establish (It can be established using
the tip of round end tapered diamond or chamfer
diamond).
• Burnishing can be done very easily.
• It provides acceptable stress distribution and adequate
seal (El-Ebrashi'S concept).
Quick Review Series for BOS 4 th Year: Prosthodontics
B. Shoulder
• It is done for all porcelain jacket crown and injectable
ceramics (Complete porcelain crown).
• The wide ledge helps in providing resistance to occlusal
forces and also provides minimum stresses that may
fracture porcelain.
• It is a well defined finish line with a butt joint and there-
fore, it cannot be used for cast restorations.
• Preparing a shoulder finish line is difficult and may also
lead to/promote adverse pulpal involvement.
C. Bevelled shoulder
• It is a modified type of shoulder finish line.
• The angle of the bevel helps in improving marginal
adaptation. It forms an obtuse angle with the axial
wall.
• The restoration margins make an acute angle with the
cavosurface.
• It is especially indicated on labial finish line of porce-
lain, which is fused to metal restorations for the follow-
ing reasons:
i. Due to high aesthetic demand.
ii. To extend the margin into gingival sulcus.
iii. It resists distortion due to the bulk of the metal.
iv. It can be used along with chamfer also.
D. Knife-edge
• It should be cut carefully, so that axial reduction is not
hampered.
• It can result in distortion under occlusal forces.
Indications
• For post and core.
• For radicular crowns.
• For lingual surface of mandibular posteriors.
• Teeth which has very convex surface.
• In case of younger patients.
Other types of finish lines
a. Heavy chamfer.
b. Radial shoulder.
c. Wing preparation.
E. Preservation of periodontium
a. The peridontium has a considerable effect based on the
location of finish line and the overall fixed prosthesis
fabrication.
b. The periodontal health is determined by the cervical
contours and finish lines.
c. Generally, a 2 mm biological width of the epithelial
attachment is maintained.
Section I I Topic Wise Solved Questions of Previous Years

SHORT ESSAYS
Q. 1. Pier abutment. Q. 3. What is ideal abutment? Discuss selection of abut-
ment teeth for a fixed partial prosthesis.
Ans.
Or
Pier Abutment Abutment selection for FPD.

Pier abutment is defined as an intermediate abutment bounded Or

by edentulous space on either side. In this case, a single tooth
Factors affecting selection of abutment tooth.
acts as an abutment for both edentulous spaces.
Or
Significance Abutment selection.
a. It has the potential to produce unfavourable leverage. Or
b. It produces unseating effect on terminal retainers.
Factors in selection of abutment in FPD.
c. Fracture of the cement seal and cement washout can be
seen. Or
Bridge abutment.
Modes of Controlling/Treating the Problem
Or
a. To prevent trauma to the abutment, a non-rigid connec-
tor with the key in a keyway can be used (Based on Selection of bridge abutment.
stress-breaking principle). Ans.
b. The non-rigid connector has a female portion also
called the keyway, which is usually seated in the normal
tooth contour on the distal surface of pier abutment, and Ideal Abutment
the male portion or the key is attached to the pantie. Ideal abutment also known as healthy abutment is defined
(Key-Retainer system). as an unrestored vital tooth in its normal anatomic position.
c. The pier abutment tooth can be intruded into the PDL Abutment should be selected based on certain criteria.
socket to improve support.
d. If the pier abutment is mobile, then rigid connector is
used.
Factors/Criteria Involved in Abutment Selection
e. A non-rigid connector is not used when the posterior A. Location, position, and condition of the tooth.
opposes an edentulous space or a removable partial B. Crown-root ratio.
denture. This is due to fact that supraeruption of the C. Root configuration.
posterior abutment will occur and unseat the key. D. Root support.
E. Shape and number of root canal.
Q. 2. Ideal abutments.
F. Periodontal ligament area.
Ans. G. Assessment of pulpal health.

A. Location, position, and condition of the tooth

Ideal Abutment
Ideal abutment also known as healthy abutment is defined
as an unrestored vital tooth in its normal anatomic position.
To develop resistance and retention form, adequate
tooth structure should be present.
Following characteristics should be present in an ideal
abutment:
a. It should have ideal crown-root ratio.
b. There should be adequate thickness of enamel and
dentine.
c. There should be adequate bone support.
d. Periodontal disease should be absent.
e. Proper gingival contour should be present.
a. It should be a vital tooth.
b. The abutment tooth should not exhibit mobility.
B. Crown-root ratio
a. The crown-root ratio is a measure of the length of the
tooth occlusal to the alveolar crest of bone compared
with the length of root embedded in the bone.
b. Ratio between the length of crown and length of root
should be always less than 1.
C. Root configuration
a. Roots for the abutment teeth should have greater labio-
lingual widths.

D. Root support
• The alveolar bone supporting the abutment tooth should
be healthy. It should not possess any bone loss and
should have good trabecular architecture.
E. Periodontal ligament area
a. If the tooth used as abutment has recession and bone
loss, then it will bear lesser load.
b. If the periodontal condition of the abutment tooth is
poor, then the benefits of splinting imparted by a fixed-
fixed bridge may be indicated.
c. The periodontal configuration (attachment status) of the
abutment tooth should be sound.
F. Assessment of pulpal health
a. Unrestored abutments are usually preferred.
b. Regular preparation can be done on the carious tooth.
Q. 4. Post and core.
Ans.
Post and Core
The post also known as dowel is usually made of metal
which is fitted into a prepared root canal of a natural tooth,
and when it combines with an artificial crown also known
as core, it helps in providing retention and resistance for the
restoration.
Types of Dowels/Posts
A. Based on type of material
• Gold.
• Stainless steel.
• Titanium.
• Carbon fibre (Latest).
SHORT NOTES
Q. 1. Ideal abutments.
Ans.
Ideal Abutment
Ideal abutment also known as healthy abutment is defined
as an unrestored vital tooth in its normal anatomic position.
Following characteristics should be present in an ideal
abutment:
a. It should have ideal crown-root ratio.
b. There should be adequate thickness of enamel and dentine.
c. There should be adequate bone support.
d. Periodontal disease should be absent.
e. Proper gingival contour should be present.
Quick Review Series for BOS 4 th Year: Prosthodontics
B. Based on shape and configuration
Examples of prefabricated posts are:
• Parallel, smooth sided: Charlton post.
• Parallel threaded: Radix anchor and Kurer.
• Tapered threaded: Dentatus screw.
• Tapered smooth sided: Kerr endopost.
Others: Whaledent ParaPost and Flexi post.
Recent Developments in Post and Core
A. Richmond crowns
These are restorations/post and core crowns in which the
crowns and the cast post/dowel acts as one single unit.
B. CAD/CAM porcelain crowns
These can be fused to conventional post I dowel.
Complications of post and core I radicular retainer
• It is technique-sensitive.
• It can result in lateral perforation and apical perforation.
• There can be apical pushing of root canal filling.
• Can result in Gutta-percha being pulled out.
Q. 5. Ante's law.
Ans.
Ante's Law
Ante's law has been stated as,
'In fixed partial denture prosthodontics for the observa-
tion, the combined pericemental area of all the abutment
teeth supporting a fixed partial denture should be equal to
or greater in pericemental area than the tooth or teeth being
replaced; as formulated for removable partial prosthodon-
tics, the combined pericemental area of the abutment teeth
plus the mucous of the denture base should be equal to or
greater than the pericemental area of the missing teeth'.
Q. 2. Pier abutment.
Ans.
Pier Abutment
Pier abutment is defined as an intermediate abutment
bounded by edentulous space on either side. In this case,
a single tooth acts as an abutment for both edentulous
spaces.
Significance
a. It has the potential to produce unfavourable leverage.
b. It produces unseating effect on terminal retainers.
c. Fracture of the cement seal and cement washout can be
seen.
Section I I Topic Wise Solved Questions of Previous Years
Q. 3. Cantilever fixed partial denture.
Ans.
Cantilever Fixed Partial Denture
The selection of cantilever abutment is more important, as
it has to withstand more occlusal forces.
Criteria for Selection of Cantilever Fixed Partial
Denture
a. There should be more than adequate bone support.
b. There should be sufficient tooth structure available for
the final retainer.
c. The selection of abutment should be such that its posi-
tion develops an appropriate occlusal relationship.
d. Teeth treated endodontically are not preferred.
e. Teeth with short roots are contraindicated.
f. Springs cantilever designs are incorporated, if strong
abutments are not available adjacent to edentulous space.
Q. 4. Osseointegration.
Ans.
Osseointegration
• Osseointegration can be defined as the apparent direct
attachment or connection of osseous tissues to an inert
Tooth Preparation
LONG ESSAYS
Q. 1. Define retention and resistance in fixed partial
dentures. What are the factors affecting retention and
resistance in posterior tooth preparation?
Or
Enumerate the principles of tooth preparation in fixed
prosthesis. What are the factors affecting retention and
resistance?
Ans.
Retention and Resistance
Retention is defined as the ability of the preparation to pre-
vent displacement of the restoration in a direction opposite
to the path of insertion.
alloplastic material without intervening connective
tissue.
• The process and resultant apparent direct connection
of the endogenous material surface and the host bone
tissues without intervening connective tissues.
Factors Affecting Osseointegration
a. Excess occlusal load leads to failure of osseointegration.
b. Biocompatibility of the material.
c. Type of implant design.
d. Type of implant surface.
e. A healthy surgical site is required for good osseointe-
gration.
f. Less traumatic surgical technique should be done to
provide good osseointegration.
g. Infection from the periodontium should be avoided.
Q. 5. Ante's law.
Ans.
Ante's Law
Ante's law has been stated as,
'In fixed partial denture prosthodontics for the observa-
tion, the combined pericemental area of all the abutment
teeth supporting a fixed partial denture should be equal to
or greater in pericemental area than the tooth or teeth being
replaced'.
( Topic s~
Risistance is defined as the feature of a tooth prepara-
tion that enhances the stability of a restoration and resists
dislodgment along an axis other than the path of placement
(GPT8).
Resistance prevents dislodgment of the restoration, by
forces directed in an apical direction or oblique direction
and prevents any movement of restoration under occlusal
forces.
The principles of tooth preparations are
• Biological considerations.
• Mechanical considerations.
• Aesthetic considerations.
The basic principles of tooth preparation are
• Preservation of tooth structure.
• Retention and resistance.

• Structural durability.
• Marginal integrity.
• Preservation of periodontium.
Factors Affecting Retention
i. Factors influencing dislodging forces.
ii. Geometry of the tooth preparation.
iii. Roughness of the fitting surface of the restoration.
iv. Type of restorative materials being cemented.
v. Type of luting agent.
vi. Film thickness of the luting agent.
i. Magnitude of dislodging forces
a. Stickiness of the food: Sticky food tends to remove a
cemented restoration along its line of draw. The magni-
tude of these forces depend on the stickiness of food,
surface area of contact, and texture of restoration being
pulled.
b. Surface area of the restoration.
c. Texture of the restoration being pulled.
Of all the type of forces, sticky food exhibits large dis-
lodging forces.
ii. Geometry of the tooth preparation
Factors influencing geometry of tooth preparation
a. Taper.
b. Surface area.
c. Stress concentration.
d. Type of preparation.
a. Taper
• Maximum retention is obtained, if a tooth preparation
has parallel walls.
• Smaller degrees of taper have more retention.
• Two opposing surfaces each with a 3° taper provides a
6° taper for the preparation.
• Ideal convergence between opposing walls is 6°. This
amount of convergence is required to restrain the
cemented restoration.
Factors decreasing retention with regard to taper
• Less amount of taper will form an undercut causing
divergence between opposing axial walls, in an occluso-
cervical direction.
• An increased amount of taper increases free movement
of the restoration and retention will be reduced (Experi-
mented by Jorgensen in 1955).
Preparation rule
A rotary instrument of the desired taper held at a constant
angulation produces the amount of taper required.
The rotary instrument of ideal taper when moved through
a cylindrical path during tooth preparation will produce the
desired axial wall taper on the completed preparation.
Quick Review Series for BOS 4 th Year: Prosthodontics
b. Surface area
• The greater the length of the clinical crown, the more is
the retention.
• In short, the surface area of clinical crown needs to
be increased with the help of grooves and box prepa-
ration.
• The greater the width of the clinical crown, the better
the retention.
• A restoration with limited path of withdrawal is more
retentive depending on the length of the surface area in
sliding contact.
c. Stress concentration
• Round margins reduce stress concentrations, which in
turn increases the retention of the restoration.
• Stresses are generally concentrated around the junction
of the axial and occlusal surfaces.
• Changes in the geometry of the preparation (e.g., round-
ing the internal line angles) reduce stress concentrations
and hence, increase the retention of the restoration.
d. Type of preparation
• Additional grooves and boxes to a preparation increase
the retention, as the surface area is increased.
• Retention is double for complete crowns than for a par-
tial crown.
• Luting agent is only effective, if the restoration has a
single path of withdrawal.
• The occlusoaxial line angle of the tooth preparation
should be a replica of the gingival margin geometry.
• Fixed prostheses depend on the geometric form than on
adhesion of the luting agents for retention.
iii. Roughness of the surfaces
• Retention is increased, if the restoration is roughened
or grooved by air-abrading the fitting surface with
alumina.
• A smooth internal surface of a restoration can cause
retentive failure at the cement-restoration interface.
iv. Materials being cemented
• The more reactive base metal alloys have more adhesion
with certain luting agents than less reactive high-gold
content metals.
• Cement adheres better to amalgam than to composite
resin or cast gold.
v. Type of luting agent
• Adhesive resin cements are the most retentive.
vi. Path of insertion
• The specific direction in which prosthesis is placed on
the abutment teeth.
Section I I Topic Wise Solved Questions of Previous Years
Factors Affecting Resistance
a. Magnitude and direction of the dislodging forces.
b. Geometry of the tooth preparation.
c. Physical properties of the luting agent.
a. Magnitude and direction of the dislodging forces
• Patients with parafunctional habits and pipe smoking or
bruxer can produce very large oblique forces to the res-
toration. So, additional retentive grooves and the resto-
ration should be luted with adhesive cements.
• Patients with abnormal biting forces should be given a
complete metal crown. A proper design and preparation
can help to resist these displacing forces.
b. Geometry of the tooth preparation
Occlusogingival length
• Short tooth preparations with large diameters were
found to have very little resistance, whereas teeth with
short diameter and short wall have better resistance.
• Increased preparation taper and rounding of axial angles
tend to reduce resistance.
• A partial-coverage restoration has less resistance, when
compared to complete crown.
c. Types of luting agents
This depends on the compressive strength and modulus of
elasticity of luting agents.
Resistance is best obtained with adhesive resin followed
by glass ionomer, zinc phosphate, polycarbonate, and zinc
oxide eugenol.
Resistance can be increased by:
a. Preparation of boxes or grooves with walls that are per-
pendicular to the direction of the applied force.
b. U-shaped grooves and flared boxes provide more resis-
tance than V-shaped ones.
c. Pinholes increase resistance, as they prevent rotational
movement and subject additional areas of the luting
agent to compression. The buccal and lingual walls must
meet the axial walls at 90° to resist rotational forces.
Q. 2. Discuss principles of tooth preparation in detail.
Or
What are biomechanical principles of tooth prepara-
tion? Discuss biologic principles in detail.
Or
Write in detail about the biomechanical considerations
for preparation of a tooth for fixed prosthesis.
Or
Define an abutment and discuss the biomechanical prin-
ciples involved in abutment preparations.
Ans.
Principles of Tooth Preparation
• Biological considerations.
• Mechanical considerations.
• Aesthetic considerations.
The basic principles of tooth preparation are:
• Preservation of tooth structure.
• Retention and resistance.
• Structural durability.
• Marginal integrity.
• Preservation of periodontium.
Abutment is defined as, 'A tooth, a portion of a tooth,
or that portion of an implant used for the support of a
fixed partial denture or removable prosthesis' (GPT).
Biological Considerations
These affect the health of the oral tissues.
i. Prevention of damage during tooth preparation to
a. Adjacent teeth,
b. Soft tissues, and
c. Pulp of the tooth being prepared.
ii. Conservation of tooth structure.
iii. Margin placement
• Placement.
• Geometry.
• Adaptation.
i. Prevention of damage during tooth preparation to
a. Adjacent teeth
Iatrogenic damage to the adjacent tooth during tooth prepa-
ration is a common error. If the proximal contact area is
damaged, then it needs to be reshaped and polished; other-
wise, it is susceptible to dental caries.
To prevent the damage, a metal matrix band needs to be
used around the adjacent tooth. A thin tapered diamond is
used to break interproximal contact.
b. Soft tissues
Damage to the tongue and cheeks can be prevented by care-
ful retraction with an aspirator tip, mouth mirror, or flanged
saliva ejector.
c. Pulp
Extreme temperatures and chemical irritation can cause
pulpal damage.
Prevention
• The morphology of the dental pulp chamber should be
assessed before preparation with the help of a radio-
graph.
• New and perfect abrasives should be used while reduc-
ing the tooth. This reduces the heat that is generated.
• Gentle pressure should be applied while preparing the
tooth.

• Copious amount of water spray is directed at the area of
contact between tooth and bur. This removes clogging
and prevents desiccation of the dentine.
• All retention grooves and polishing need to be done
with a slow-speed handpiece with adequate amount of
water spray.
• The use of chemical agents for cleaning should be
avoided.
ii. Conservation of tooth structure
• Partial veneer crowns are used instead of full veneer
crowns.
• Minimum taper between axial walls.
• Occlusal surface reduction should be done following
anatomic planes.
• Tilted tooth to be repositioned, so that less tooth struc-
ture is removed during preparation.
• A conservative margin finish.
• Supragingival or crest of the gingival margin finish line.
Failures due to improper preparation of tooth are as:
• Insufficient axial reduction with an overcontoured resto-
ration can cause periodontal disease or dental caries.
• Inadequate occlusal reduction can cause occlusal dys-
function and poor margin placement.
• Excessive axial contours can cause gingival inflam-
mation.
iii. Margin placement
Requirements
• Ease of preparation without overextension.
• Easy to identify in the impression and on the die.
• Easy to finish on wax pattern.
• Sufficient bulk of material.
• Preserve tooth structure.
Types
• Supragingival.
• Subgingival.
• At the crest of the gingiva.
Supragingival margins
• They can be easily finished.
• They are more easily kept clean.
• Impressions are more easily made with less potential for
soft tissue damage.
• Restorations can be easily evaluated at recall appoint-
ments.
Subgingival margins
Subgingival margins are often seen on dentine or cementum.
They are done when cervical erosion or restorations
extend subgingivally and when a crown-lengthening proce-
dure cannot be carried out.
Quick Review Series for BOS 4 th Year: Prosthodontics
A well designed preparation has a margin that is smooth
and will provide the patient with a long-lasting restoration.
ii. Finish line types
• Feather-edge or shoulderless crown preparations: Con-
servative, but not to be used.
• Chiesel-edge: Only on tilted tooth.
• Chamfer: All metal restorations.
• Shoulder: All ceramic restorations and not conservative.
• Sloped shoulder: Reduces possibility of leaving unsup-
ported enamel and leaves sufficient bulk to allow thin-
ning of the metal framework to a knife-edge for good
aesthetics.
• Shoulder with bevel: In subgingivally extended finish
lines due to cervical erosion. A bevelled shoulder mar-
gin is used for the facial surface of a metal-ceramic
restoration where a metal collar is to be used.
Advantages of a bevel
• Easy burnishing of the cast metal margin.
• Decreases marginal discrepancy.
• Protects unprepared tooth structure from chipping.
Occlusal Considerations
If occlusion is disrupted by supraerupted or tilted teeth
either uprighting of tooth or a modified restoration should
be considered after endodontic treatment.
Adequate occlusal clearance is required for an optimal
occlusion.
The basic principles of tooth preparation are:
• Preservation of tooth structure
Care should be taken to prevent excessive tooth preparation.
The morphology of the dental pulp should be assessed
before the preparation with the help of radiograph.
Gentle pressure should be applied while preparing the
tooth.
All retentive grooves and polishing needs to be done
with a slow-speed handpiece.
• Retention and resistance
Retention prevents the removal of the restoration along the
path of insertion on the long axis of the tooth.
There are two types of retention:
i. Primary retention
Sleeve retention is given by opposing vertical surfaces of
the tooth preparation.
Wedge type retention is seen in intracoronal restoration.
ii. Secondary retention
Here, retention is obtained by retentive features like pins,
boxes, and grooves.
Section I I Topic Wise Solved Questions of Previous Years
Resistance prevents dislodgment of the restoration by
forces directed in an apical direction or oblique direction
and prevents any movement of restoration under occlusal
forces.
Retention and resistance are reciprocative to one an-
other, hence an optimal balance between these factors
should be established during any preparation.
These are the following features:
Taper
Zero degree taper is the most retentive, but it is almost im-
possible to obtain.
For optimum retention 4-10° convergence is sufficient.
Mandibular premolars are lingually tilted by 9°. A tapering
fissure diamond is ideal to produce required taper
Freedom of displacement
A single path of insertion gives the best retention.
Proximal box prepared with its wall at right angles to
the pulpal wall prevents sliding of the restoration.
Patients with abnormal biting forces should be given a
complete metal crown. A proper design and preparation can
help resist these displacing forces.
In patients with parafunctional habits and pipe smoking,
to prevent large oblique forces from being applied to a res-
toration, additional retentive grooves and the restoration
should be luted with adhesive cements.
U-shaped grooves and flared boxes provide more resis-
tance than V-shaped ones.
Pinholes increase resistance as they prevent rotational
movement and subject additional areas of the luting agent
to compression. The buccal and lingual walls must meet the
axial walls at 90° to resist rotational forces.
Length: Greater the length of the crown, better the retention
of the restoration. Increase in the height increases the area
of cementation, thereby improving retention.
Substitution of internal features
Internal features like proximal grooves, boxes, and reten-
tion pinholes can be incorporated in the preparation to im-
prove retention.
Retention can be improved in faulty preparations by the
placement of internal features, which are accurate and easy
to prepare.
Path of insertion
'It is an imaginary line along which the restoration will
be placed onto or removed from the preparation'. A sur-
veyor should be used to accurately determine the path of
insertion.
A facial path of insertion is generally avoided, because
it forms a prominent unaesthetic cervical margin.
The mesiodistal inclination of prepared tooth should be
parallel to the proximal inclinations of adjacent teeth.
• Structural durability
The ability of the restoration to withstand destruction due
to external forces is known as structural durability. The
amount of reduction required for structural durability de-
pends on the type of restorative material being used and the
design of the restoration.
Occlusal reduction
The occlusal surface reduction follows the anatomic planes.
The amounts of occlusal reduction commonly required are
• Gold alloys require 1.5 mm clearance for the functional
cusp and 1.0 mm clearance for the non-functional cusp.
• Metal ceramic restorations require 1.5-2.0 mm reduc-
tion in the functional cusp and 1.0- 1.5 mm reduction in
the non-functional cusp.
• All ceramic restorations require a minimum of 2 mm
reduction throughout.
Functional cusp bevel
• It is provided to increase the thickness on the occluso-
axial junction of the restoration.
• It is an integral part of occlusal reduction.
• Lack of a functional cusp bevel can cause a thin area or
perforation in the casting.
• It is prepared on the palatal cusp of the maxillary and
buccal cusp of the mandibular posterior teeth.
Axial reduction
Adequate axial reduction is necessary for structural dura-
bility. Inadequate axial reduction may lead to over-
contoured proximal surfaces, which can lead to periodontal
problems.
The reduction is done such that it aligns the abutments
parallel to each other. Mandibular premolars are inclined by
9°, hence the preparation also inclines in the same angle.
Marginal integrity
Poor marginal adaptation will lead to percolation of oral
fluids (marginal leakage) and secondary caries.
There are three types of margins:
a. Supragingival.
b. Subgingival.
c. At the crest of the gingiva.
The margin of a restoration should be placed supragingi-
vally, because it has the following advantages:
• It can be easily finished.
• It is easy to maintain.
• It is easy to identify and reproduce during impression
making.
• It is easy to examine during future visits.
The indications for subgirgival margin are
• For teeth with short clinical crowns.
• Teeth affected by subgingival caries or cervical erosion.

• If the contact area is present at or below the gingival
crest.
• Where aesthetics is of concern (e.g., gummy
smile).
• For cases with unmanageable root sensitivity.
• When the axial contours should be modified.
• When additional retention is required.
• To conceal the metal ceramic margin behind the la-
biogingival crest.
• Shallow bevels nearly parallel to the cavosurface
should be avoided, because the restoration will be
too thin at this area and may chip easily. The dis-
crepancy decreases with the increase in angulation
of the bevel.
Finish line configurations
The characteristics to be followed are:
• Shallow bevels are nearly parallel to the cavosurface
and should be avoided, because the restoration will be
too thin at this area and may chip easily.
• The bevel should not produce a very acute margin
which can lead to fracture of the wax pattern during
removal.
• The tooth should not be reduced more than half of the
width of the diamond.
Types of finish line
a. Chamfer
• It has a curved slope from the axial wall till the margin.
• Torpedo diamond point is used.
• It has good success rate.
• Heavy chamfer is used to provide 90° cavosurface angle
with large round radius.
• For cast metal restoration, a bevel should be added to
the heavy chamfer.
b. Shoulder
• This has a gingival finish wall perpendicular to the axial
surfaces of the teeth.
• This is used for all the anterior restorations, which are
fabricated with a shoulder margin where aesthetics is
the primary concern.
• The sharp internal line angle may cause stress concen-
tration and fracture of the tooth.
• Requires more tooth reduction.
c. Radial shoulder
• A flat-end tapered diamond and end-cutting parallel
side carbide-finishing bur are used and finishing is done
by modified special binangle chisel.
d. Shoulder with a bevel
• It is similar to a shoulder finish line, but an external
bevel is created on the gingival margin of the finish line.
Quick Review Series for BOS 4th Year: Prosthodontics
• It is used as a gingival finish line on the proximal box of
inlays and onlays.
• It can be used as the facial finish line of metal ceramic
crowns, where aesthetics is not of concern.
Advantages of a finish line bevel
• Aids in contouring the restoration.
• Improves burnishability.
• Minimizes the marginal discrepancy.
e. Shoulderless or feather-edge preparation
It is similar to a knife-edge preparation, but is marginally
thinner.
Knife-edge
It is an extremely thin finish line. It is similar to a sloping
shoulder with a very thin margin. It is indicated for lingual
surface of mandibular posterior.
• Preservation of periodontium
• The placement of finish lines influences the fabrication
of the restoration and the final outcome of the treatment.
• The finish lines should be such that it can be reproduced
in the impression.
• It should also facilitate the easy removal of the impres-
sion without any tear or deformation.
• The finish line should be in enamel whenever possible.
• Most preferable finish line is a supragingival finish line.
• Subgingival finish lines predispose to periodontitis.
Q. 3. Give in detail the step by step procedure for prepar-
ing metal ceramic crowns for a maxillary central incisor.
Ans.
Preparation of Metal Ceramic Crowns
The following are the step by step procedure for preparing
metal ceramic crowns for a maxillary central incisor:
A. Preparation of an index.
B. Labial reduction.
C. Incisor reduction.
D. Lingual reduction.
E. Proximal reduction.
Instruments Used
• Laboratory knife with a No. 25 blade.
• Silicone putty and accelerator.
• Handpiece.
• Flat-end tapered diamond.
• Small wheel diamond.
• Long needle diamond.
• Torpedo diamond.
• Torpedo bur.
• H15S-012 radial fissure bur.
• RS-I binangle chisel.
Section I I Topic Wise Solved Questions of Previous Years

A. Preparation of an Index
• Before the preparation, an index is made to check for
reduction produced by the preparation.
• If the tooth has proper contours, the index can be made
intraorally. If the tooth is extensively damaged or the
existing contours are to be changed by the restoration,
then the index is made from the preoperative wax-up on
the diagnostic cast.
• In intraoral indexing, a half scoop of putty elastomer is
kneaded with adequate accelerator. The kneaded mix is
adapted over the entire facial and lingual surface of the
tooth to be prepared plus the facial and lingual surfaces
of at least one adjacent tooth. It is allowed to polymerise
for 2 min.
• After removing the index from the teeth, laboratory
knife is used to cut along the incisal edges of the index
to split it into a labial and a lingual half.
• The labial half of the index is cut transversly to form an
incisal and gingival half.
• The individual halves are placed over the tooth and
verified for adaptation over the tooth structure. The lin-
gual index is verified or adapted over the incisal edges.
• The junction between the lingual wall and the cingulam
should not be over-reduced.
• The lingual wall of the reduced lingual surface should
be parallel to the gingival half of the labial surface.
E. Proximal Reduction
• The contact should be broken to gain access into the
proximal region.
• A long needle diamond point is used.
• The lingual aspect of the proximal surface and the re-
maining lingual wall are reduced using a torpedo dia-
mond point.
• The axial surfaces and the chamfer finish line are
smoothened with a torpedo bur.
• RS-I binangle chisel with rounded comers can also be
used to finish the radial shoulder finish line.
Q. 4. Enumerate the principles of tooth preparation.
Discuss in detail the mode of preparation of 36 to
receive a ¾ crown.
Ans.

B. Labial Reduction Tooth Preparation

• During the labial reduction, depth-orientation grooves A ¾ crown is usually a partial veneer crown with an intact
are placed on the labial and incisal surfaces. buccal surface. It is used where aesthetics in not a major
• A flat-end tapered diamond point is used. concern.
• The labial groves should be at least 1.2 mm in depth to
provide adequate thickness of ceramic. Instruments Used
• Insufficient reduction will lead to a poorly countered
• Handpiece.
restoration that may affect the surrounding gingival and • Round-end tapered diamond.
may lack aesthetics. The shade and translucency of the • Short needle diamond.
restoration will not match the adjacent natural teeth.
• Torpedo diamond.
• The labial grooves are done in two plane reduction-one
• Torpedo bur.
set is parallel to the gingival half of the labial surface and
• No. 169L bur.
the other is parallel to the incisal half of the labial surface.
• No. 171L bur.
• Then, the island of enamel formed between the depth
• Flame diamond.
orientation grooves is removed.
• Flame bur.
• Facial reduction is done in two planes, incisal and gin-
• Enamel hatchet.
gival planes using a flat-end tapered diamond points. The following are the steps in tooth preparation:

C. Incisor Reduction
• A flat-end tapered diamond bur is used.
• After the labial reduction, incisal grooves should be
placed across the incisal edge of 2.0 mm deep.
• The bur should be held at a direction perpendicular to
the incisal half of the labial reduction.
D. Lingual Reduction
• The cingulum should be reduced with a small wheel
diamond to obtain a minimum clearance of 0.7 mm with
the opposing tooth.
i. Occlusion Reduction
• Depth orientation grooves should be made using a
round-end tapered diamond bur.
• The grooves should be 1.5 mm deep on the functional
cusps and 1.0 mm deep on the non-functional cusps.
• The grooves should be 0.5 mm deep on the occlusobuc-
cal line angle.
• The tooth structure between the grooves is then re-
moved.
• A functional cusp bevel should be prepared using a
round-end tapered diamond point.

• Three to five depth orientation grooves may be neces-
sary. These grooves are 1.5 mm deep at the cusp tip and
faded out near the base of the cusp.
• The occlusal reduction and the functional cusp bevel are
smoothened with a No. 171L bur.
• The occlusal finish line on the buccal surface is gingival
to the occlusal contacts.
• An occlusal shoulder is prepared on the buccal aspect of
buccal cusps. It connects the proximal grooves and
strengthens the bucco-occlusal margin.
ii. Axial Reduction
• A torpedo bur is used to reduce axial surface.
• The reduction starts with the lingual surface with a tor-
pedo diamond point.
• The reduction should be extended into the proximal
surfaces.
• A chamfer finish line is established during the reduction.
• All sharp angles should be rounded.
• Proximal access can be obtained by breaking the con-
tact using a short needle diamond point in an up-down
sawing motion.
• The facial extension of the axial reduction should be
done using a short needle diamond point or an enamel
hatchet.
• The axial wall and chamfer are finished with a tor-
pedo bur.
iii. Placement of Additional Features
Proximal grooves
• Grooves are placed to increase the retention.
• No.171L or No.169L bur is used here.
• A small 1 mm deep groove is made on the proximal
surface as guide, to extend the groove to half its length.
• After examining the alignment and direction, the groove
is extended up to a point 0.5 mm occlusal to the finish line.
• Grooves are placed in the inaccessible areas like the
distal surface of the molars.
iv. Proximal Flare
• The facial wall of the proximal groove should be ex-
tended such that it forms a line angle with the facial
surface. This produces a flare.
• It is cut using the tip of the flame diamond in an outward
direction from the groove.
• Flare is smoothened with a carbide bur using short and
crisp strokes.
• Buccal bevel.
• It is made with a No. I 70 bur.
• A 0.5 mm bevel is placed along the bucco-occlusal fin-
ish line perpendicular to the path of insertion.
Quick Review Series for BOS 4th Year: Prosthodontics
• It extends over the mesial and the distal comers and
blends into the proximal flares.
Q. 5. Describe the clinical and laboratory steps in the
preparation of a porcelain jacket crown.
Ans.
Clinical and Laboratory Steps in the
Preparation of Porcelain Jacket Crown
Following are the laboratory steps in the preparation of a
porcelain jacket crown:
i. Coping fabrication.
ii. Axial contours.
iii. Occlusal surface.
iv. Remargination.
v. Finishing and polishing.
vi. Removing the wax pattern.
i. Coping Fabrication
• It can be done by wax or resin. Usually wax is preferred.
• The die is first coated with separating medium to facili-
tate easy removal of pattern.
• The coping is formed by adding wax with a No. 7 wax
spatula or dipping the die into hot wax.
• While adding new layers of wax, the previous layer of
wax is melted before the addition of new layers of wax.
This prevents the formation of voids and flow lines.
• The proximal areas should be given extra-bulk to help
in the removal from die.
• Excess wax is trimmed from the margins, so that the
coping can be removed and evaluated.
ii. Axial Contours
This involves fabrication or contour of the proximal, buc-
cal, and lingual surfaces.
Proximal
• First, the size and location of contact is established. If
the contact area is too narrow, there may be wedging of
food and on the other hand, if the contact area is wide,
it may injure the gingival tissues.
• When viewed from the occlusal aspect, usually the pos-
terior proximal contacts occur at the occlusal third.
• The contour of the proximal axial surface below the
contact point should be flat.
Fabrication
• The wax coping is replaced on the die. Then wax is
added in the contact areas.
• The proximal surface gingival to the contact area is then
correctly contoured.
Section I I Topic Wise Solved Questions of Previous Years
Buccal and lingual surfaces
• They should follow the contour of the adjacent teeth.
• Height of contour of the buccal surface of posterior
teeth occurs in the cervical third of the teeth.
• Height of contour of the lingual surface of maxillary
posteriors also occurs in the cervical third, but on the
lingual surface of mandibular posteriors it occurs in the
middle third.
• Emergence profile is the contour of a tooth in relation to
the gingival tissues or below the height of contour.
• It should be straight or concave. Overcontouring this
part, results in gingival inflammation and hyperplasia.
Fabrication
• The buccal and lingual surfaces are contoured to their
anatomic form using the adjacent and contralateral teeth
as guides. A smooth flat emergence profile is shaped.
iii. Occlusal Surface
Two types of occlusal schemes can be developed on the
location of contact of the functional cusps:
a. Cusp-marginal ridge
• This type of occlusion is very commonly found.
• The functional cusps contact the embrasure of the
opposing teeth.
• Most commonly used and indicated for most short-span
replacements.
b. Cusp-fossa
• It is rarely found in natural dentition.
• The functional cusps contact the fossa of the opposing
teeth. It is a tooth-to-tooth occlusal arrangement.
• It is indicated in full mouth occlusal reconstructions.
• Here, occlusal forces are directed centrally and along
the long axis of the teeth with less food impaction. Tri-
pod contact produces greater stability.
Fabrication
Whichever occlusal scheme is used, the following proce-
dure is used to fabricate the occlusal surface:
a. Placement of cusp cones
Here, cones are placed at the desired location and height of
the cusps with a PKT No. 1 instrument. Location and height
of functional cusp is determined by the area of location of
its contact with its antagonist (depending on whether it is a
cusp-fossa or cusp-marginal occlusal scheme). The location
and height of non-functional cusp is determined by the
curve of Spee and curve of Wilson, the adjacent teeth, and
the clearance required in excursive movements.
b. Placement of marginal and cusp ridges
The cusps are connected by placing the marginal and cusp
ridges with the same instrument. Occlusion is checked
by closing the articulator, so that vertical dimension is
not raised. The axial surface is carved with a No. -4 PKT
instrument.
c. Placement of triangular ridges
A triangular ridge is placed for each cusp which runs
towards the centre of the tooth. The apex of the triangle is
at the cusp tip and the base is at the tooth centre. The bases
should be convex buccolingually and mesiodistally. Occlu-
sion is checked.
d. Completing the occlusal surface
Remaining areas (pits) between the ridges are filled
with wax by using PKT No. 2 instrument. Secondary
and supplemental grooves are carved with a PKT No.
3 instrument.
Occlusal surface is dusted with powder, such as
zinc stearate and contacts are verified closing the
articulator.
iv. Remargination
To obtain optimum fit, the margins must be refabricated and
finished just before investing the wax pattern. This termed
as remargination.
Procedure
• The die is lubricated and pattern is reseated.
• The entire margin is remelted using a No. 1 PKT
instrument ensuring that the wax is melted through to
the die. This results in a depression around the entire
margin.
• The depression is filled with additional wax.
• The margin is finished by carving the excess wax with
a No. 4 PKT instrument. A sharp instrument should
not be used, as it may destroy the delicate margin in
the die.
v. Finishing and Polishing
For finishing the occlusal surface, a cotton pellet is held by
tweezer and dipped in the die lubricatnt.
Axial surface is smoothened using wet cloth and liquid
detergent.
vi. Removing the Wax Pattern
By holding the die with the forefinger and the thumb, force
in the opposite direction is applied.

SHORT ESSAYS
Q. 1. Principles of tooth preparation.
Ans.
Principles of Tooth Preparation
The basic principles of tooth preparation are as follows:
• Preservation of tooth structure.
• Retention and resistance.
• Structural durability.
• Marginal integrity.
• Preservation of periodontium.
Preservation of Tooth Structure
Care should be taken to prevent excessive tooth preparation.
The morphology of the dental pulp should be assessed
before the preparation with the help of radiograph.
Gentle pressure should be applied while preparing the
tooth.
All retentive grooves and polishing needs to be done
with a slow-speed handpiece.
Retention and Resistance
Retention prevents the removal of the restoration along the
path of insertion on the long axis of the tooth.
There are two types of retention:
a. Primary retention
Sleeve retention is given by opposing vertical surfaces of
the tooth preparation.
Wedge type retention is seen in intracoronal restoration.
b. Secondary retention
Here, retention is obtained by retentive features like pins,
boxes, and grooves.
Resistance prevents dislodgment of the restoration, by
forces directed in an apical direction or oblique direction
and prevents any movement of restoration under occlusal
forces.
Retention and resistance are reciprocative to one an-
other. Hence, an optimal balance between these factors
should be established during any preparation.
• Structural Durability
The ability of the restoration to withstand destruction due
to external forces is known as structural durability. The
amount of reduction required for structural durability de-
pends on the type of restorative material being used and the
design of the restoration.
Quick Review Series for BOS 4 th Year: Prosthodontics
• Marginal Integrity
Poor marginal adaptation will lead to percolation of oral
fluids (marginal leakage) and secondary caries.
There are three types of margins:
a. Supragingival.
b. Subgingival.
c. At the crest of the gingiva.
• Preservation of Periodontium
• The placement of finish lines influences the fabrication
of the restoration and the final outcome of the treatment.
• The finish lines should be such that it can be reproduced
in the impression.
• It should also facilitate the easy removal of the impres-
sion without any tear or deformation.
• The finish line should be in enamel whenever possible.
• Most preferable finish line is a supragingival finish line.
• Subgingival finish lines predispose to periodontitis.
Q. 2. Finish lines in FPD.
Or
Supragingival finish line.
Or
Marginal finish lines.
Or
Gingival finishing lines.
Or
Types of gingival finish lines in crown preparation.
Ans.
Finish Line Configurations
The characteristics to be followed are:
• Shallow bevels are nearly parallel to the cavosurface
and should be avoided, because the restoration will be
too thin at this area and may chip easily.
• The bevel should not produce a very acute margin which
can lead to fracture of the wax pattern during removal.
• The tooth should not be reduced more than half of the
width of the diamond.
• Poor marginal adaptation will lead to percolation of oral
fluids (marginal leakage) and secondary caries.
There are three types of margins:
a. Supragingival.
b. Subgingival.
c. At the crest of the gingival.
Section I I Topic Wise Solved Questions of Previous Years
The margin of a restoration should be placed supragingi-
vally, because it has the following advantages:
• It can be easily finished.
• It is easy to maintain.
• It is easy to identify and reproduce during impression
making.
• It is easy to examine during future visits.
The indications for subgirgival margin are:
• For teeth with short clinical crowns.
• Teeth affected by subgingival caries or cervical
erosion.
• If the contact area is present at or below the gingival
crest.
• Where aesthetics is of concern (e.g., gummy
smile).
• For cases with unmanageable root sensitivity.
• When the axial contours should be modified.
• When additional retention is required.
• To conceal the metal ceramic margin behind the
labiogingival crest.
• Shallow bevels nearly parallel to the cavosurface
should be avoided, because the restoration will be
too thin at this area and may chip easily. The discre-
pancy decreases with the increase in angulation of
the bevel.
Types of Finish Line
a. Chamfer
• It has a curved slope from the axial wall till the
margin.
• Torpedo diamond point is used.
• It has good success rate.
• Heavy chamfer is used to provide 90° cavosurface angle
with large round radius.
• For cast metal restoration, a bevel should be added to
the heavy chamfer.
b. Shoulder
• This has a gingival finish wall perpendicular to the axial
surfaces of the teeth.
• This is used for all the anterior restorations which are
fabricated with a shoulder margin where aesthetics is
the primary concern.
• The sharp internal line angle may cause stress concen-
tration and fracture of the tooth.
• Requires more tooth reduction.
c. Radial shoulder
• A flat-end tapered diamond and end-cutting parallel
side carbide-finishing bur are used and finishing is done
by modified special binangle chisel.
d. Shoulder with a bevel
• It is similar to a shoulder finish line, but an external
bevel is created on the gingival margin of the finish
line.
• It is used as a gingival finish line on the proximal box of
inlays and onlays.
• It can be used as the facial finish line of metal ceramic
crowns, where aesthetics is not of concern.
Advantages of a finish line bevel
• Aids in contouring the restoration.
• Improves burnishability.
• Minimizes the marginal discrepancy.
e. Shoulderless or feather-edge preparation
It is similar to a knife-edge preparation, but is marginally
thinner.
Knife-edge
It is an extremely thin finish line. It is similar to a
sloping shoulder with a very thin margin. It is indicated for
lingual surface of mandibular posterior.
Q. 3. Describe the indications, contraindications, advan-
tages, and disadvantages of partial veneer crowns.
Or
Partial veneer crown.
Ans.
Partial Veneer Crown
Partial veneer crown is defined as a restoration that restores
all but one coronal surface of a tooth or dental abutment
usually not covering the facial surface (GPT8).
Indications
• The partial veneer crown is a conservative restoration.
• They are used in cases where minimal retention is suf-
ficient and the abutment tooth is healthy.
• Here, crown does not cover the entire abutment and fa-
cial surface of the abutment is left intact for superior
aesthetics.
Contraindications
• Short clinical crown.
• Extensively damaged tooth.
• Endodontically treated tooth.
• Retainer for long-span fixed partial dentures.
• Poorly aligned abutments.
• Dentitions with active caries or periodontal disease.
 Quick Review Series for BOS 4 th Year: Prosthodontics

Advantages • In that outline, a small 1 mm deep groove is formed on

the proximal surface and is used as a guide to extend the
• Conservation of tooth structure.
groove to half its length.
• Improved access for finishing by the dentist and for
• This groove is extended up to 0.5 mm occlusal to the
cleaning by the patient.
finish line.
• Improved periodontal health, as there is limited contact
Proximal grooves in the anterior and posterior tooth
between the margins of the restoration and the gingiva.
Depth: 0.3-0.5 mm cervically after proximal reduction.
• Cementation is easy, as there is open margin for the
Width: 1 mm.
excess cement to escape.
Angulation: Parallel to the path of insertion.
• The marginal fit of the partial veneer crown can be eas-
Rotary instrument: 1 mm diameter flat-end tapering
ily verified.
fissure bur.
• The unveneered portion of the enamel can be used for
electric pulp testing which is not possible in a full ve- Q. 6. Give the advantages and the disadvantages of
neer crown. porcelain jacket crown.
Or
Disadvantages
What are the advantages of porcelain jacket crown?
• Lesser retention as compared to full veneers.
Or
• There can be some display of metal and it requires high
skill to hide the same. Indications and contraindications of porcelain jacket
• May not have adequate rigidity as retainer, for a fixed crown.
prosthesis.
Ans.
• Tooth preparation is more complicated.
Q. 4. Indications, advantages, and disadvantages of¾ th
partial veneer crown.
Porcelain Jacket Crown
Porcelain jacket crown are also called as all-ceramic
Ans.
crowns.

¾th Partial Veneer Crown

Advantages
Indications
• Aesthetics.
• Usually used in maxillary posterior teeth, where aes- • Good translucency as to that of natural tooth.
thetics is not a major concern. • Good biocompatibility.
• It is given when the buccal surface is intact. • Can select the appropriate shade for luting agent.

Contraindications Disadvantages
• Anterior tooth. • Reduced strength of the restoration, if metal reinforcing
substructure is not given.
Advantages • Significant tooth reduction on proximal and lingual
aspects.
• Tooth preparation is conservative. • Less conservative than metal-ceramic crown.
• Difficulties in obtaining a well fitting margin.
Disadvantages • The success of the restoration depends on proper prepa-
ration design.
• Partial veneer crown lacks retention. • An extensively damaged tooth that cannot be restored
Q. 5. Proximal grooves in partial veneer crown. with an all-ceramic crown.
• It can be worn on the functional surfaces of opposing
Ans. natural teeth.
• Grooves are usually placed to increase the retention.
• For the posterior tooth, a proximal groove is done with
Indications
a No. 179L or No. 169L bur.
• The outline of the preparation is drawn on the occlusal • Where a high aesthetic requirement is high.
surface using a pencil. • When the tooth has sound tooth structure present.
Section I I Topic Wise Solved Questions of Previous Years
Contraindications
• Where a more conservative restoration can be used.
• Not recommended for molar teeth.
• Where increased occlusal loads are present.
• When adequate support cannot be provided.
• When an even shoulder width cannot be prepared.
Q. 7. Full veneer crown.
Ans.
Full Veneer Crown
In full veneer crown, the whole of the tooth surface is pre-
pared.
Following are the step by step preparation of posterior
tooth to receive a complete veneer crown:
Steps in Tooth Preparation
i. Occlusal reduction.
ii. Axial reduction.
iii. Seating groove.
Instruments Used
• Handpiece.
• No. 171L bur.
• Round-end tapered diamond.
• Short needle.
• Torpedo bur.
• Red utility wax.
i. Occlusal reduction
• The occlusal reduction is done to achieve an occlusal
clearance of 1.5 mm for the functional cusps.
• As a reference guide of occlusal reduction, deep orien-
tation grooves are placed on the occlusal surface.
• A round-end tapered diamond is used to place grooves.
• The tooth structure between the orientation grooves are
removed following the occlusal cuspal inclines of the
tooth.
• The reduction should be smooth without any rough
spots.
• A functional cusp bevel is placed using a round-end ta-
pered diamond on the buccal inclines of mandibular
buccal cusps and on the palatal inclines of maxillary
palatal cusps.
• The angulation of the bevel should be parallel to the in-
ner inclination of the opposing cusps.
• Verification of the occlusal clearance is done by asking
the patient to close on a 2.0 mm thick red utility wax.
Insufficient clearance can be detected as thin spot on
the wax.
ii. Axial reduction
• The buccal and the lingual walls are reduced with a
torpedo diamond. This bur forms the chamfer finish line
along with the axial reduction.
• The proximal reduction is started with a short needle dia-
mond. To break the contact, the bur is used in a sawing
motion in an occlusogingival or buccolingual direction.
• Then the torpedo diamond is used to prepare the proxi-
mal surface and establish the finish line.
• The axial surfaces are smoothened with a torpedo car-
bide finishing bur.
• The finish line should be smooth and continuous.
iii. Seating groove
• This prevents the rotation of the crown during cementa-
tion and acts as a guide during insertion of the crown.
• Seating is made on the buccal surface of the mandibular
teeth, on the palatal surface of the maxillary teeth, and
on the palatal surface of the maxillary teeth.
• It is made on the axial surface of the greatest bulk. A
No. 171L diamond is used.
Q. 8. Retention grooves in anterior and posterior partial
veneer crowns.
Ans.
• Grooves are usually placed to increase the retention.
• For the posterior tooth, a proximal groove is done with
a No. 179L or No. 169L bur.
• The outline of the preparation is drawn on the occlusal
surface using a pencil.
• In that outline, a small 1 mm deep groove is formed on
the proximal surface and is used as a guide to extend the
groove to half its length.
• This groove is extended up to 0.5 mm occlusal to the
finish line.
Proximal grooves in the anterior and posterior tooth
Depth: 0.3-0.5 mm cervically after proximal reduction.
Width: 1 mm.
Angulation: Parallel to the path of insertion.
Rotary instrument: 1 mm diameter flat-end tapering
fissure bur.
Q. 9. Finish line and its location and types.
Ans.
Types of Finish Line
a. Chamfer
• It has a curved slope from the axial wall till the margin.
• Torpedo diamond point is used.
• It has good success rate.
• Heavy chamfer is used to provide 90° cavosurface angle
with large round radius.

• For cast metal restoration, a bevel should be added to
the heavy chamfer.
b. Shoulder
• This has a gingival finish wall perpendicular to the axial
surfaces of the teeth.
• This is used for all the anterior restorations which are
fabricated with a shoulder margin where aesthetics is
the primary concern.
• The sharp internal line angle may cause stress concen-
tration and fracture of the tooth.
• Requires more tooth reduction.
c. Radial Shoulder
A flat-end tapered diamond and end-cutting parallel side
carbide-finishing bur are used and finishing is done by
modified special binangle chisel.
d. Shoulder with a Bevel
• It is similar to a shoulder finish line, but an external
bevel is created on the gingival margin of the finish line.
• It is used as a gingival finish line on the proximal box of
inlays and onlays.
• It can be used as the facial finish line of metal ceramic
crowns, where aesthetics is not of concern.
Advantages of a finish line bevel
• Aids in contouring the restoration.
• Improves burnishability.
• Minimizes the marginal discrepancy.
e. Shoulderless or Feather-edge Preparation
It is similar to a knife-edge preparation, but is marginally
thinner.
Knife-edge
It is an extremely thin finish line. It is similar to a sloping
shoulder with a very thin margin. It is indicated for lingual
surface of mandibular posterior.
Q. 10. What are the different types of finish lines?
Which finish line is used for metal ceramic restoration
and why?
Ans.
Finish Line
Types of Finish Lines
a. Chamfer
• It has a curved slope from the axial wall till the margin.
• Torpedo diamond point is used.
Quick Review Series for BOS 4th Year: Prosthodontics
• It has good success rate.
• Heavy chamfer is used to provide 90° cavosurface angle
with large round radius.
• For cast metal restoration, a bevel should be added to
the heavy chamfer.
b. Shoulder
• This has a gingival finish wall perpendicular to the axial
surfaces of the teeth.
• This is used for all the anterior restorations, which are
fabricated with a shoulder margin where aesthetics is
the primary concern.
• The sharp internal line angle may cause stress concen-
tration and fracture of the tooth.
• Requires more tooth reduction.
c. Radial shoulder
• A flat-end tapered diamond and end-cutting parallel
side carbide-finishing bur are used and finishing is done
by modified special binangle chisel.
d. Shoulder with a bevel
• It is similar to a shoulder finish line, but an external
bevel is created on the gingival margin of the
finish line.
• It is used as a gingival finish line on the proximal box of
inlays and onlays.
• It can be used as the facial finish line of metal ceramic
crowns, where aesthetics is not of concern.
Advantages of a finish line bevel
• Aids in contouring the restoration.
• Improves burnishability.
• Minimizes the marginal discrepancy.
e. Shoulderless or feather-edge preparation
• It is similar to a knife-edge preparation, but is margin-
ally thinner.
Knife-edge
It is an extremely thin finish line. It is similar to a
sloping shoulder with a very thin margin. It is indicated for
lingual surface of mandibular posterior.
In metal ceramic crown, the tooth preparation has a
labial shoulder and a lingual chamfer which meets proxi-
mally and the junction is called as wing.
A shoulder is given labially, because labial surface is
porcelain restoration. And porcelain restoration cannot tol-
erate the shearing forces. Shoulder produces a wide ledge
which resists compressive occlusal forces.
A lingual chamfer is given, as it is most conservative.
Q. 11. Post core crown.
Ans.
Section I I Topic Wise Solved Questions of Previous Years

Post Core Crown A. Prefabricated noble metal dowels, which are designed
to accept custom-made cores.
Dowel/post is the screw component that is inserted into the
B. Resin pattern fabrication.
root canal.
C. Wax pattern fabrication.
It is placed when an endodontically treated tooth is
prepared for a full veneer crown. Q. 12. Shoulder.
It improves resistance and supports the crown.
Ans.
It acts as a substitute for the lost tooth structure.

Disadvantages
• It does not take up any masticatory load.
• It weakens the tooth structure rather than strengthening it.
Core
Core is the retentive component of the post. It acts as a
prepared crown for the placement of a retainer.
Types of Dowel Cores
i. Prefabricated.
ii. Custom-made.
i. Prefabricated dowel with amalgam or resin core
Amalgam core are more successful than resin or GIC cores.
The most commonly used materials are stainless steel,
titanium, nickel, or chromium containing alloys.
ii. Custom caste dowel core
They are caste from the wax patterns fabricated in the canal.
Types of custom-made core systems are
Shoulder
• Shoulder finish line is a right angled finish line.
• Its preparation is not conservative.
• Shoulder produces a wide ledge, which resists compres-
sive occlusal forces.
• This has a gingival finish wall perpendicular to the axial
surfaces of the teeth.
• This is used for all the anterior restorations which are
fabricated with a shoulder margin where aesthetics is
the primary concern.
• The sharp internal line angle may cause stress concen-
tration and fracture of the tooth.
• Requires more tooth reduction.
Indications
• All ceramic and metal-ceramic crowns. In metal
ceramic crown, it is given where ceramic forms the
margin.

SHORT NOTES
Q. 1. PFM (porcelain fused to metal restoration). Dowel Crown
Ans. • Dowel is the screw component that is inserted into the
root canal.
• It is placed when an endodontically treated tooth is pre-
Porcelain Fused to Metal Restoration
pared for a full veneer crown.
Advantages • It improves resistance and supports the crown.
• It acts as a substitute for the lost tooth structure.
• Aesthetic.
• It also incorporates the strength of metal.
Disadvantages
Disadvantages • It does not take up any masticatory load.
• It weakens the tooth structure rather than strengthening it.
• Preparation is not conservative.
• Cause gingival destruction. Q. 3. Post and crown.
• Failure at the metal-ceramic junction can occur.
Ans.
• The facial margin needs to be extended subgingivally
for better aesthetics.
Post and Crown
Q. 2. Dowel crown.
• Dowel or post is the screw component that is inserted
Ans.
into the root canal.
 Quick Review Series for BOS 4th Year: Prosthodontics

• It is placed when an endodontically treated tooth is pre-
pared for a full veneer crown.
• It improves resistance and supports the crown.
• It acts as a substitute for the lost tooth structure.
Disadvantages
• It does not take up any masticatory load.
• It weakens the tooth structure rather than strengthening it.
Q. 4. Metal crown.
• Shoulder finish line is a right angled finish line.
• Its preparation is not conservative.
• Shoulder produces a wide ledge, which resists compres-
sive occlusal forces.
• Indication: All ceramic and metal-ceramic crowns. In
metal ceramic crown, it is given where ceramic forms
the margin.
Q. 8. Ante's law.
Ans.

Ans.
Ante's law
Ante's law states that, 'Abutment tooth/teeth should have a
Metal Crown
combined pericemental area equal to or greater in perice-
Advantages mental area than the tooth or teeth to be replaced'.
a. All metals have the maximum strength and durability. Factors that result in modifications to Ante's law
b. Less tooth structure is reduced, as compared to all • Root proximities.
porcelains. • Common path of insertion.
c. Chamfer margin is given for preparation. • Span length.
• Root shape/root angulation/root numbers.
Disadvantages • Bone support and periodontal involvement.
• Occlusal scheme.
• Aesthetically poor.
Q. 9. Resistance and retention form in tooth preparation.
Q. 5. Functional cusp bevel.
Ans.
Ans.

• It is given during the tooth preparation to increase the Resistance and Retention
thickness of otherwise thin occlusoaxial junction of the
restoration. • Retention is defined as the ability of the preparation to
prevent displacement of the restoration in a direction
• It is prepared on the palatal cusps of maxillary and buc-
opposite to the path of insertion.
cal cusps of mandibular tooth.
• Resistance is defined as the feature of a tooth preparation
• It placed using a round-end tapered diamond.
that enhances the stability of a restoration and resists dis-
Q. 6. Chamfer finish line. lodgment along an axis other than the path of placement.
Resistance prevents dislodgment of the restoration, by
Or
forces directed in an apical direction or oblique direction and
Chamfer. prevents any movement of restoration under occlusal forces.
Ans.
Factors Affecting Retention
Chamfer • Factors influencing dislodging forces.
• Geometry of the tooth preparation.
• It has a curved slope from the axial wall till the margin.
• Roughness of the fitting surface of the restoration.
• Torpedo diamond point is used.
• Type of restorative materials being cemented.
• It has good success rate.
• Type of luting agent.
• Heavy chamfer is used to provide 90° cavosurface angle
• Film thickness of the luting agent.
with large round radius.
• For cast metal restoration, a bevel should be added to
the heavy chamfer. Factors Affecting Resistance Form
• Exhibits least stress. • Magnitude and direction of the dislodging forces.
Indication: Metal crown and metal ceramic crown • Geometry of the tooth preparation.
where metal forms the margin. • Physical properties of the luting agent.
Q. 7. Shoulder finish line. Q. 10. Shoulder with bevel.
Ans. Ans.
Section I I Topic Wise Solved Questions of Previous Years
Shoulder with Bevel
• In a shoulder, the bevel is given on the external edge.
• This bevel protects the edge of the finish line, which
prevents chipping.
Indications
• Metal-ceramic crown to hide the supragingival facial
metal margin of the restoration.
• It is used as gingival finish line on the onlays and inlays.
• It is also used as occlusal finish line for onlays and par-
tial veneer crowns.
Q. 11. Importance of functional cusp bevel.
Ans.
• Functional cusp bevel is given during the tooth prepara-
tion to increase the thickness of otherwise thin occluso-
axial junction of the restoration.
• It is prepared on the palatal cusps of maxillary and buc-
cal cusps of mandibular tooth.
• It placed using a round-end tapered diamond.
• Functional cusp bears the maximum masticatory forces,
so additional thickness should be given.
Q. 12. Advantages and disadvantages of all ceramic
systems.
Ans.
Advantages of All Ceramic Systems
• Can duplicate tooth colour exactly.
• Good translucency.
• Different shades of luting agent give the retainer a natu-
ral appearance.
• Good as anterior retainers.
Disadvantages of All Ceramic Systems
• Reduced strength.
• Brittle.
• More expensive.
• Cannot be used on extensively damaged teeth.
• More amount of tooth structure need to be removed
compared to other restorations.
• Wear of opposing natural teeth.
Q. 13. Disadvantages of partial veneer crown.
Ans.
Disadvantages of Partial Veneer Crown
• Lesser retention as compared to full veneers.
• There can be some display of metal and it requires high
skill to hide the same.
• May not have adequate rigidity as retainer, for a fixed
prosthesis.
• Tooth preparation is more complicated.
Q. 14. Depth orientation groove.
Ans.
• These grooves are placed on the labial and incisal sur-
face of the tooth.
• A flat-end tapered diamond point is used.
• This grove is given to check for the reduction.
• The labial groove should be I .2 mm in depth.
• Insufficient reduction will lack aesthetics and also may
affect the health of the surrounding soft tissue. The
shade may not match the adjacent teeth.
Q. 15. Give the benefits of supragingival margins in
fixed prosthodontics.
Or
Supragingival finish line.
Ans.
• Supragingival finish line can be easily finished and it is
placed on the enamel.
• It is above the gingival sulcus, so it is easy to prepare
without soft tissue trauma.
• Impression is easy to reproduce.
• It can be maintained easily by patient.
Q. 16. Advantages of porcelain jacket crown.
Ans.
• Porcelain jacket crowns are aesthetic.
• No allergic potential.
• Reduce thermal conductivity.
• Superior metals in corrosion, galvanism, and biocom-
patibility.
Q.17. Write four advantages ofsubgingival margin.
Ans.
Advantages of Subgingival Margin
• It is indicated for the teeth with short clinical crowns
and teeth affected by subgingival caries or cervical ero-
sion, where aesthetics is of concern (e.g., gummy
smile).
• It provides additional retention.
• To conceal the metal-ceramic margin behind the labio-
gingival crest.
• It is placed 2 mm above the alveolar crest, so that the
biological width is not encroached.

------------------ - <( Topic 6)
Types of Fixed Partial Dentures
SHORT ESSAYS
Q. 1. Discuss the recent advances in the materials used
for fixed partial dentures.
Ans.
Materials Used in FPD
Plastic materials: They require less tooth preparation,
but their success is limited due to their poor strength,
e.g., resin.
Cast metal: They are strong and have an excellent suc-
cess rate. They are most commonly used.
Classification
a. lntracoronal replacements,
e.g., gold
It gives excellent fit and finish line, but they require
excessive tooth preparation.
b. Extracoronal replacements
They are used in tooth with severe carious lesions.
But the disadvantage is periodontal health, which may
affect as the margin is placed gingivally and it requires
extensive tooth preparations. For example:
Metal ceramic: This requires extensive tooth reduction and
is unaesthetic.
Resin veneer: It contains bis-GMA, which improves the
strength and wear resistance.
Fibre-reinforced resin: It is aesthetic and gives a good fit
and finish.
Complete ceramic: Aesthetically best, but requires
maximum tooth reduction. It has low elastic strain. Re-
cent system has high strength fillers like alumina and
zirconia, which promise to improve the tensile strength of
porcelain.
Q. 2. Cantilever fixed partial denture.
Ans.
Cantilever Fixed Partial Denture
• Cantilever fixed denture is used when support can be
obtained only from one side of the edentulous space.
• These types of dentures have compromised support.
Quick Review Series for BOS 4th Year: Prosthodontics
• Support can be obtained from more than one tooth on
the same side of the edentulous space.
Advantages
• Very conservative design, especially when a single abut-
ment is involved.
• While placing the secondary abutment, parallel prepara-
tion can be easily obtained as the abutment is adjacent
to one another.
• It is easy to fabricate.
Disadvantages
• Torque force is produced on the abutment.
• It cannot be used in long edentulous space.
• Minor error in the design can affect the abutments in
large scale.
Q. 3. Resin-bonded fixed partial dentures.
Ans.
Resin-bonded Fixed Partial Denture
• Resin-bonded fixed partial denture is a fixed dental
prosthesis that is luted to the tooth structure, primarily
enamel, which has been etched to provide mechanical
retention for the resin cement.
• It was described by Rochette in 1973 and was used in
mandibular anterior teeth.
Types
Based on the technique used to finish the tissue surface of
the retainer, they are classified as:
• Rochette bridge.
• Maryland bridge.
• Cast mesh fixed partial dentures.
• Virgina bridge.
Indications
• Splinting of periodontically weak teeth.
• Stabilizing the dentition after orthodontics retainer.
Section I I Topic Wise Solved Questions of Previous Years

• Replacement of the missing anteriors in children and Advantages

adolescents.
• Short-span bridges. • Conservation of tooth structure; preparation is non-
• Abutments with sufficient enamel to etch for retention. invasive to dentine.
• Medically compromised patient. • Decreased tissue irritation due to the placement of
supragingival margin.
• Reduced chair-time with less cost.
Contraindications • Rebonding is possible.
• Insufficient occlusal clearance.
• Thin faciolingual anterior teeth. Disadvantages
• Short clinical crowns.
• Insufficient enamel available for bonding. • It is technique-sensitive, even minor laboratory errors
• Parafunctional habits. cannot be corrected easily.
• Long-span bridges. • Possibility of overcontouring is high, which can lead to
• Sensitivity to base metal alloys. increased plaque accumulation.
• Incisors with extremely thin faciolingual dimension. • Aesthetics is moderate.

SHORT NOTES
Q. 1. Mechanical/Rochette bridge. Ceramic Laminate
Ans. Porcelain laminate veneer is defined as a thin bonded ce-
ramic restoration that restores the facial surface and part
Rochette Bridge of the proximal surfaces of teeth requiring aesthetic resto-
ration (GPT).
Rochette bridge was the first resin-bonded prosthesis to be
developed. Q. 4. Polycarbonate crowns.
It was introduced in 1973 by Rochette.
Ans.
He used a wing-like retainer with multiple flared perfo-
rations to provide mechanical retention for resin cement.
It was used for both anterior and posterior fixed partial Polycarbonate Crowns
dentures.
Polycarbonate crowns are commonly available as preformed
crowns.
Disadvantages They have more natural appearance.
• Perforations weaken the metal retainers. They are usually available in a single shade, but the
• The resin in the perforation causes rnicroleakage and wear. shade can be altered by the shade of luting agent.
• Limited retention is provided by the perforations. They are indicated for incisor, canine, and premolar
teeth.
Q. 2. Failure effect in post and core restorations.
Q. 5. Richmond crown.
Ans.
Ans.
Failure Effects in Post and Core Restorations
Richmond Crown
• Corrosion.
• Discolouration of gingiva and dentine. Richmond crown is a one-piece post crown.
• Its use is decreasing, due to safety and environmental
reasons.
Indications
Q. 3. What is ceramic laminate?
• Patient with deep incisal overbite, where it is difficult to
Ans. provide space for a core and crown separately.
 Quick Review Series for BOS 4 th Year: Prosthodontics

------------------- - <( Topic 7)

Impression Making in Fixed Partial Dentures

LONG ESSAYS
Q. 1. What are the objectives of an impression and ex- • lnterfacial surface tension.
plain your techniques in recording the impressions of a • Capillarity or capillary tension.
FPD. • Atmospheric pressure or peripheral seal.
Or iv. Mechanical factors
Describe the technique of impression making in fixed The mechanical factors responsible for retention are as follows:
partial denture treatment. • Undercuts.
• Retentive springs.
Ans.
• Magnetic forces.
• Denture adhesives.
Impression Making in Fixed Partial Dentures • Suction chamber and suction discs.
Objectives of Impression Making v. Muscular factors

The objectives of an impression making are as follows: Neutral zone: This is mainly obtained due to the balance
A. Retention. between tongue and forces which acts from the buccal mus-
B. Stability. culature. Therefore, in order to achieve the best retention,
C. Support. the artificial teeth should be arranged in the neutral zone.
D. Aesthetics.
B. Stability
E. Preservation of remaining structures.
Stability is defined as, 'The quality of a denture to be firm,
A. Retention steady, or constant, to resist displacement by functional
• Retention is usually defined as that quality inherent in stresses and not to be subjected to change of position when
the prosthesis which resists the force of gravity, adhe- forces are applied.
siveness of foods, and the forces associated with the Stability is affected by the factors such as:
opening of the jaws. • Vertical height of the residual ridge.
• Quality of soft tissue covering the ridge.
Factors that affect retention are as follows: • Quality of the impression.
i. Anatomical factors. • Occlusal rims.
ii. Physiological factors. • Arrangement of teeth.
iii. Physical factors. • Contour of the polished surface.
iv. Mechanical factors.
v. Muscular factors. C. Support
Support is defined as, 'The resistance to vertical forces of
i. Anatomical factors mastication, occlusal forces, and other forces applied in a
Retention is mainly affected by anatomical factors, such as: direction towards the denture-bearing areas'.
• Size of the denture-bearing areas.
• Quality of the denture-bearing areas. D. Aesthetics
Aesthetics is one of the main concerns of patients undergo-
ii. Physiological factors ing complete denture treatment.
Physiological factors that affect retention are as follows: The most important factor that governs aesthetics is the
• Saliva: Retention is mainly determined by the viscosity thickness of the denture flange. In patients with long-term
of the saliva. edentulousness, thicker denture flange is preferred.

iii. Physical factors E. Preservation of Remaining Structures

The physical factors that affect retention are as follows: Here, the impression should record all the details of the
• Adhesion. structures and basal seat in an appropriate manner in order
• Cohesion. to prevent injury to the oral tissues.
Section I I Topic Wise Solved Questions of Previous Years
Techniques of Impression Making in Fixed Partial
Denture
A. Stock tray/Putty wash impression
a. Double mix.
b. Single mix.
B. Custom tray impression
a. Single mix technique
C. Closed bite double arch method or triple tray technique.
D. Copper tube impression.
E. Post space impressions.
A. Impression recording using a stock tray/putty
wash impression
In this technique, primary impression is made using a stock
tray and final impression by using the preliminary impres-
sion as a custom tray.
Advantages
• Trays are readily available.
• No distortion is seen as metal trays are rigid.
Disadvantages
• There is no need to sterilize the tray.
• The impression material required is more.
Techniques
• Stock tray or putty wash impression
• It can be done by two techniques:
a. Double mix putty wash technique
• Firstly, an appropriate stock tray is selected.
• Then tray adhesive is applied into the tray in a uniform
manner.
• Putty impression material is mixed and it is loaded on
the tray.
• A spacer mainly of polythene is placed over the putty
material.
• Then the tray along with the spacer is placed in the
patient's mouth for impression.
• After the impression, the polythene sheet is carefully
removed.
• The light body material is then syringed over the putty
impression and also on the tooth preparation.
• Then the final impression is taken. It records all the
details recorded by light body impression materials.
b. Single mix putty wash technique
• In this procedure, both the putty and light body material
are used simultaneously.
• The stock tray is first loaded with the putty material.
• Then the light body material is syringed around the
tooth preparation.
• Then with the loaded stock tray, a full mouth impression
is taken.
B. Impression making using custom tray
• Firstly, an acrylic special tray is constructed over the
cast using two sheets of tinfoil spacer to provide space
for impression material.
• Then tray adhesive is applied on the special tray.
• On the tray medium body, elastomer is loaded.
• Light body elastomer is syringed over the tooth.
• Then the tray along with the material is seated on the
tooth.
Advantages
• The amount of material used for the impression
is less.
• It is more hygienic, as it is used for a single patient.
• There is less chance for distortion, as there is uniform
thickness of impression material.
Disadvantages
• More time is required for fabrication.
• It cannot be used in patients who are sensitive to acrylic.
C. Closed bite double arch method/dual quad tray/
double arch/closed mouth impression/triple tray/
accubite method
• A high viscosity material is mixed and placed in both
the arches.
• The syringe material is then injected over the area to be
recorded.
• The tray is placed in both the arches.
• Then the patient is asked to bite slowly.
• Then the patient is instructed to open the mouth slowly
after the impression.
• In order to prevent distortion, bilateral pressure should
be applied to remove the tray from the patient's
mouth.
• In the impression of the tooth preparation, die stone is
poured.
• Then the cast is poured after the boxing of the impres-
sions.
D. Copper band impression technique
• Firstly, a copper band or tube is selected.
• The band should be such that it should well adapt to the
tooth.
• Petroleum jelly is applied onto the fingers to avoid
sticking of the materials.
• Then green stick is heated over the flame and then
placed into the copper band and it is filled till one third
of the tube.
• It is then placed onto the tooth preparation.
• Light body material is then syringed over the prepared
tooth.
• The surface of the compound is coated with adhesives
and seated over the syringed material.
 Quick Review Series for BOS 4th Year: Prosthodontics

Indications • It helps in isolation of the mandibular teeth.

• It is used for single tooth preparation. • It can also be used without cotton rolls.
• If one or two preparations are not recorded properly in • Operator can work alone.
case of multiple preparations.
Disadvantages
Q. 2. Describe the methods to control saliva and soft tis-
• It is difficult to gain access to lingual surface of man-
sue management for fixed partial denture procedure.
dibular teeth.
Ans. • The metal portion may traumatize the tissues.
• May trigger a gag reflex.
Methods to Control Saliva
There are two methods used to control saliva: b. Chemical Methods
a. Mechanical. Commonly used chemical methods are as follows:
b. Chemical. • Antisialogogues.
• Local anaesthetics.
a. Mechanical Methods
Antisialogogues
i.Rubber dam. These drugs are effective in controlling the salivary flow.
ii.Suction device. Commonly used drugs are methantheline bromide
iii.High volume vacuum. (Banthine), and propanthelene bromide (Pro-banthine).
iv. Saliva ejector.
v. Svedopter. Contraindications
i. Rubber dam a. In case of hypersensitive patients.
• It was introduced by S C Barnum. b. Patients with eye problems such as glaucoma.
c. Asthmatic patients.
• It is used to separate one or more teeth in the operating
d. In case of obstructive conditions of the GIT.
field from fluid contamination.
e. Patients with compromised CVS.
• Punch holes are made on the rubber dam and clamped
in position of the desired tooth/teeth. Q. 3. What do you understand by the term tissue
• It can be used during impression making for onlays and dilatation and what are the different methods to ob-
inlays. tain it?
• It also retracts the soft tissues.
Or
ii & iii. Suction device and high volume suction
Describe the various methods of gingival retractions in
• It is an apparatus which helps in the removal of small fixed prosthodontics.
operatory devices.
• It helps in lip retraction. Or

iv. Saliva ejector Describe gingival tissue management in fixed prosthesis.

• It is used for evacuation. Ans.
• It helps in removing saliva from the floor of the mouth.
• The tip of the ejector should be such that it should pre-
vent tissue damage in the floor of the mouth. Tissue Dilatation
Advantages Tissue dilatation refers to displacing the gingival tissue by
its lateral movement and to expose the cervical finish line
a. It can be used without the help of an assistant.
of the preparation, in order to record it during impression
b. It can also be used alone for the maxillary arch.
procedures.
Disadvantages
a. It has a slow water removal capacity.
Methods of Gingival Retraction
b. It can be readily displaced by tongue.
a. Mechanical.
v. Svedopter b. Chemical.
• Svedopter is a flanged type of metallic salivary ejector c. Chemicomechanical.
with a tongue deflector. d. Surgical.
Section I I Topic Wise Solved Questions of Previous Years

a. Mechanical Methods • The cord is first adjusted in the mesial interproximal

area and the distal interproximal area with a cord-pack-
• Copper band.
ing instrument.
• Retraction cord.
• After the cord is secured in the distal interproximal area,
• Rubber dam.
the cord is inserted from the mesiolingual to distolin-
Copper band gual comer. While placing in the cord, the tip of the
packing instrument should be angled toward the area
It is used to carry impression material and also to displace
where the cord has been placed.
gingival to expose the finish line.
• The excess amount of cord in the mesial interproximal
Technique
area is cut off and placement of cord on the buccal side
• Firstly, a copper wire is welded to form a tube according
from the distal end to the mesial side is completed, until
to the size of the tooth.
it overlaps the mesial side.
• One end of the tube is trimmed according to the gingival
• After 5-10 min, the cord is gently removed in order to
finish line.
avoid bleeding and haemostasis maintained.
• Then the tube is positioned on the tooth and it is filled
• Then the impression is taken. It should be noted that
with modelling compound.
impression should be taken only after cessation of blood.
• The tube along with the filled modelling compound is
carefully seated along the path of insertion of tooth
preparation and impression is made. d. Surgical Tissue Dilatation
Retraction cord i. Electrosurgery.
ii. Rotary curettage.
• It is packed in the gingival sulcus to provide sufficient
gingival retraction.
i. Electrosurgery
It denotes surgical reduction of sulcular epithelium using
b. Chemical Methods electrode for gingival retraction.
i. Antisialogogues.
Types of electrodes
ii. Local anaesthetics.
iii. Anticholinergics: Methantheline bromide (50 mg), pro- • Coagulating electrode.
pantheline bromide (15 mg), atropine, etc. • Small wire-loop electrode.
iv. Antihypertensives, such as clonidine hydrochloride • Round electrode.
(0.2 mg). • Large-loop electrode.
• Straight electrode.
c. Chemicomechanical Methods Indications
Chemicals used are: • It is used in areas of inflamed gingival tissues.
• 8% racemic epinephrine. • It is also used in case of gingival proliferation around
• Aluminium chloride. prepared finish line.
• Alum.
• Aluminium sulphate. Contraindications
• Ferric sulphate. • It cannot be used in cardiac pacemaker patients.
• It is not suitable to use in thin attached gingiva.
Technique
• Firstly, the prepared tooth area is dried and it is isolated Methods
with cotton rolls. a. Firstly, local anaesthesia is given and aromatic oil is ap-
• A retraction cord of two-inch length is taken out from plied on the vermilion border of upper lip.
the dispenser bottle held with sterile pliers and cut with b. Plastic suction tips and plastic mounted mouth mirrors
scissors. are used.
• The retraction cord is then dipped in 25% aluminum The odour is controlled by an outside ventilated oral
chloride solution or 8% epinephrine. evacuator system.
• The excess amount of aluminium chloride is squeezed c. An adequate power is set on the unit. Electrode is passed
out with a gauze piece. quickly over the tissue to be removed. It should never be
• The cord is made into a U-shape and it is looped placed stagnant in one place, as it leads to dissipation of
around the prepared tooth. The cord is only touched at heat and leads to gingival tissue injury. An adequate time
the end. interval between each stroke needs to be followed.
 Quick Review Series for BOS 4th Year: Prosthodontics

d. The tissue fragments are removed with an alcohol
soaked sponge.
ii. Rotary curettage/Gingettage
It was introduced by Amsterdam in 1954.
It is a troughing technique to remove limited amount of
epithelial tissue in the sulcus, while chamfer finish line is
prepared.
This technique is mainly preferred on healthy, non-
inflamed gingiva to avoid tissue shrinkage after healing of
the diseased tissue.

SHORT ESSAYS
1. Various gingival retraction methods in FPO. Technique

Or • Firstly, a copper wire is welded to form a tube according

to the size of the tooth.
Gingival retraction. Explain briefly. • One end of the tube is trimmed according to the gingival
Or finish line.
• Then the tube is positioned on the tooth and it is filled
Gingival retraction techniques. with modelling compound.
Or • The tube along with the filled modelling compound is
carefully seated along the path of insertion of tooth
Write about the different methods of gingival retrac- preparation and impression is made.
tion.
Retraction cord
Or
It is packed in the gingival sulcus to provide sufficient
What are the different methods to obtain gingival gingival retraction.
dilatation?
b. Chemical methods
Or
• Antisialogogues.
Gingival management. • Local anaesthetics.
Ans. • Anticholinergics: Methantheline bromide (50 mg), pro-
pantheline bromide (15 mg), atropine, etc.
• Antihypertensives, such as clonidine hydrochloride
Gingival Retraction (0.2 mg).
Gingival retraction refers to the displacing of the gingival c. Chemicomechanical methods
tissue by its lateral movement, to expose the cervical finish
Chemicals used are as follows:
line of the preparation in order to record it during impres-
sion procedures. • 8% racemic epinephrine.
• Aluminium chloride.
• Alum.
Methods of Gingival Retraction • Aluminium sulphate.
a. Mechanical. • Ferric sulphate.
b. Chemical. Technique
c. Chemicomechanical.
a. Firstly, the prepared tooth area is dried and it is isolated
d. Surgical.
with cotton rolls.
a. Mechanical methods b. A retraction cord of two-inch length is taken out from
the dispenser bottle held with sterile pliers and cut with
• Copper band.
scissors.
• Retraction cord.
c. The retraction cord is then dipped in 25% aluminium
• Rubber dam.
chloride solution or 8% epinephrine.
Copper band d. The excess amount of aluminium chloride is squeezed
out with a gauze piece.
It is used to carry impression material and also to displace
e. The cord is made into a U-shape and it is looped around
gingival to expose the finish line.
the prepared tooth. The cord is only touched at the end.
Section I I Topic Wise Solved Questions of Previous Years

The cord is first adjusted in the mesial interproximal
area and the distal interproximal area with a cord-
packing instrument. The cord is placed by using:
• Fischer packing instrument.
• De-plastic instrument.
• Gregg 4-5 instrument.
f. After the cord is secured in the distal interproximal area,
the cord is inserted from the mesiolingual to distolin-
gual comer. While placing in the cord, the tip of the
packing instrument should be angled toward the area
where the cord has been placed.
g. The excess amount of cord in the mesial interproximal
area is cut off and placement of cord on the buccal side
from the distal end to the mesial side is completed, until
it overlaps the mesial side.
h. After 5-10 min, the cord is gently removed in order to
avoid bleeding and haemostasis maintained.
i. Then the impression is taken. It should be noted that
impression should be taken only after cessation of
blood.
d. Surgical tissue dilatation
i. Electrosurgery.
ii. Rotary curettage.
i. Electrosurgery
It denotes surgical reduction of sulcular epithelium using
electrode for gingival retraction.
ii. Rotary curettage/Gingettage
It was introduced by Amsterdam in 1954.
It is a troughing technique to remove limited amount of
epithelial tissue in the sulcus, while chamfer finish line is
prepared.
Q. 2. Write in detail about the impression procedures in
crown and bridge prosthesis.
Ans.
A. Stock Tray or Putty Wash Impression
It can be done by two techniques:
a. Double mix putty wash technique
• Firstly, an appropriate stock tray is selected.
• Then tray adhesive is applied into the tray in a uniform
manner.
• Putty impression material is mixed and it is loaded on
the tray.
• A spacer mainly of polythene is placed over the putty
material.
• Then the tray along with the spacer is placed on the
patient's mouth for impression.
• After the impression, the polythene sheet is carefully
removed.
• The light body material is then syringed over the putty
impression and also on the tooth preparation. Then the
final impression is taken.
• It records all the details recorded by light body impres-
sion materials.
b. Single mix putty wash technique
• In this procedure, both the putty and light body material
are used simultaneously.
• The stock tray is first loaded with the putty material.
• Then the light body material is syringed around the
tooth preparation.
• Then with the loaded stock tray, a full mouth impression
is taken.
B. Impression Making Using Custom Tray
• Firstly, an acrylic special tray is constructed over the
cast using two sheets of tinfoil spacer to provide space
for impression material.
• Then tray adhesive is applied on the special tray.
• On the tray medium body, elastomer is loaded.
• Light body elastomer is syringed over the tooth.
• Then the tray along with the material is seated on the
tooth.

Impression Procedures for Crown and Bridge C. Closed Bite Double Arch Method/Dual Quad
Prosthesis Tray/Double Arch/Closed Mouth Impression/
Triple Tray/Accubite Method
A. Stock tray/Putty wash impression
• Double mix. • A high viscosity material is mixed and placed in both
• Single mix. the arches.
B. Custom tray impression • The syringe material is then injected over the area to be
• Single mix technique. recorded.
C. Closed bite double arch method or triple tray tech- • The tray is placed in both the arches.
nique. • Then the patient is asked to bite slowly.
D. Copper tube impression. • Then the patient is instructed to open the mouth slowly
E. Post space impressions. after the impression.
 Quick Review Series for BOS 4th Year: Prosthodontics

• In order to prevent distortion, bilateral pressure should
be applied to remove the tray from the patient's mouth.
• In the impression of the tooth preparation, die stone is
poured.
• Then the cast is poured after the boxing of the impres-
sions.
D. Copper Band Impression Technique
• Firstly, a copper band or tube is selected.
• The band should be such that it should well adapt to the
tooth.
• Petroleum jelly is applied onto the fingers to avoid
sticking of the materials.
• Then green stick is heated over the flame and then
placed into the copper band and it is filled till one third
of the tube.
• It is then placed onto the tooth preparation.
• Light body material is then syringed over the prepared
tooth.
• The surface of the compound is coated with adhesives
and seated over the syringed material.
Q. 3. Impression materials in FPD.
Q. 4. Double impression technique in FPD.
Ans.
Closed Bite Double Arch Method/Dual Quad
Tray/Double Arch/Closed Mouth Impression/
Triple Tray/ Accubite Method
a. A high viscosity material is mixed and placed in both
the arches.
b. The syringe material is then injected over the area to be
recorded.
c. The tray is placed in both the arches.
d. Then the patient is asked to bite slowly.
e. Then the patient is instructed to open the mouth slowly
after the impression.
f. In order to prevent distortion, bilateral pressure should
be applied to remove the tray from the patient's mouth.
g. In the impression of the tooth preparation, die stone is
poured.
h. Then the cast is poured after the boxing of the impres-
sions.
Q. 5. Elastomeric impression materials.

Or Ans.

Rubber base impression materials.

Elastomeric Impression Materials
Ans.
Elastomeric impression materials is a group of elastic
impression materials, which is soft and rubbery in consis-
Various Impression Materials Used for Fixed tency.
Partial Denture Elastomeric materials contain large molecules with
weak interaction between them.
a. Alginate.
b. Agar-Agar.
c. Rubber base materials. Types
Chemically there are four kinds of elastomers:
Rubber Base Impression Materials • Polysulfide.
• Condensation polymerizing silicones.
Rubber base materials are generally used for FPD impres- • Addition polymerizing silicones.
sions. • Polyether.
They are available as:
• Light body.
• Medium body. Uses
• Heavy body. • It is used for impression of prepared teeth in fixed
• Extra heavy or putty. partial denture.
• It is used to make impressions of dentulous mouth for
Disadvantages of Rubber Base Impression removable partial denture.
Materials • It is used for bite registration.
• Polyether is used for border moulding of special trays.
a. It needs tray adhesive.
b. It has a setting time of about 5-8 min.
Properties
c. It is hydrophilic in nature.
d. It possesses poor tear strength. • Elastomeric materials are supplied as two-paste systems
e. It gets tear in thinner sections, especially gingival sulcus. (base and catalyst) in collapsible tubes.
Section I I Topic Wise Solved Questions of Previous Years

• It has an excellent reproduction of surface details.
• The elastic properties of elastomers are good.
• Coefficient of thermal expansion is high.
• The tear strength of these materials is good.
• The shelf life of the elastomers is about two years.
• Elastomers can be either copper- or silver-plated.
• Dimensional changes can be seen due to:
i. Shrinkage on curing.
ii. Because of loss of by-products of reaction.
iii. Due to thermal contraction.
iv. Removal of impression, before it completely sets.

SHORT NOTES
Q. 1. Gingival retraction techniques. Rubber base materials are generally used for FPD impres-
sions. They are available as:
Ans.
• Light body.
• Medium body.
Methods of Gingival Retraction • Heavy body.
a. Mechanical.
• Extraheavy or putty.
b. Chemical.
Q. 3. Uses of reversible colloid.
c. Chemicomechanical.
d. Surgical. Ans.

a. Mechanical Methods
Reversible Colloid
• Copper band.
Agar is one of the examples for reversible colloid. It is an
• Retraction cord.
organic hydrophilic colloid.
• Rubber dam.

b. Chemical Methods Uses

• Antisialogogues.
• Local anaesthetics.
• Anticholinergics: Methantheline bromide (50 mg), pro-
pantheline bromide (15 mg), atropine, etc.
c. Chemicomechanical Methods
Chemicals used are 8% racemic epinephrine, aluminium
chloride, alum, aluminium sulphate, ferric sulphate, etc.
d. Surgical Tissue Dilation
• It is used for cast duplication.
• It is used for full mouth impressions.
• It is also used as a tissue conditioner.
Q. 4. Tissue management in FPO.
Ans.
Tissue Management in FPD
Tissue management in FPD can be done as follows:

• Electrosurgery.
• Rotary curettage. A. Mechanically
Q. 2. Enumerate the various impression materials used
The methods include
for crown and bridge work.
• Rubber dam.
Or • Suction device.
• High volume vacuum.
Name the impression materials used in fixed partial
• Saliva ejector.
dentures.
• Svedopter.
Ans.
The various impression materials used in fixed partial
B. Chemically
dentures include the following:
i. Alginate. Commonly used chemical methods are
ii. Agar -agar. • Antisialogogues.
iii. Rubber base materials. • Local anaesthetics.
 Quick Review Series for BOS 4th Year: Prosthodontics

Q. 5. Write about gingival retraction cords. • The cords are packed into gingival sulcus using instru-
ments such as Fischer packing instrument or a DE plas-
Or
tic instrument.
Retraction cord.
Q. 6. Purpose of gingival retraction.
Ans.
Ans.
• The gingival retraction cord helps in providing suffi-
cient retraction. • It helps in providing maximum exposure of operating site.
• It is usually packed into the gingival sulcus. • It helps in retraction of gingival tissue, tongue, lips, and
• It is made of absorbent materials like cotton. cheek.

------------------ -<( Topic 8)

Temporization or Provisional Restorations
and Lab Procedures Involved in Fabrication of FPO

LONG ESSAYS
1. Discuss in detail the fixed partial denture failures. Various types of failures, their causes, prevention, and
management are discussed in table given below:
Ans.

SI.No. Types Causes Prevention and Mana~ement

1. Cementation failure Inadequate retainers
• Partial • Short crowns • Crown lengthening remake bridge
• Overtapered preparation
• Insufficient
• Insufficient rigidity in casting •(ThisRemake bridge
• Poor cementation technique can be prevented by ideal taper
of about 6°, use of hard gold, correct
heat treatment, and by sufficient
• Complete • Wrong choice of materials thickness of restoration)
• Improper mixing • Recementation with correct choice
• Contaminated materials and mixing of material
• Delay in cementation • Remake bridge

2. Mechanical breakdown
• Flexion, fracture of metal • Inadequate thickness
• Improper casting technique
• Improper occlusion

• Solder joint failure • Insufficient width and depth of

the joint
• Insufficient bulk of joint metal
• Improper soldering technique • Remake bridge

• Pon tic failure • Inadequate strength

• Faulty occlusion in lateral
excursion
• Remake bridge

Continued
Section I I Topic Wise Solved Questions of Previous Years

SI.No. Tl'.ees Causes Prevention and Manasement

• Failure of bonded porcelain
• Faulty design • Correct tooth preparation and re-
• Incorrect occlusal preparation make
on the teeth
• Inadequate strength at
interproximal metal

3. Gingival irritation • Plaque retention

Gingival recession
• Improper design • Give correct instructions on home
• Faulty retainer margin care
• Incorrect occlusal anatomy
• Overcontoured retainer • Remake bridge
• Inadequate embrasure

4. Periodontal • Poor bridge design

breakdown • Incorrect assessment of • Remake bridge
• General abutment strength
• Local • Insufficient abutment selected
5. Caries • Traumatic occlusion • Remake bridge
• Directly on the margins • Improper tooth preparation • Conventional filling
• Indirectly starting elsewhere
in mouth following cementa-
technique materials

tion failure
6. Pulpal necrosis • Increased occlusal load due to
improper occlusion
• Remove and recement/
remake

Q. 2. What is provisional restoration? What are the re-
quirements of a provisional restoration? Write an ac-
count on the various types of provisional restorations.
Or
What are provisional restorations? Justify their need
and discuss their limitations.
Or
Discuss the role of provisional restorations in FPD and
describe the different types used.
Ans.
Provisional Restoration
The word provision means established for the time being,
until a permanent arrangement is made.
After tooth preparation, a temporary protective/func-
tional restoration is fabricated over the prepared tooth to be
used, until the fabrication of the final prosthesis. Temporary
restorations are usually fabricated and provided on the
same day of tooth preparation.
i. Ideal Requirements of Provisional Restorations
The basic requirements of provisional restorations can be
broadly classified into biological, mechanical, and aesthetic
requirements.
ii. Biological requirements
A temporary restoration should:
• Protect the pulp, because a freshly prepared tooth will
have increased sensitivity.
• Maintain periodontal health (good marginal fit).
• Good occlusal compatibility/harmony.
• Tooth position should establish contact with adjacent
and opposing teeth. Inadequate contacts will lead to
supraeruption and horizontal movement of the opposing
and the adjacent teeth respectively.
Mechanical requirements
These include function, displacement, and removal for reuse.
Function
The restoration should function like a beam in which sub-
stantial occlusal forces can be transmitted/distributed.
Greater strength is achieved by reducing the depth and
sharpness of embrasures and by increasing the cross-sec-
tional area of the connector.
Displacement
This can be prevented by proper tooth preparation and
provisional restoration with a closely adapted internal
surface.
Removal for reuse
The provisional restoration should not be damaged during
removal. The luting agent should be sufficiently weak to
allow removal.

Material requirement
Usually provisional restorative materials are of fluid con-
sistency during fabrication, which become rigid once the
material is set. Hence, the setting/set material should have
the following requirements:
• Convenient handling: Adequate working time, easy
mouldability, rapid setting time, etc.
• Biocompatibility: Non-toxic, non-allergic, and non-
exothermic.
• Dimensionally stable during setting.
• Easy to contour and polish.
• Adequate strength and abrasion resistance.
• Good aesthetics: Translucency, colour, contourable, and
stable colour.
• Good patient acceptance: The material should be non-
irritant to the oral tissues.
• It should be easy to repair or to add more materials.
• Chemical compatibility with the provisional luting
agent. It should not react adversely with the luting agent
used to fix the restoration.
iii. Types of Provisional Restorations
Provisional restoration can be classified based on the
following methods:
A. Method of fabrication.
B. Type of material used.
C. Duration of use.
D. Technique for fabrication.
A. Depending on the method of fabrication
Based on the method of fabrication, provisional restora-
tions can be classified into:
a. Custom-made and
b. Preformed restorations.
a. Custom-made provisional restorations
• Here, the restoration is fabricated to reproduce the
original contours of the tooth. An impression of the
prepared teeth is made and a cast is poured.
• The prepared tooth on the cast is waxed up and carved
to reproduce the original contours.
Advantages
• Minimum interference.
• A wide variety of materials can be used.
• Helpful in evaluating the adequacy of tooth reduction.
By measuring the thinness of the restoration, the tooth
preparation can be altered.
Disadvantages
• Additional lab procedure involved.
• Time-consuming.
Quick Review Series for BOS 4 th Year: Prosthodontics
b. Preformed provisional restorations
• Preformed crowns are commercially available prefabri-
cated crowns.
• These crowns are available in various sizes. The
operator can choose the size and material that would
best suit the patient and can be placed as a provisional
restoration.
• Before cementation, these crowns are slightly altered
and modified to fit the tooth.
Advantages
• Less time-consuming.
Disadvantages
• Rarely satisfies the requirements of contour.
• It has to be customized with self-cure resin.
• Generally limited to single tooth restorations.
Materials available in preformed crowns
Commonly available preformed crowns include polycar-
bonate, cellulose acetate, aluminium and tin-silver, and
nickel-chromium.
Polycarbonate crowns
• It has the most natural appearance.
• It is usually available in a single shade.
• It can be altered by the shade of the luting agent.
• It is available for incisor, canine, and premolar teeth.
Cellulose acetate crowns
• It is available as shells into which auto-polymerizing
resin can be filled and inserted over the prepared
tooth.
• As the resin does not bond to the shell, it can be easily
removed.
• It is a thin (0.2-0.3 mm) transparent material.
• It is available in all tooth types.
• The shade of this temporary crown depends entirely on
the auto-polymerizing resin.
• Shade matching can be done by adding colours to the
resin.
Aluminium and tin-silver
• These materials are suitable for posterior teeth.
• They have anatomically shaped occlusal and axial
surfaces.
• Care must be taken during try-in verification, to avoid
fracture of their delicate margins.
• As it is highly ductile, it allows easy contouring.
• The crown may require cervical enlargement during
insertion.
• This can be done using special instruments like swap-
ping or stretching blocks.
Section I I Topic Wise Solved Questions of Previous Years
Nickel-chromium
• These are used for children with extensively damaged
primary teeth.
• They cannot be altered with resin.
• These crowns can be easily recontoured using pliers.
• They should be cemented using high strength luting agent.
• They are very strong.
• They are indicated for long-term temporaries.
B. Depending on the type of material used
They are classified into resin restorations and metal restorations.
Resin-based metal restorations
In this category, the materials used to make provisional
restorations are
• Cellulose acetate.
• Polycarbonate.
• Poly-methyl methacrylate: Chemically activated resin.
• Poly-R methacrylate: R group could be ethyl or isobutyl
forms of resin.
• These resins have greater strength than conventional resins.
• Microfilled composite: Bis GMA (Bis-phenol A glycidyl
dimethacry late).
• Urethane di-methacrylate: Light-cured resins. The
amount of filler in these systems should have sufficient
filler for optimal handling or manipulation.
Choice of resin material should be based on:
• Polymerization shrinkage.
• Strength.
• Colour stability.
• Toxicity.
Direct composite provisional restoration
• This is a new type of resin-based provisional restoration.
The composite used here is bis-acryl composite. This
material exhibits less heat and curing shrinkage. Hence,
it can be fabricated using direct technique intraorally.
Metal provisional restorations
It is usually fabricated using:
• Aluminium.
• Nickel-Chromium.
• Tin-Silver
C. Based on duration of use
It can be classified into:
a. Short-term temporary: for use up to two weeks.
b. Long-term temporary: for use from two weeks to few
months.
a. Short-term temporary restorations
• These are used when the prosthesis is to be used for a
maximum of two weeks.
• They are indicated after tooth preparation in FPD.
• They are either custom-made resins or available as pre-
formed crowns.
• Polycarbonates or aluminium crowns are the most com-
monly used short-term temporary restorations.
b. Long-term temporary restorations
• They are usually made of cast metal. Though their
strength is more than average, they have a history of
frequent breakage.
Indications
• Long-span posterior FPD.
• Prolonged treatment time.
• If the patient is unable to avoid excessive forces on the
prosthesis.
D. Depending on technique of fabrication
It can be classified as:
a. Provisional restorations fabricated using direct
technique.
b. Provisional restorations fabricated using indirect technique.
c. Provisional restorations fabricated using direct-indirect
technique.
a. Provisional restorations fabricated using direct
technique
• Here, a preformed crown is altered, adapted, and ce-
mented over the prepared tooth surface.
Fabricating a direct, composite provisional restoration
Bis-acryl composites exhibit less heat and shrinkage
during polymerization and hence can be used to fabricate
provisional restorations via direct technique.
First, an overimpression is made using addition silicone.
After making the over impression, tooth preparation is
carried out.
The prepared tooth is coated with petrolatum.
The base and the catalyst of the composite are mixed
and loaded into the overimpression.
Before the composite polymerizes, the overimpression
is reseated in the patient's mouth.
The composite is allowed to polymerize intraorally for
IO min.
The overimpression is removed and the polymerized
composite restoration should be carefully teased out.
Voids in restoration can be repaired by adding additional
material.
Finally, the restoration is finished, polished, and
cemented.
b. Provisional restorations fabricated using indirect
technique
In this technique, the temporary crown is entirely fabricated
in the lab. An impression of the prepared tooth surface is re-
corded and a cast is poured. A wax pattern is fabricated on
the cast, which is polymerized, finished, and inserted.
 Quick Review Series for BOS 4th Year: Prosthodontics

This can be done using an alginate overimpression or a
vacuum from template.
c. Provisional restorations fabricated using direct-
indirect technique
In this technique, a preformed crown is checked for ex-
ternal fit in the patient's mouth. Later, the tissue surface
of the preformed crown is customized for the patient in
the lab.
An impression of prepared tooth surface is made and a
cast is poured.
The altered, preformed crown is then placed on the cast
and the tissue surface is contoured using resins. Hence, the
final restoration is a customized one.

SHORT ESSAYS
Q. 1. Temporization in fixed partial prosthesis. b. Temporary crowns

Ans. Preformed
• Polycarbonate (direct A).
• Stainless steel.
Temporization
• Celluloid crowns (peel-off).
Temporization is defined as a transitional restoration, which • Aluminium shells.
provides protection, stability, and function, before fabrica-
tion of a definitive prosthesis. It may also be used to deter- Lab made
mine the aesthetic, functional, and therapeutic effectiveness Advised for multiple crowns and when the period of
of the treatment plan. temporization needed is more.

i. Requirements of Temporary Restorations Chair-side

• Biological. • Pro-temp (bis-acrylic resin).
• Mechanical. • Trim (pol y-n-butylmetha-crylate).
• Aesthetic. • Fermit (light-cured).
• Psychological.
• Ability to evaluate the treatment plan.
c. Temporary resin materials
• Polymethyl methacrylate.
ii. Methods/Techniques of Temporization • Auto-polymerising resins (alginate technique).
• Epmine resins.
lntracoronal preparation • Microfilled composite resins.
For intracoronal, the cavity can be directly filled with rein- • V LC resins (Visible Light Cured Resins), e.g. Triad.
forced ZnOE, gutta-percha, or the restoration can be pre-
pared as an inlay with temporary resin and cemented with a. Vacuum formed plastic template technique
ZnOE cement. • Biostar thermoplastic sheets are heated and pressed on
to the cast to adapt.
Extracoronal preparation
• Once they are adapted, they can be used either with
Direct technique acrylic resin or in template form.
Restoration is prepared directly on the prepared tooth using
preformed crowns. b. Post and core technique
• Temporary post and core system, e.g., parapost (Ortho
Indirect technique wires can also be used).
Temporary crown is done on a model of the prepared tooth
and then cemented in the mouth. c. Temporary cement dressings
E.g. ZOE, GIC, etc.
iii. Various Temporary Restoration Modalities
a. Cast metal Q. 2. Give your method of cementing 3 units fixed
partial prosthesis and instructions and aftercare to
It is used when the temporary restoration has to stay in
patients.
place for a longer time or when the patient is having some
TMJ problems, e.g., Japanese gold alloy can be used. Ans.
Section I I Topic Wise Solved Questions of Previous Years
Cementation
Cementation is defined as, 'The process of attaching parts
by means of a cement' (GPT).
Or
It is the process by which the restoration is cemented to the
tooth using a suitable luting agent.
i. Step-wise Procedures to be Followed During
Cementation
i. Preparation of tooth surface
The tooth surface should be free of contamination, as
it greatly affects the performance of the luting agent.
ii. The surface should be dried without desiccating the
odontoblasts.
iii. After cleaning the preparation, cavity varnish should
be applied if a non-adhesive cement like zinc phos-
phate is to be used.
iv. Oxalate treatment of the tooth surface can be done to
reduce dentine sensitivity.
v. Preparing the casting
The casting should be cleaned by sand blasting with
50 µm alumina or by steam, followed by ultrasonic or
organic cleaning.
vi. Next, the operatory site is isolated with cotton rolls.
The cement should be mixed to a luting consistency.
vii. A thin coat of cement should be applied on the internal
surface of the casting.
viii. The tooth surface is dried and the prosthesis is in-
serted with a firm, rocking dynamic seating force. A
static load will lead to incomplete seating. Excessive
force may lead to fracture.
ix. Next, the margins of the retainers are examined to
verify the fit of the prosthesis.
Excess cement should be removed with an explorer.
Floss can be used to check with mylar shim stock or
articulating paper.
x. The patient should be advised to avoid loading for the
first 24 h.
ii. Post-cementation Instructions
i. The patient is asked to exercise all oral functions
and awareness should be created regarding the initial
discomfort.
ii. Hidden impact forces should be avoided in the restored
area, e.g., biting on a nut or metallic object.
iii. Maintenance
• Oral hygiene procedures with special attention to use
of floss and interdental brushes in the concerned area.
• Desensitizing tooth paste or mouth wash can be
used, if there is sensitivity.
iv. Regular recall visits for review.
v. The patient is advised to report immediately, if there
is pain.
Q. 3. Give the biological requirements of provisional
restorations.
Ans.
Biological Requirements of Provisional
Restorations
i. Pulp Protection
When the dentine is exposed to the oral cavity, any trivial
stimuli can lead to a painful perception. Therefore, in order
to prevent irreversible pulpal damage, the temporary resto-
ration should render adequate pulp protection.
ii. Maintenance of Periodontal Health
After tooth preparation, the gingival sulcus is open for
cervical damage, as the contour is lost. Therefore, the
cervical contour has to be restored with a proper temporary
restoration, so that periodontal health is maintained.
iii. Positional Stability of Tooth
The abutment should not extrude or drift.
iv. Protection of Tooth from Fracture
Especially the sharp enamel margins should be protected
from fracture.
v. Occlusal Compatibility
Proper occlusion should be maintained, to prevent any un-
due forces/trauma to underlying tissues.
vi. Hygiene
The contours of the temporary restoration should be such
that they are self-cleansable and hygienic. At the same time,
they should not impinge/hurt surrounding soft tissues.
 Quick Review Series for BOS 4 th Year: Prosthodontics

SHORT NOTES
Q. 1. Temporisation.
Ans.
Temporisation
• Temporisation is defined as a transitional restoration,
which provides protection, stability, and function,
before fabrication of a definitive prosthesis. It
may also be used to determine the aesthetic,
functional, and therapeutic effectiveness of the treat-
ment plan.
Provisional Restorations
The word provision means established for the time being,
until a permanent arrangement is made.
After tooth preparation, a temporary protective/
functional restoration is fabricated over the prepared
tooth to be used, until the fabrication of the final prosthe-
sis. Temporary restorations are usually fabricated and
provided on the same day of tooth preparation.
Q. 3. Indirect procedure of fabricating provisional res-
toration.
Ans.

i. Requirements of Temporary Restorations Provisional restorations fabricated using indirect technique

is as described below:
• Biological. • In this technique, the temporary crown is entirely fab-
• Mechanical. ricated in the lab.
• Aesthetic. • An impression of the prepared tooth surface is recorded
• Psychological. and a cast is poured.
• Ability to evaluate the treatment plan. • A wax pattern is fabricated on the cast, which is polym-
erized, finished, and inserted.
Q. 2. Provisional restorations.
This can be done using an alginate overimpression or a
Ans. vacuum from template.

------------------1( Topic 9)
Cementation of Fixed Partial Dentures
and Miscellaneous

LONG ESSAYS
Q. 1. Discuss soldering. • It should be free-flowing
• It should match the colour of parent metal.
Ans. • The joint should be strong.

Soldering Composition of Solders

Soldering is defined as joining two components of metal
with an intermediate metal whose melting temperature is
lower than the parent metal.
Requirements of a Solder
• The solders most commonly used in fixed partial den-
tures include gold and silver.
• Dental gold solders are designated by fineness to indi-
cate the proportion of pure gold contained in 1000 parts
of the alloy.

• It should fuse safely below the sag or creep temperature

of the parent alloy. Soldering Flux
• It should resist tarnish and corrosion. • Soldering flux is a chemical, which is used to improve
• It should be non-pitting. the flow of a soldering metal.
Section I I Topic Wise Solved Questions of Previous Years
• Chemicals that limit the flow of metals are called anti-
fluxes.
Functions of a Flux
It acts as:
• Protector: It covers the metal surface and prevents oxide
formation.
• Reducer: It helps reduce the oxides present on the metal
surface.
• Solvent: It dissolves any oxide present and removes it.
Composition of a Flux
• Borax glass (55 parts).
• Boric acid (35 parts).
• Silica (10 parts).
Anti-flux
• Soldering anti-fluxes are used to control the flow of the
solder metal. These materials are very essential to pro-
duce a parallel/even continuous connector.
• One of the most common anti-fluxes used is graphite.
But, pencil graphite vaporizes. Hence, better fluxes like
Rouge (Iron oxide) in chloroform can be used.
Soldering Investment
• These are silica-bonded investments that contain fused
quartz.
• Fused quartz is used because it is the lowest thermally
expanding form of silica.
Soldering is of different types. They are as follows:
Types of Soldering for Metal-ceramic
Restoration
• Oven soldering.
• Torch soldering.
• Infrared soldering.
• Laser welding.
Soldering for Metal-ceramic Restoration
• It is usually done prior to ceramic application. Hence, it
is also known as preceramic soldering.
• Postceramic soldering materials are also available.
• Preceramic soldering is done at a temperature of 1075-
11200C, whereas postceramic soldering should be done
at a temperature of 920°C, because ceramic may begin
to sag at higher temperatures.
• Postceramic soldering should be done after ceramic fir-
ing. Hence, the procedure should be more cautiously
done to avoid staining of the ceramic.
• The ceramic portions should be finished only after
soldering.
Advantages of Preceramic Soldering
• The metal framework can be soldered and tried-in prior
to ceramic build up.
• Minor casting errors can also be patched up during
ceramic build-up.
Disadvantages of Preceramic Soldering
• Difficult to build ceramic on already soldered units.
Advantages of Postceramic Soldering
• Porcelain can be properly built up due to better access.
Disadvantages of Postceramic Soldering
• The metal and porcelain may sag at high soldering
temperatures.
• More technique sensitive.
• The solder joint should be reglazed and refired.
Oven soldering
• Furnace or oven soldering is performed under vacuum
or in air.
• A piece of solder is placed in the joint space and it is
heated to a standard temperature in the furnace.
Advantage
• They produce superior joint strength.
Disadvantage
• The parent metal will sag or melt, if heated for a long
time.
Torch soldering
• Soldering is done under direct flame. A gas air torch is
used for this purpose.
• The torch flame has two parts, namely, the reducing part
and the soft brush part. The reducing part is at a higher
temperature compared to the soft brush flame.
• The solder should be melted using the soft brush flame.
• The flame should be constantly swiped over the solder
for a period of 4-5 min. At no point of time, the flame
should be held in a stationary position.
Infrared soldering
• It can be used for low-fusing connectors.
• Good accuracy is possible and the heating is controlled.
• Joints have similar strengths as conventional soldering.
• Protective eyewear is necessary for the operator.
• The smaller units are inserted separately in the mouth.

Laser welding
• It is done to join titanium components of dental crowns,
bridges, and partial denture frameworks.
• Pulsed high power neodymium lasers with very high
density are used.
• Because of its low thermal influence, they are more
preferred in dentistry. Since low heat is generated, the
parts can be hand held.
• The maximum penetration depth of the laser-welding
unit is 2.5 mm.
• Superior joint strength can be obtained.
Soldering Technique
• The design of the connector is determined while fabri-
cating the wax pattern (All solder connectors require
about 0.25 mm parallel space between the parent com-
ponents).
• The smaller units are inserted separately in the mouth.
• A thick mix of quick setting plaster is moulded over the
inserted units.
• Once the plaster sets, it is removed along with the in-
serted units.
• When the plaster index is inverted, the tissue surface of
the components of the prosthesis will be visible.
• A triangular piece of utility wax should be placed to the
indexed restoration in order to shape the soldering as-
sembly. For the metal-ceramic restorations, it is added
over the porcelain regions for protection.
• The units are invested and the investment is allowed to
bench set.
• The invested wax is eliminated using boiling water or
chloroform.
• The area of the restoration surrounding the joint should
be coated with antiflux to limit the flow of the metal.
• After coating the flux and antiflux, the assembly is pre-
heated in a burnout furnace.
• The connectors are soldered using a torch or a furnace.
Disadvantages
• Not economical.
Q. 2. Luting agents used in fixed prosthesis and explain
in detail cementation of FPD.
Ans.
Luting Agents in Fixed Prosthesis
Luting agents commonly used for fixed partial dentures
include the following:
• Zinc phosphate cements.
• Zinc oxide eugenol cements.
• Zinc silicophosphate cements.
• Zinc polycarboxylate cements.
Quick Review Series for BOS 4th Year: Prosthodontics
• Glass ionomer cements.
• Resin cements.
The ideal requirements of luting agents are:
• Have a long working time.
• Adhere well to both tooth structure and cast alloys.
• Provide a good seal.
• Be nontoxic to the pulp.
• Have adequate strength properties.
• Be compressible into thin layers.
• Have low viscosity and low solubility.
• Have good working and setting characteristics.
Zinc Phosphate Cement
• It is advocated in most clinical situations. It is preferred
in cementation of permanent and long-term temporary
restorations.
Advantages
• Adequate compressive strength.
• Good mechanical properties.
• Limited solubility.
Disadvantages
• Produces pulpal irritation due to low initial pH.
• Slow setting time.
Composition
• Available as powder and liquid systems.
• The powder contains heavy metal oxides (zinc oxide
and magnesium oxide) and the liquid contains phos-
phoric acid and water (28-38%). Traces of aluminium
phosphate are also present.
Setting reaction
When powder and liquid (1.4 g: 0.5 mL) are mixed, the
phosphoric acid attaches to the surface of the powder par-
ticles. The zinc oxide dissolves to form zinc aluminophos-
phate gel complex.
Manipulation
• A clean glass slab and stainless steel cement spatula are
needed. The glass slab can be cooled to prolong the set-
ting time (cool slab technique).
• The powder is added into the liquid in small increments.
• Mixing is done on a wide area using a rotary motion to
dissipate the heat released during the setting reaction.
• The setting time is around 5-9 min (ADA specification).
Zinc Oxide Eugenol Cement and Modified ZnOE
Composition
• It is also supplied as a powder liquid system.
• Powder contains zinc oxide with accelerators like
zinc acetate, zinc propionate, and zinc succinate.
Section I I Topic Wise Solved Questions of Previous Years

Other accelerators like alcohol may also be present. Composition

Other ingredients include glacial acetic acid and a It is also available as powder liquid system.
small amount of water.
• The primary ingredient of the liquid is eugenol. Powder
It is basically a type of glass containing the following:
Setting reaction
• Silica.
• Zinc oxide reacts with water to form zinc hydroxide, • Alumina.
which reacts with eugenol to form zinc eugenolate. • Fluoride (e.g. NaF, CaF2, Na3AlF6).
• During degradation the zinc eugenolate, matrix breaks • Calcium salts: Ca (PO4)2.2H2O or CaO.
down to reform eugenolate and zinc hydroxide.
Liquid
• Phosphoric acid.
Zn + H2O ---7ZnO + H2
• Water.
ZnO + H2O --- 7Zn (OH)2 • Buffer salts.
Zn (OH)2 + 2HE 7ZnE2 + 2H2O
(Base) (Acid) (Salt) (Water) Setting reaction
(Zinc Eugenolate)
• When powder and liquid are mixed, the surfaces of the
powder particles are attacked by the acid in the liquid,
Modified ZnOE mixtures releasing calcium, aluminium, and phosphate ions.
There are two types of modified ZnOE cements used for • The metal ions combine with phosphoric acid in the
luting. They are liquid and precipitate as phosphates and form the ce-
a. Type I ZOE + alumina/quartz + EBA (Ethoxybenzoic ment matrix in which fluoride ions are dispersed.
acid)
• Alumina is added to the powder and ethoxybenzoic Manipulation
acid is used to partly replace eugenol. • A paper pad and plastic spatula are used. Stainless steel
b. Type II ZOE + polymer resin. spatula is avoided, because it will get abraded by the
glass particles in the cement.
Manipulation • Bulk mixing can be done.
• Glass slab and stainless steel spatula are used. Advantages
• Liquid is dispensed and powder can be incorporated in
bulk as two increments. • Good compressive strength.
• Anticarcinogenic property due to the release of fluoride
Advantages ions.
• Reinforced ZOE is highly biocompatible. Disadvantages
• Increased compressive strength.
Not used due to the high acidic pH of cement, as this may
• Can be used in a moist environment.
produce pulpal irritation.
• It produces the least pulpal irritation (irritation by euge-
nol is avoided).
Zinc Polycarboxylate Cement
Disadvantages
Composition
• Solubility. It is available as a powder liquid system.
Uses Powder
• Usually used to cement provisional restorations. • Zinc oxide.
• Can also be used for cementing retentive, small single • Magnesium oxide.
tooth castings, and three unit fixed partial dentures, and • Bismuth and aluminium oxide.
oversensitive teeth receiving cast restorations. • Stannic oxide may be substituted for MgO.
• Stannous fluoride (small amounts).
Zinc Silicophosphate Cements Liquid
Type I zinc silicophosphate cement can be used as a luting Polyacrylic acid or copolymer of acrylic acid and other
cement. unsaturated carboxylic acids (e.g., itaconic acid) are present.

Setting reaction
• When powder and liquid are mixed, the surface of the
powder particles are attacked by the acid releasing zinc,
magnesium, and tin ions.
• These ions react with the carboxyl group of adjacent
polyacrylic acid chain, so that a cross-linked salt is
formed and the cement sets.
• The hardened cement consists of an amorphous gel ma-
trix in which residual powder particles are dispersed.
The carboxyl groups also get linked to the calcium in
the hydroxyapatite of the tooth structure.
Manipulation
• A glass slab is preferred to treated paper pads, since the
cement should be mixed on the surface that does not
absorb liquid.
• The liquid should not be dispensed prior to mixing, be-
cause it tends lose water.
• The powder is rapidly incorporated into the liquid in
large quantities within 30 sec.
• Cooling the slab increases the setting time.
Advantages
• It is the most ideal luting agent.
• It provides adhesion to the tooth structure.
• Good compressive strength, but less than zinc phos-
phate.
• Anticarcinogenic in nature, but this property is less than
that of glass ionomer cement (GIC).
• Low pulp reaction.
• Lack of postoperative sensitivity.
Disadvantages
• It is thixotropic in nature, therefore it may be too thick
and will not flow adequately.
• Because of short setting time, it is difficult to lute long-
span bridges.
Uses
• For routine clinical use.
• Sensitive teeth receiving cast restorations.
Glass lonomer Cement (GIC)
Type I GIC is used as a luting agent.
Composition
It is also available as a powder liquid system.
Powder
• Acid-soluble calcium-fluoro-alumino-silicate glass with
a higher silica-alumina ratio.
• Calcium fluoride.
• Sodium fluoride.
Quick Review Series for BOS 4th Year: Prosthodontics
• Aluminium phosphate.
• Lanthanum, strontium, barium, or zinc oxide (for radio-
opacity).
Liquid
• Water is the most important constituent.
• Polyacrylic acid is present in the form of a copolymer
with itaconic, maleic, or tricarboxylic acids.
• Tartaric acid.
Setting reaction
When the powder and liquid are mixed, the surface of
glass particles is attacked by the acid in the liquid. Cal-
cium, aluminium, sodium, and fluoride ions are leached
into the aqueous medium. Calcium polysalts are formed
first followed by aluminium polysalts. These polysalts
cross-link with the polyanion chains. The salts hydrate to
form a gel matrix, where unreacted glass particles are
embedded.
Advantages
• Adhesion to tooth structure.
• Anticarcinogenic property.
• High flow.
• Biocompatible (minimal pulpal irritation is produced
during final set).
• Good compressive strength.
Disadvantages
• Can cause initial sensitivity during cementation.
Uses
• Can be used for routine clinical use.
• Used in patients with extreme caries activity.
• Post and core cementation.
• For luting long-span bridges.
Resin Cements
Composition
• They are basically microfilled bis-GMA resins with low
viscosity.
• They form a thin mix, which is more flowable.
• Adhesion of these cements to tooth structure can be
mechanical or chemical.
• Mechanical adhesion occurs due to the flow of resin
tags in-between the etched enamel crystals.
• Acid etching can be done using 35-37% phosphoric
acid on the enamel surface for 15-30 sec.
• Chemical adhesion can be obtained with the use of
bonding agents like hydroxy ethyl methacrylate
(HEMA) or 4-methacryloxy ethyl trimellitic anhydride
(4- META).
Section I I Topic Wise Solved Questions of Previous Years

Manipulation • After cleaning the preparation, cavity varnish should be

• The tooth should be cleaned and acid etched with 37% applied if a nonadhesive cement, e.g., zinc phosphate is
phosphoric acid for 30 sec. to be used.
• Bonding agent should be applied over the etched • Oxalate treatment of the tooth surface can be done to
surface. reduce dentine sensitivity.
• The resin is placed on the prosthesis and on the tooth
structure and is allowed to set. Preparing the Casting
Uses • The casting should be cleaned by sandblasting with 50
• For cementing laminate veneers, all ceramic restora- ppm alumina or by steam, followed by ultrasonic or
tions, castable ceramics, Maryland bridge, exposed oc- organic cleaning.
clusal dentine, and incisal halo. • Then the operatory site is isolated with cotton rolls.
• The cement should be mixed to a luting consistency.
Advantages • A thin coat of cement should be applied on the internal
• Insoluble in oral fluids. surface of the casting.
• Has mechanical adhesion to tooth structure. • The tooth surface is dried and the prosthesis is inserted
• Good colour matching to tooth structure. with a firm, rocking dynamic seating force.
• Good strength. • The margins of the retainers are examined to verify the
• Easy to use. fit of the prosthesis.
• Excess cement should be removed with an explorer.
Disadvantages Floss can be used to remove the excess cement in the
• Not cariostatic. interproximal surface.
• Greater film thickness than other luting agents. • Occlusion should be checked with Mylar shim stock or
• Resin in sulcus can lead to serious periodontal problems. articulating paper.
• It is susceptible to marginal leakage due to polymerisa- • The patient should be advised to avoid loading for the
tion shrinkage. first 24 h.

Cementation Post-cementation Instructions

• Cementation is defined as, 'The process of attaching
parts by means of a cement' (GPT).
• It is the process by which the restoration is cemented to
the tooth using a suitable luting agent.
In this section, we shall discuss the step-wise procedure to
be followed during cementation.
• The patient should be advised to exercise all oral func-
tions and awareness should be created regarding the
initial discomfort.
• Sudden impact forces should be avoided in the restored
area, e.g., biting on a nut or metallic object.
Maintenance

Preparation of Tooth Surface
• The tooth surface should be free of contamination, as it
greatly affects the performance of the luting agent.
• The surface should be dried without desiccating the
odontoblasts.
• Oral hygiene procedures with special attention to use of
floss and interdental brushes in the concerned area.
• Desensitizing tooth paste or mouth wash can be used, if
there is sensitivity.
• Regular recall visits for review.
• The patient is advised to report immediately, if there is
pain.

SHORT ESSAYS
Q. 1. Castable ceramics. Castable Ceramics
• Dental ceramics are the restorative materials that can
Or accurately duplicate the tooth structure.
• They are far more stronger, wear-resistant, and very
indestructible in the environment
Classification of ceramics.
• They are impervious to oral fluids and absolutely
Ans. biocompatible.

Classification of Dental Porcelains
According to firing temperature
High fusing - 1300°
Medium fusing - 1101-1300°
Low fusing - 850-1100°
Ultra low-fusing - less than 850°
According to type
• Feldspathic or conventional porcelain.
• Aluminous porcelain.
• Leucite-reinforced porcelain.
• Glass-infiltrated alumina.
• Glass-infiltrated spinel.
• Glass-ceramic.
According to use
• Porcelain for artificial denture teeth.
• Jacket crown, veneer, and inlay porcelain,
• Metal ceramics.
• Anterior bridge porcelain.
According to processing method
• Sintered porcelain.
• Cast porcelain.
• Machined porcelain.
Uses
• Inlays, onlays, and aesthetic laminates.
• Single (all ceramic crowns).
• Short-span (all ceramic bridges).
• As veneer for cast metal crowns.
• Artificial denture teeth.
• Ceramic orthodontic brackets.
Composition
The basic constituents are
• Feldspar as basic glass former.
• Kaolin as binder.
• Quartz as filler.
• Alumina as glass former and flux.
• Alkalies as glass modifiers.
• Colour pigments, which modifies colour.
• Opacifiers, which reduces transparency.
Ceramic Restoration
The two parts of ceramic restoration are
• Core.
• Veneer.
Quick Review Series for BOS 4 th Year: Prosthodontics
Based on the substructure or core material used, there are
two basic groups of ceramic restorations. They are
A. Metal-ceramic restoration
i. Cast metal-ceramic restoration.
• Cast noble metal alloys.
• Cast base metal alloys.
• Cast titanium.
ii. Swagged metal-ceramic restoration
• Gold alloy foil coping.
• Bonded platinum foil coping.
B. All ceramic restoration
i. Platinum foil matrix constructed porcelain
• Conventional porcelain jacket crown.
• Porcelain jacket crown with aluminous core.
• Ceramic jacket crown with leucite-reinforced.
ii. Castable glass ceramics.
iii. Injection-moulded.
iv. Glass-infiltrated core porcelains
• Glass-infiltrated aluminous core.
• Glass-infiltrated spine! core.
v. Glass-ceramic blocks
• Feldspathic porcelain block
vi. Ceramic restoration with copy milled ceramic core
• Alumina blocks.
• Ice cream spinel.
Castable glass ceramics (Dicor)
• Dicor is a castable glass-ceramic, which is moulded to
shape by introducing the molten glass into a mould got
by the lost-wax casting procedure (conventional).
• It has tetra silicic fluoro mica and glass.
Technique
• The material is heated to 1750°F and flown into the
mould by centrifugal force. After cooling, the glass
casting is retrieved. The material is transparent at this
stage.
• In the next step, this glass casting is subjected to a
heating treatment for 11 h after reinvestment. The
maximum temperature used during the heating cycle
is 1900°F. During this heating cycle, the mica crys-
tals grow in size and improve the strength of the
material (Transformation toughening). Now, the glass
casting has a milky white appearance. This heating
cycle used to achieve transformation toughening is
called ceramming.
• After this, specially formulated veneering porcelains
are applied to the glass casting in very thin layers to
improve aesthetics. The inner surface is acid-etched
and fixed to the prepared tooth by using a composite
adhesive resin such as ALL BOND II (BISCO).
Section I I Topic Wise Solved Questions of Previous Years

Features Prevention
• The dicor glass-ceramic crown is very aesthetic. • Using correct WIP ratio and select investment of correct
• It is because of the absence of opaque core. particle size.
• It picks up some colour from the adjacent teeth as well iv. Prolonged heating causes disintegration of mould
as from the underlying cement. cavity.
• Uses
• Inlays, onlays, veneers, and low-stress crowns. Prevention
• Complete the casting as soon as the ring is heated and
Q. 2. Casting defects.
ready.
Or i. Overheating of gold alloy has the same effect. It
disintegrates the investment.
Porosities in casting.
ii. Too high or too low casting pressure.
Ans.
Prevention
Casting Defects • Using 15 lbs/sq inch of air pressure or three to four turns
of centrifugal casting machine.
During casting if proper procedure is not followed, then the
v. Composition of the investment-proportion of the
casting may have some defects.
quartz and binder influences the surface texture of cast-
ing. Coarse silica will give coarse casting.
Classification of Casting Defects (Coombe) vi. Foreign body inclusion shows sharp, well defined defi-
ciencies. Inclusion of flux shows bright concavities.
I. Distortion.
II. Surface roughness. Ill. Porosity
III. Porosity.
• Porosity may be internal or external.
IV. Incomplete casting.
• External porosity can cause discoloration of the casting.
I. Distortion • Severe porosity at the tooth restoration junction can
even cause secondary caries.
• Distortion of the casting is usually due to distortion of
• Internal porosity weakens the restoration.
wax pattern.
• Some distortion of wax occurs when the investment Porosities are classified according to Phillips as
hardens or due to hygroscopic and setting expansion. It i. Those caused by solidification shrinkage
does not cause serious problems. • Localized shrinkage porosity.
• Some distortion of wax occurs during manipulation, • Suck back porosity.
because of the release of stresses. • Microporosity.
ii. Those caused by gas
Prevention • Pinhole porosity.
• Manipulation of wax at high temperature. • Gas inclusions.
• Investing pattern within one hour after finishing. • Subsurface porosity.
• If storage is necessary, then it is stored in refrigerator. iii. Those caused by air trapped in the mould (back pres-
sure porosity).
11. Surface roughness
Surface roughness can usually be traced to: Spot or localized shrinkage porosity
i. Air bubbles on wax pattern cause nodules on the casting. • These are large irregular voids usually found near the
sprue-casting junction.
Prevention • It occurs when the cooling sequence is incorrect and the
• Proper mixing of investment. sprue freezes before the rest of the casting.
• Vibration of mix or by vacuum investing. • If the sprue solidifies before the rest of the casting, then
• Application of wetting agent. no more molten metal can be supplied from the sprue.
ii. Too rapid heating cracks the investment resulting in fins The subsequent shrinkage produces voids or pits known
as shrink-spot porosity.
Prevention
• Heat the ring gradually to 700°C (in at least 1 h). Prevention
iii. W/P ratio: Higher W/P ratio gives rougher casting. • Using sprue of correct thickness.
Larger particle size of investment has the same effect. • Sprue should be attached to thickest portion of wax pattern.

• Flaring the sprue at the point of attachment or placing a
reservoir close to the wax pattern.
Suck back porosity
• This is an external void usually seen in the inside of a
crown opposite the sprue. A hot spot is created by the
hot metal impinging on the mould wall near the sprue.
• The hot spot causes this region to freeze last.
• Since the sprue has already solidified, no more molten
material is available and the resulting shrinkage causes
a peculiar type of shrinkage called suck back porosity.
Prevention
• It can be prevented by reducing the temperature differ-
ence between the mould and the molten alloy.
Microporosity
• These are fine irregular voids within the casting.
• It is seen when the casting freezes too rapidly.
• Rapid solidification occurs when the mould or casting
temperature is too low.
Pinhole porosity
• Many metals dissolve gases when molten, and upon
solidification the dissolved gases are expelled caus-
ing tiny voids, e.g., platinum and palladium absorb
hydrogen.
Gas inclusion porosities
• Gas inclusion porosities are also spherical voids, but are
larger than the pinhole type.
• They are also caused due to dissolved gases, but are
more likely due to gases carried in or trapped by the
molten metal.
Back pressure porosity
• This is caused by inadequate venting (air escape) of the
mould.
Prevention
• The sprue pattern length should be adjusted, so that
there is not more than 1/4" thickness of the investment
between the bottom of the casting ring and the wax
pattern.
• Using adequate casting force.
• Using investment of adequate porosity.
• Placing pattern not more than 6-8 mm away from the
end of the ring.
• Providing vents in large castings.
Casting with gas blowholes
• If there is any wax residue remaining in the mould, then
it gives off a large volume of gas, as the molten alloy
enters the mould cavity.
Quick Review Series for BOS 4th Year: Prosthodontics
• This gas can cause deficiencies in the casting and blow
holes in the residue button.
Prevention
For complete elimination of the wax from the mould, the
burnout should be done with the sprue hole facing down-
wards for the wax to run down.
IV. Incomplete casting
An incomplete casting may be due to the following reasons:
• Insufficient alloy used.
• Alloy not able to enter thin parts of mould.
• When mould is not heated to casting temperature.
• Premature solidification of alloy.
• Sprues are blocked with foreign bodies.
• Back pressure due to gases in mould cavity.
• Low casting pressure
• Alloy not sufficiently molten or fluid.
Too bright and shiny casting with short and rounded
margins
• When the wax is not completely eliminated, it combines
with oxygen or air in the mould cavity forming carbon
monoxide, which is a reducing agent.
• The gas prevents the oxidation of the surface of the cast-
ing gold with the result that the casting which comes out
from the investment is bright and shiny.
• The formation of gas in the mould is so rapid that it also
has a back pressure effect.
Small casting
• If compensation for shrinkage of alloy is not done
by adequate expansion of mould cavity, then a small
casting will result.
• It can also be due to shrinkage of the impression
material.
Contamination
• Due to oxidation when molten alloy is over heated
• Use of oxidizing zone of the flame
• Failure to use flux
• Due to formation of sulphur compounds (see black
casting).
Prevention
• Not overheating alloy.
• Use reducing zone of the flame.
• Use flux.
Black casting
It can be due to two reasons:
• Overheating the investment above 700°C causes it to
decompose liberating sulphur or sulphur compounds.
They readily combine with the metals in gold alloy
Section I I Topic Wise Solved Questions of Previous Years
forming a sulphide film. This gives a dark casting,
which cannot be cleaned by pickling.
• A black casting can be also due to incomplete elimina-
tion of the wax pattern, as a result of heating the mould
at too low temperature. A carbonized wax remains,
which sticks to the surface of the casting. It can be re-
moved by heating over a flame.
Q. 3. Die materials.
Ans.
Die Materials
A positive replica of a prepared tooth or teeth in a suitable
hard substance on which inlays, crowns, and other restora-
tions are made.
Types of Die Materials
Gypsum
• Type IV dental stone.
• Type V dental stone, high strength, and high expansion.
• Type V dental stone + lignosulphonates.
Metal and metal-coated dies
• Electroformed.
• Sprayed metals.
• Amalgam.
Polymers
• Metal or inorganic-filled resins.
• Epoxy.
Cements
• Silicophosphate or polyacrylic acid-bonded cement.
Refractory materials
• This includes investments and divestments.
• Investment casts are used to make patterns for RPD
frames. Divestment dies are used in direct baking of
porcelain crowns or preparation of wax patterns.
Ideal Properties of Die Materials
• It should be dimensionally accurate.
• It should have high abrasion resistance, should possess
good strength and have a smooth surface.
• Toughness to allow burnishing of foil and resist
breakage.
• Ability to reproduce all fine details in the impression.
• Compatibility with all impression materials.
• Colour contrast with wax, porcelain, and alloys.
• Easy to manipulate and quick to fabricate.
• Non-injurious to health by touch or inhalation.
• Economical-low cost.
Disadvantages of Some Die Materials
Polymers
• They shrink during polymerization and so tend to pro-
duce an undersized die.
Cements
• All cements shrink slightly and exhibit brittleness and
have a tendency to crack due to dehydration.
Metal-sprayed dies
• The bismuth-tin alloy is rather soft; care is needed to
prevent abrasion of the die.
Q. 4. Factors affecting colour of ceramics.
Ans.
Factors Affecting Colour of Ceramics
The factors affecting colour of ceramics are as follows:
i. Opacifiers
• Opacifiers are added to increase the opacity to simu-
late natural teeth, since feldspathic porcelain is quite
colourless.
• Commonly used opacifiers are oxides of zirconium,
titanium, and tin.
ii. Colour Modifiers
• These are used to adjust the shades of the dental
ceramic.
• Various metallic oxides provide a variety of colour,
e.g., Titanium oxide gives yellowish brown, nickel
oxide gives brown, copper oxide gives green, manga-
nese oxide gives lavender, cobalt oxide gives
blue, etc.
• They are fused together with regular feldspar and
then reground and blended to produce a variety of
colours.
iii. Glazes
• It is a type of colourless porcelain applied to the surface
of the completed ceramic restoration to give it glossy
life-like finish.
• They do not contain opacifiers.
iv. Stains
• They are porcelain powders containing a high concen-
tration of colour modifiers.
• They are used to provide individual colour variation in
the finished restoration.

v. Opaquer
• The opaquer is a dense yellowish white powder supplied
along with a special liquid.
• It is used to cover the metal frame to prevent it from
being visible.
• It is a first layer applied before the addition of a regular
porcelain.
• It contains a high concentration of opacifiers.
• Colour modifiers are also added.
vi. Dentine and Enamel
• The dentine powder which is pink in colour is mixed
with distilled water or the liquid supplied.
• The bulk of the tooth is built up with dentine.
• A portion of the dentine in the incisal area is cut back
and white colour enamel porcelain can be added
After the built up and condensation is over, it is returned to
the furnace for sintering.
Q. 5. Working cast and die preparation.
Ans.
Die
A die is a positive replica of the individual prepared tooth
on which the margins of the wax patterns are finished.
Types of Dies
Based on the designs, die system can be classified into:
• Working cast with separate die system.
• Working cast with removable die system.
Working Cast and Separate Die System
• Two casts are poured from a single impression and one
cast is sectioned and used as a die and the other is not
sectioned and is used as the working cast.
• The wax pattern is prepared on the die and later trans-
ferred to the working cast.
• The die is shaped and finished using an acrylic trimmer
and the portion of the die below the cervical line is fin-
ished using a scalpel. Sharp undercuts in the base
should be avoided.
Advantages
• It is the simplest and easiest method.
Disadvantages
• The wax pattern may get distorted while transferring it
from the die to the cast.
• Proximal margins tend to get overcontoured.
Quick Review Series for BOS 4 th Year: Prosthodontics
Working Cast with a Removable Die System
• In this system, a special type of working cast is prepared
and the dies are carefully sectioned, so that the individ-
ual dies can be removed and replaced in their original
position in the cast.
Types of Removable Die system
• Dowel pin systems,
• Di-lok tray systems, and
• Pindex systems.
Dowel pin systems
• Dowel pins may be straight or curved.
Straight dowel pin systems
They are prepared using two techniques:
• Pre-pour.
• Post pour.
Pre-pour technique
• The die pins are positioned in their appropriate places
within the impression using bobby pins and sticky wax.
• After positioning the pins, the impression is poured up to
the level of the alveolar process of the remaining teeth.
• Separating medium is applied over the first pour and die
pin and the remaining portion of the cast is poured.
• After the cast is set, the dies are sectioned by placing
vertical sections on the interproximal regions on the cast
using a die sectioner or a manual saw. Vertical sections
at the interproximal regions should be made without
damaging the contour of the adjacent teeth.
• Since the separating medium is applied before pouring
the second half of the cast, the dies can be easily sepa-
rated with vertical sections alone.
• The die is carefully separated from the cast without
chipping.
• After removing the die, a small hole will be visible in
the cast.
• This indexing hole will guide the pin into position while
replacing the die.
Post pour technique
• The cast is poured up to the level of the crowns of the
teeth in the impression.
• Small holes are drilled within the first pour in the re-
quired places and the dowel pins are cemented into the
holes.
• The remaining part of the cast is poured and the dies are
sectioned as described in the pre-pour technique.
Advantages
• It is easy to prepare.
• No special equipment is necessary.
Section I I Topic Wise Solved Questions of Previous Years

Disadvantages • The metal structure is placed in a porcelain furnace and

heated according to the manufacturer's instruction for
• The pins may get displaced while pouring the cast.
the specific alloy.
Curved dowel pin system • Porcelain application begins after the coping is removed
from the furnace and cooled.
• It is similar to straight dowel pin technique except that
• Opaque porcelain powder is mixed with the modelling
curved pins are used.
liquid and the paste is applied on the metal substructure
• The curved pins will project from the sides of the base
in a thin layer first.
of the cast.
• After firing in the ceramic furnace, a second thick layer
• When the projecting pins are pressed, the die unit at-
is added with a brush with light vibration which will
tached to the respective pin will pop out from its place.
completely mask the metal.
Accutrac system • This is again fired according to the manufacturer's in-
structions.
• These dies are exclusively used in the fabrication of
• The dentine and enamel are then mixed with modelling
laminate veneers.
liquid and the tooth contour is built up with specific
• It involves the fabrication of two casts similar to the
brushes.
working cast with separate die system.
• A second application and firing of the dentine and
• One cast (master cast) is sectioned into dies and used to
enamel may be necessary to complete the contour of the
prepare the coping.
restoration.
• After preparing the wax pattern, the sectioned dies are
• A porcelain release agent is applied to the die while
reassembled in the master cast.
adding porcelain under panties and cervical areas.
• The master cast is blocked out with wax.
• Finally, the restoration is glazed to produce a glass-like
• The second cast (refractory cast) is duplicated from the
surface and characterizations like stains are added as
blocked out, sectioned die master cast using addition silicone.
required.
• The second cast is poured using specially formulated
stone, whose expansion will compensate for the shrink-
age of porcelain when fired in the furnace. Resin Veneering
Q. 6. Veneering materials. Acrylic and composite resins are used.

Ans. Advantages
• Low cost.
Veneering • Ease of manipulation.
The metal surface can be veneered with ceramic or resin for
Disadvantages
aesthetics.
• Poor wear resistance.
• Colour instability.
Ceramic Veneering
• Mechanical retention to metal.
• It is the most popular and commonly used veneering
material. Procedure
• Only the labial surface should be covered by resin.
Advantages • Proximal contact and occlusal/lingual surfaces are in metal.
• It gives excellent aesthetics. • On the metal surface, mechanical undercuts must be
• It has good wear resistance and colour stability. provided for the retention of resin.
• It provides chemical bonding to metal through oxide • This is achieved by incorporating 27 or 28 gauge wire-
formation. loops or retention beads in the wire pattern.
• Undercuts should also be prepared at the junction or
Disadvantages margin of metal.
• Wear of opposing tooth. • After casting and finishing of metal, the labial surface of
• Difficult to repair. metal that is to be veneered is built up to the appropriate
• High cost. contour of the wax.
• Then it is flasked and dewaxed.
Procedure • After dewaxing, an opaque resin is painted on the labial
• After the metal is finished for the ceramic application, metal surface to mask the metal; and, heat cure tooth
gold alloy is oxidized to produce a controlled oxide colour resin of appropriate shade is mixed and packed
layer for bonding with ceramics. on the surface.

• The flask is then closed and the resin is then cured under
heat and pressure as recommended.
• The resin is finished and polished with acrylic trimmers
and polishing agents.
Q. 7. Porcelain teeth.
Ans.
Porcelain Denture Teeth
• Porcelain denture teeth are more natural looking than
acrylic teeth.
• They have excellent biocompatibility and are more re-
sistant to wear.
• Porcelain denture teeth are the only type of denture
teeth that allow the denture to be rebased.
• Porcelain teeth are made with high fusing porcelains.
SHORT NOTES
Q. 1. Welding and soldering.
Ans.
• Welding is the term used when two pieces of similar
metal are joined together without the addition of an-
other metal.
• Soldering is defined as joining two components of metal
with an intermediate metal whose melting temperature
is lower than the parent metal.
Q. 2. Porcelain fused to metal crown.
Ans.
Porcelain Fused to Metal Crown
It is divided into two groups:
• Chemical bonding across the porcelain-metal inter-
face.
• Mechanical interlocking between porcelain and metal.
Chemical Bonding
• It is currently known as the primary bonding mechanism.
• An adherent oxide layer is essential for good bonding.
• In base metals, chromic oxide is responsible for the bond.
• In noble metal alloys, tin oxide and possibly iridium
oxide does this role.
Mechanical Interlocking
• In some systems, mechanical interlocking provides the
principal bond.
Quick Review Series for BOS 4th Year: Prosthodontics
• Two or more porcelains of different translucencies for
each tooth are packed into metal moulds and fired on
large trays in high temperature ovens.
• The retention of porcelain teeth on the denture base is
by mechanical interlocking.
• Anterior teeth have projecting metal pins that get em-
bedded in the denture base resin during processing.
• Posterior teeth are designed with holes (diatoric spaces)
in the underside into which the denture resin flows.
Disadvantages
• Brittle and make a clicking sound during contact.
• Require a greater inter-ridge distance, as they cannot be
ground as thin as acrylic teeth in the ridge-lap areas
without destroying the diatoric channels that provide
their only means of retention.
• Increased weight due to high density.
• Presence of surface roughness on the metal oxide sur-
face gives retention, especially if undercuts are present,
wettability is important for bonding.
Q. 3. Metal-free ceramics.
Ans.
Metal-free Ceramics
• The metal-free ceramics are the ceramic restorations
without a metallic core or substructure.
• They are aesthetically superior to the metal-ceramic
restorations.
• They have lesser strength.
Different types of all ceramic restorations are as follows:
• Porcelain jacket crown.
• Ceramic jacket crowns.
• Cast glass-ceramic jacket crown.
• Injection moulded.
• Ceramic restoration with glass-infiltrated aluminous
core.
• Ceramic restoration with CAD-CAM core.
Q. 4. Removable dies.
Ans.
Removable Dies
Removable dies are the dies which can be carefully sec-
tioned, so that the individual dies can be removed and re-
placed in their original position in the cast.
Section I I Topic Wise Solved Questions of Previous Years

The commonly used removable die systems are Composition of Solders

• Dowel pin systems
• The solders most commonly used in fixed partial den-
i. Straight.
tures include gold and silver.
ii. Curved
• Dental gold solders are designated by fineness to indi-
• Di-lok tray system.
cate the proportion of pure gold contained in 1000 parts
• Pindex system.
of the alloy.
• Accutrac system.
Q. 5. Titanium alloy. Requirements of a Solder
Ans. • It should fuse safely below the sag or creep temperature
of the parent alloy.
Titanium Alloy • It should resist tarnish and corrosion.
• It should be non-pitting.
Titanium alloys play a great role in dentistry, because of its • It should be free-flowing.
excellent biocompatibility, light weight, good strength, and • It should match the colour of parent metal.
ability to passivate. • The joint should be strong.
Q. 8. Tooth coloured cements for all porcelain crowns.
Uses in Dentistry
Or
• Metal-ceramic restorations.
• Dental implants. Cements used in fixed partial dentures.
• Partial denture frames. Ans.
• Complete denture frames.
Q. 6. Dental ceramics. Cements Used in Fixed Partial Dentures
Ans. The cements used for fixed partial denture are:
• Zinc phosphate cements.
• Zinc oxide eugenol cements.
Dental Ceramics
• Zinc silicophosphate cements.
• Dental ceramics are the restorative materials that can • Zinc polycarboxylate cements.
accurately duplicate the tooth structure. • Glass ionomer cements.
• They are far more stronger, wear-resistant, and very • Resin cements.
indestructible in the environment.
Q. 9. Phosphate-bonded investment.
• They are impervious to oral fluids and absolutely
biocompatible. Ans.

Uses Phosphate-bonded Investment

• Inlays and onlays aesthetic laminates. • Phosphate-bonded investments are used for casting high
• Single (all ceramic crowns). fusing alloys, e.g., high-fusing noble metal alloys,
• Short-span (all ceramic bridges). metal-ceramic alloys, and base metal alloys like nickel
• As veneer for cast metal crowns. chromium and cobalt chromium.
• Artificial denture teeth. • It is supplied as powder in packets with a special liquid.
• Ceramic orthodontic brackets.
Composition
Q. 7. Solders for dental cast units assembly.
Powder contains
Ans. • Ammonium diacid phosphate.
• Silica.
Solders for Dental Cast • Magnesium oxide.

• Soldering is defined as joining two components of metal Liquid

with an intermediate metal whose melting temperature • The liquid is a form of silica sol in water, which gives
is lower than the parent metal. higher thermal expansion.

Q. 10. Enumerate tooth coloured veneering material.
Ans.
Tooth Coloured Veneering Material
The tooth colour veneering materials are
• Ceramics.
• Resins.
Q. 11. Dicor.
Ans.
Dicor
• Dicor is a castable glass-ceramic, which is moulded to
shape by introducing the molten glass into a mould got
by the lost-wax casting procedure (conventional).
• It has tetra silicic fluoro mica and glass.
Technique
• The material is heated to 1750°F and flown into the mould
by centrifugal force. After cooling, the glass casting is
retrieved. The material is transparent at this stage.
• Next, this glass casting is subjected to a heating treat-
ment for 11 h after reinvestment. The maximum tem-
perature used during the heating cycle is 1900°F. Dur-
ing this heating cycle, the mica crystals grow in size and
improve the strength of the material. Now the glass cast-
ing has a milky white appearance. This heating cycle
used to achieve transformation toughening is called
ceramming.
• After this, specially formulated veneering porcelains
are applied to the glass casting in very thin layers to
improve aesthetics. The inner surface is acid-etched
and fixed to the prepared tooth by using a composite
adhesive resin such as ALL BOND II (BISCO).
Q. 12. Cerestore.
Ans.
Ce restore
• Cerestore system was introduced to overcome problems
related to firing shrinkage of all ceramic crowns.
• They have both chemical and crystalline transformation
during firing, and are therefore 'shrink-free'.
Composition
• Alumina, MgO, glass, and silicone resin.
Quick Review Series for BOS 4th Year: Prosthodontics
Technique
• A wax pattern is made on an epoxy resin die and is
invested in stone.
• After wax elimination, cerestore is forced into the
mould by injection moulding technique.
• After setting, it is retrieved from the die and cerestore is
further fired and sintered at 1300°C.
• After this retiring, the material becomes hard and serves
as a ceramic coping. On this ceramic coping of cere-
store, conventional porcelain is applied as a veneer.
• Therefore, the final product has an inner cerestore cop-
ing and a surface of veneer porcelain.
Q. 13. Nickel-chromium alloy.
Ans.
Nickel-Chromium Alloy
Nickel-chromium alloys are used for metal-ceramic
crowns and bridges.
Composition
The basic elements are nickel, chrome, and molybdenum.
The additional minor elements include nickel, beryl-
lium, aluminium, iron, silicon, copper, manganese, cobalt,
and tin.
Q. 14. Sprue former.
Ans.
Sprue Former
• A sprue former is made of wax, plastic, or metal.
• Thickness is in proportion to the wax pattern.
• A reservoir is attached to the sprue.
• The attachment of the sprue to the wax pattern is flared;
length of the sprue is adjusted to 3/8 inch to 1/2 inch, so
that the wax pattern is approximately 1/4 inch from the
other end of the casting ring.
Functions of the Sprue Former
• To form a mount for the wax pattern.
• To create a channel for the elimination of wax during
burnout.
• Forms a channel for entry of molten alloy during
casting.
• Provides a reservoir of molten material which compen-
sates for alloy shrinkage during solidification.
Section I I Topic Wise Solved Questions of Previous Years

--------------------<(Topic 1 o)
Maxillofacial Prosthetics and Implant Dentistry

SHORT ESSAYS
Q. 1. Obturators. • It reduces oral and nasal contamination and permits
deglutition and reduces hospitalization.
Or
Advantages
Permanent obturator.
i. It provides a matrix on which the surgical packing can
Or be placed.
ii. It ensures a close adaptation of the skin graft to the raw
Types of obturator. surface on the cheek flap.
Ans. iii. It reduces oral contamination of the wound and thus
may prevent local infection.
iv. Postoperatively, it enables the patient to speak more
Obturator effectively by reproducing normal palatal contours and
• Obturator is defined as a prosthesis that is used to close by covering the defect.
a congenital or acquired tissue opening primarily of the v. It permits deglutition.
hard palate and/or contiguous alveolar structures. vi. It reduces the psychological impact of surgery.
vii. It reduces the period of hospitalization.

a. Classification of Obturators ii. Interim obturator

Obturators can be classified as follows: • This type of obturator is inserted after 3-4 weeks
postsurgery to ensure minimization of wound con-
Based on the phase of treatment traction.
• Surgical obturators. • Modification from immediate surgical obturator-teeth
• Interim obturators. and a bulb can be added, but this bulb should be relined
• Definitive obturators. with tissue conditioner.
• The lining material should be changed once a week for
Based on the material used 4-5 weeks.
• Metal obturators. • It is also called as interim immediate obturator.
• Resin obturators.
Advantages
• Silicone obturators.
i. It improves speech, deglutition, and function.
Based on the area of restoration ii. If the patient undergoes radiation therapy, then it can
• Palatal obturator. be used to maintain the defect and provide adequate
• Meatal obturator. function.
iii. It may serve for several months or even indefinite periods
The various obturators are discussed in detail below: as well.
iv. The interim obturator is fabricated with pink colour
Based on the phase of treatment
PMMA and light wire clasping may be used to increase
i. Surgical obturator retention.
• It is inserted at the time of surgery (immediate surgical
obturator); or sometimes due to unavailability of ser- iii. Definitive obturator
vices or due to the type of tumour, the surgery would • This type is given when the surgical wound is fully
be carried on and after 1-2 weeks postmaxillectomy. healed.
• It can be used for partially edentulous or completely • Usually, it is fabricated using cast metals; however,
edentulous patients. acrylic definitive obturators can also be used.

• The patients may be partially edentulous or fully eden-
tulous.
Based on the area of restoration
i. Palatal obturator
• Palatal obturator covers the palatal defects and aids in
normal speech production.
• Various problems caused in speech, mastication, deglu-
tition, and aesthetics due to palatal defects are overcome
by the use of palatal obturators.
ii. Meatal obturator
• A special type of obturator that extends up to the nasal
meatus.
• It establishes closure within the nasal structures at
a level posterior to the posterior border of the hard
palate.
• It separates the nasal and oral cavity.
• It is indicated in patients with extensive soft palatal
defects.
Disadvantages
• Nasal air emission cannot be controlled, because it is an
area where there is no muscle function.
• Nasal resonance will be altered.
Q. 2. Osseointegration.
Or
Requirements for successful osseointegration.
Ans.
Osseointegration
a. Requirements for Successful Osseointegration
i. Biocompatibility
• Materials available are commercially pure titanium,
titanium 6-aluminium 4-vanadium, commercially pure
niobium and hydroxyapatite.
• Commercially pure titanium is the most biocompatible.
ii. Implant design
• The most conducive design for osseointegration is
cylindrical.
• It can be either threaded, HA coated, or not.
iii. Implant surface
• Implant surface should be smoothed.
iv. Surgical site
• For good osseointegration, a healthy site is required.
• Previously irradiated area is contraindicated.
Quick Review Series for BOS 4 th Year: Prosthodontics
v. Surgical technique
• There should be minimum trauma to the surgical site.
• Surgical drilling is performed intermittently at a low
rotary rate using sharp instruments.
vi. Infection control
• Infection should be avoided, especially from the peri-
odontium.
• All infection control protocols should be avoided.
Q. 3. Ear prosthesis.
Ans.
Ear Prosthesis
• Ear or auricular prosthesis is made from impressions
made with silicone or irreversible hydrocolloids.
• During impression making, the patient is made to lie in
a supine position.
• The defect area should be confined with wax.
• Additional water of about 50% can be added while
mixing irreversible hydrocolloids in order to increase
the flow.
• For supporting the impression, a plaster with gauze
backing can be used.
• With reference to a presurgical cast or using the healthy
ear, the shape of the ear can be formed.
• This procedure of shaping the ear is known as sculpting.
• Stippling is done to match the texture of the prosthesis
with the adjacent skin.
• It also facilitates extrinsic tinting and it provides me-
chanical retention for extrinsic colorants.
• On the margins of the wax pattern, feathering is done.
• The prosthesis is flasked in a three part mould and the
material either acrylic or silicone is processed as
usual.
• Retention of the prosthesis is acquired through ear-glass
frames, tissue adhesives, extensions, or prosthesis into
the ear canal.
Q. 4. Implant materials.
Or
Biomaterials used in implants.
Ans.
Implant Materials
Various types of materials used in implants are as follows:
a. Commonly Used Metals
• Stainless steel.
• Titanium and its alloys.
Section I I Topic Wise Solved Questions of Previous Years

• Surface-coated titanium. f. Cobalt-chromium-molybdenum Alloys

• Cobalt-chromium-molybdenum alloys.
They are suitable to be cast and annealed for custom-made
• Gold.
implant designs.
• Tantalum.
Composition
b. Ceramics • Cobalt (63%): Provides biphasic properties.
• Chromium (30% ): Provides corrosion resistance due to
• Bioglass. oxide formation.
• Hydroxyapatite.
• Molybdenum (5%): Serves to stabilize the structure.
• Aluminium oxide.
• Carbon: Present in traces and acts as hardener.
• Manganese and nickel: Trace amounts.
c. Polymer, Composites and Others Properties
• Carbons. • Excellent resistance to corrosion.
• Tensile strength is 95 psi
d. Metals • Modulus of elasticity is 34X 106 psi.
• Ductility is very low.
Platinum, silver, cobalt alloys, steel, lead, and titanium are • It has good biocompatibility, if properly fabricated.
the most commonly used.
Advantages
• Economical.
e. Stainless Steel • Clinically exhibits long-term success.
• Stainless steel is a type of steel containing 12-30%
Disadvantages
chromium.
• It can be classified based on its composition into three • Exhibits poor ductility.
types: ferritic, martensitic, and austenitic steel.
• In implantology, the most commonly used variety is g. Titanium and its Alloys
austenitic steel.
• Titanium is one of the highly reactive metals.
• When iron is heated between 912°C and 1394°C tem
• It is the material of choice, because of its predictable
perature, it obtains a face-centred cubic structure called
interaction with the biological environment.
austenite.
• When steel is heated to the fore-mentioned temperature Composition
and quenched, it retains the austenitic structure and is • Commercially pure titanium (99.999% pure).
called austenitic steel. • Traces of nitrogen, carbon, and hydrogen are also pres
ent in the alloy.
Composition
Properties
• Chromium [18%]: Provides corrosion resistance.
• Nickel [8%]: Stabilizes the austenitic structure. • It has a density of 4.5 g/cm2. Hence, it is 40% lighter
• Iron [80%]. than steel.
• Carbon [0.05-0.15%]. • It has high strength:weight ratio.
• Its modulus of elasticity is low: 17 X 106 psi.
Properties • It has own tensile strength of 95 psi.
• It has high strength and ductility. Hence, it is resistant to • Elongation to fracture is more than 8.
fracture. • It has high corrosion resistance.
• Modulus of elasticity is 28X 106 psi. • Titanium is more ductile compared to the titanium alloy.
• Tensile strength is 70-145 psi. Hence, it is preferred for endosteal blade-form implants.
• Elongation to fracture is more than 30%. • It has high dielectric property which helps in its osseo
integration.
Disadvantages Advantages
• It cannot be used in patients sensitive to nickel. • Good osseointegration.
• It has high susceptibility to pit and crevice corrosions. • Biodegradative products from aluminium and vanadium
• Direct contact with a dissimilar metal crown will cause produce favourable tissue response ..
galvanism reaction. • Corrosion resistance is high.
 Quick Review Series for BOS 4 th Year: Prosthodontics

h. Surface-coated Titanium j. Hydroxyapatite

• This is a new implant design, where the titanium implant • It is hydrated form of calcium phosphate similar to bone
is coated with a plasma spray of hydroxyapatite, which and teeth.
will improve the rate and quality of osseointegration. • It is available as blocks and also in granular form.

Procedure Properties
• Molten droplets of titanium in the plasma state are bom- • Has low strength and poor ductility.
barded against the implant surface with high velocity at
high temperatures (15000°C). Uses
• After solidification, the plasma spray will form a layer • Used as a bone implant in ridge augmentation procedures.
of 0.04-0.05 mm. • Used as an outer coating for titanium sub-structures.
• Under microscopic examination, small interconnected
pores are found on the plasma spray. Disadvantage
• It tends to get dispersed within the tissues.
Advantages
• Promotes high rate of bone growth.
k. Aluminium Oxide
• Osseointegration is excellent.
• It is found either in the poly-crystalline form or mono-
Disadvantages crystalline form (sapphire).
• May disrupt interfacial attachment. • It is well tolerated by bone but it does not promote bone
formation. Hence it is bio-inert.
i. Ceramics Properties
• They are inorganic, non-metallic and non-polymeric • High strength, stiffness, and hardness.
materials which are manufactured by compacting and • Available in blade or screw form.
sintering the different components at high tempera- • Bone and soft tissue integration has been demonstrated.
tures.
• Ceramic implants are of two types, namely: Uses
a. Bioactive (hydroxyapatite, bioglass), and • It is used as abutment for partially edentulous arches.
b. Bioinert (aluminium oxide). • It is advantageous for tissue interface-related investiga-
tions.
General properties of ceramics
• High compressive strength of around 500 MPa.
I. Polymers and Composites
• Exhibits less resistance to shear and tensile stress.
• Modulus of elasticity is 40-120 GPa (hydroxyapatite) • They are used primarily as internal force distribution
and 40-140 GPa for Bioglass. connectors for osseointegrated implants.
• Bending stress for hydroxyapatite is 40-300 MPa and • Polymers are fabricated in solid and porous forms and
for bioglass, it is 20-350 MPa. are used for tissue attachments and replacement aug-
• It has excellent biocompatibility. mentations respectively.
• Thermal and electrical conductivity is minimal. • Also used as coatings for force transfer from implants to
• It can be used for load-bearing areas, as its modulus of the tissues.
expansion is similar to bone. • They are sensitive to sterilization and handling
• Its colour is similar to bone, enamel, and dentine. techniques.
• Chemical composition is same as that of constituents of
normal biological tissues. Advantages
• Long-term experience.
Disadvantages • Biocompatible.
• Under fatigue loading, it exhibits low mechanical, • Ability to control properties through composite struc-
tensile, and shear strength. tures.
• Exhibits variations in chemical and structural character-
istics. Disadvantages
• It has low attachment strengths for some coatings with • Elastic deformation.
substrate interfaces. • Difficult to maintain.
Section I I Topic Wise Solved Questions of Previous Years ~

Q. 5. Implant. Disadvantages
Or • It is rigid.
• There is difficulty in duplicating the prosthesis.
Indications for dental implant.

Ans.
b. Acrylic Copolymers
These are plasticized methyl methacrylate polymers. It also
Implant shows elastic properties.

• Implant is defined as a graft or insert that is set firmly or Disadvantages

deeply into or onto the alveolar process that may be • It has poor edge strength.
prepared for the insertion. • It has poor durability.
• It is also defined as a substance that is placed into the • It degrades under sunlight.
jaw to support a crown or a fixed removable denture.

a. Indications of Dental Implants c. Polyvinyl Chloride and Copolymers

i. It is indicated for completely edentulous patient with It is a clear, hard, tasteless, and odourless resin.
advanced residual ridge resorption.
ii. It is indicated for partially edentulous arches where re- Disadvantages
movable partial denture may weaken the abutment teeth. • It causes excessive shrinkage.
iii. In case of single tooth replacement, where fixed partial • It has a long processing time.
denture cannot be placed.
iv. In case of patient's desire.
d. Chlorinated Polyethylene
Q. 6. Materials used for maxillofacial prosthesis.
Louis and Castleberry were the first to test this
Ans. material.

Disadvantage
Materials Used for Maxillofacial Prosthesis
• There is a requirement of metal moulds for
The various materials used for maxillofacial prosthesis are processing.
as follows:
• Acrylic resins.
• Acrylic copolymers. e. Polyurethane Elastomers
• Polyvinyl chloride and copolymers.
They are elastomers with urethane linkages.
• Chlorinated polyethylene.
• Polyurethane elastomers.
Advantage
• Silicones.
• Polyphosphazines. • They provide excellent elasticity.
• Adhesives.
Disadvantages
• Metal.
• They are sensitive to moisture.
• They have poor colour stability.
a. Acrylic Resins
These materials are used for the defects which require less
f. Silicones
or minimum movement.
It can also be used for both intraoral and extraoral pros- It is the most commonly used material.
thesis. Silicone is a combination of organic and inorganic com-
pounds.
Advantages
• It is readily available. Types of silicones
• It is very familiar among the practitioners. Based on their use, it is classified as:
• It has a better colour stability. • Implant grade.
• It is compatible with most adhesive resins. • Medical grade.
 Quick Review Series for BOS 4th Year: Prosthodontics

• Clean grade. h. Adhesives

• Industrial grade.
Based on their mode of application, it is classified as
Disadvantages • Double side tapes.
• It has poor tear strength. • Paste.
• They have a lifeless appearance. • Liquid.
• Emulsion.
• Spray-ans.
g. Polyphosphazines
i. Metals
• They are one of the newer materials which are used for
maxillofacial prosthesis. They are used to obtain bone anchorage for a prosthesis.

SHORT NOTES
Q. 1. Osseointergration. B. Based on shape and configuration

Or For example, prefabricated posts available are:

• Parallel, smooth-sided: Charlton post.
Osseointegration of dental implants. • Parallel threaded: Radix anchor, Kurer.
Ans. • Tapered threaded: Dentatus screw.
• Tapered smooth-sided: Kerr endopost.
Q. 3. Subperiosteal implants.
Osseointegration
Ans.
Osseointeg ration is defined as the apparent direct
attachment or connection of osseous tissues to an inert, • It is an endosteal dental implant that is placed beneath
alloplastic material without intervening connective the periosteum while overlying the bony cortex.
tissue. • The implant body lies over the bony ridge. When a sub-
• The process that results in apparent direct connection periosteal implant supports a partial denture it is termed
of the endogenous material surface and the host bone as unilateral subperiosteal implant. And when a sub-
tissues without intervening connective tissue is known periosteal implant supports a complete denture it is
as osseointegration. termed as a complete subperiosteal implant.
• It is the interface between alloplastic material and Q. 4. Define implant.
bone (GPT).
Ans.
Q. 2. Dowel post.
• Implant is defined as a graft or an insert that is set firmly
OR or deeply into or onto the alveolar process that may be
Post and core crowns. prepared for the insertion.
• It is also defined as a substance that is placed into the
Ans. jaw to support a crown or a fixed removable denture.
Q. 5. Surgical obturator.
Dowel Post Ans.
The post also known as dowel is usually made of metal
which is fitted into a prepared root canal of a natural Surgical Obturator
tooth.
• Surgical obturator is a type of obturator which is in-
serted at the time of surgery (immediate surgical obtura-
Types of Dowels/Posts tor); or, sometimes due to unavailability of services or
due to the type of tumour, the surgery would be carried
A. Based on type of material
on and after 1-2 weeks postmaxillectomy, it is inserted.
• Gold. • It can be used for partially edentulous or completely
• Stainless steel. edentulous patients.
• Titanium. • It reduces oral and nasal contamination and permits
• Carbon-fibre (Latest). deglutition and reduces hospitalization.
Section I I Topic Wise Solved Questions of Previous Years

Advantages • For rehabilitation of the acquired soft palate defects,

proper extension must allow the remaining structures
a. Provides a matrix on which the surgical packing can be
and lateral and posterior pharyngeal muscles to con-
placed.
strict and contact the bulb portion of the speech-aid
b. It ensures a close adaptation of the skin graft to the raw
prosthesis.
surface on the cheek flap.
c. It reduces oral contamination of the wound and thus Q. 9. Classify obturators.
may prevent local infection.
Or
d. Postoperatively, it enables the patient to speak more
effectively by reproducing normal palatal contours and
Types of obturator.
by covering the defect.
e. It permits proper deglutition. Ans.
f. It reduces the psychological impact of surgery.
g. It reduces period of hospitalization.
Obturator
Q. 6. Classification of dental implants.
Obturators can be classified as follows:
Ans. A. Based on the Phase of Treatment
Implants can be classified as follows: • Surgical obturators.
i. Based on the placement within the tissues • Interim obturators.
• Epiosteal. • Definitive obturators.
• Transosteal. B. Based on the Material Used
• Endosteal. • Metal obturators.
• Root-form implants. • Resin obturators.
• Plate-form implants. • Silicone obturators.
ii. Based on the materials used C. Based on the Area of Restoration
• Metallic implants. • Palatal obturator.
• Non-metallic implants. • Meatal obturator.
iii. Based on their reaction with bone
Q. 10. Parts of an implant.
• Bioactive implants.
• Bioinert implants. Ans.
iv. Based on the classification of edentulous spaces.
Q. 7. Obturator. Parts of an Implant
Ans. • Implant body or fixture.
• Healing screw.
Obturator • Healing caps.
• Abutments.
• A prosthesis used to close congenital or acquired tissue • Impression posts.
opening primarily of the hard palate and/or contiguous • Laboratory analogues.
alveolar structures is known as obturator. • Waxing sleeves.
• Prosthesis retaining screws.
Types of Obturators
Q. 11. Hollow bulb obturator.
• Surgical obturator.
Ans.
• Interim obturator.
• Definitive obturator.
Q. 8. Speech-aid prosthesis. Hollow Bulb Obturator
Ans. Hollow bulb obturator is used in case of any palatal
• Speech-aid prosthesis is used for rehabilitation, in case defects. Palatal defects cause various problems in
of total soft palate resection. speech, mastication, deglutition, and aesthetics. In
• Speech-aid prosthesis has extension into the velopha- these cases, palatal obturator is used, and the vertical
ryngeal space, which occupies the nasopharyngeal extent of this defect is best treated with hollow bulb
space at the level of the atlas and the axis. obturator.
 Quick Review Series for BOS 4th Year: Prosthodontics

Advantages Types of Hollow Bulb Obturator

• It is easy to fabricate. a. Type 1
• It has increased speech intelligibility. • Open.
• It is lighter in weight. • Closed.
• It is more hygienic. b. Type 2
• It aids in speech resonance. • Single piece.
• Two-piece.
Section I I Topic Wise Solved Questions of Previous Years
Part Ill
Removable Partial Dentures
------------------ - <( Topic
Introduction, Treatment Planning, and Mouth
Preparation
LONG ESSAYS
Q.1. Classify partially edentulous areas according to
Applegate-Kennedy's classification and mention
Applegate's rules for Kennedy's classification.
Or
Present the entire Applegate Kennedy's classification of
partially edentulous situation with the latest nomencla-
ture and modification.
Or
What are the requirements of classifying partially eden-
tulous arch. Explain Kennedy's classification of partially
edentulous arch with diagram. List Applegate's rules
applied for classification of partially edentulous arch.
Or
Explain the mode of classification of removable partial
denture with a diagram. Give the importance of such a
classification.
Ans.
Importance of an Acceptable Method of
Classification
a. It should permit immediate visualization of the type of
partially edentulous arch being considered.
b. It should allow immediate differentiation between
the tooth-borne and tooth-tissue supported removable
partial denture.
c. It should be universally acceptable.
Need for the Classification
i. To formulate a good treatment plan.
ii. To communicate about the case with professional dentist.
iii. To design the denture according the occlusal load.
1 )
Kennedy's Classification
• This is the most accepted classification for partially
edentulous arch. This was given by Edward Kennedy in
1923 of New York.
• When used in conjunction with a support classification,
it helps to give a clear classification understanding
about the type of denture under consideration during a
discussion on partial dentures.
The Kennedy's classification is based on the relation-
ship of the saddles to the natural teeth.
Kennedy's classification has four main groups with
modifications of each of the first three of these:
Class I: Bilateral free-end edentulous spaces posterior to
the natural teeth.
Class II: Unilateral free-end edentulous space posterior to
the natural teeth.
Class III: A bounded unilateral edentulous space having
natural teeth at each end.
Class IV: A bounded edentulous space anterior to the natu-
ral teeth.
Modifications of Kennedy's Classification
All classes, except Class IV, have modifications. Each
modification is an additional edentulous area.
Examples of modifications:
• An additional edentulous area in Class I would be called
as Class I modification 1.
• If two additional edentulous areas are present, then it
could be called as Class I modification 2.
• A unilateral saddle with one additional edentulous area
is Class II modification 1.
• A unilateral bounded edentulous area with three addi-
tional edentulous areas is Class III modification 3.
• Class IV has no modifications.

Criteria for Kennedy's Classification
i. The most posterior edentulous area determines the
class.
ii. The size of the modification is not important.
iii. If a third molar is missing and not to be replaced, then
it is not considered in determining the class.
Merits/Advantages of Kennedy's Classification
• Classification is simple and universally accepted.
• Differentiates between tooth-supported and tooth-tissue
supported.
• Type of design can be decided.
• It is universally accepted.
• It aids in discussing, identifying, and planning the
design.
• It is easy to apply the system to any situation.
• It is the widely used system.
• It forms the basis for two other systems, as Applegate-
Kennedy and Swenson's systems.
• It allows visualization of partially edentulous arch.
Disadvantages of Kennedy's Classification
• Kennedy's classification is a positional or anatomic
classification which conveys a tooth saddle relationship,
but doesn't give proper information of teeth present and
their positions.
• Without Applegate's modifications, Kennedy's classifi-
cation could have been meaningless.
• Critics argue that grouping of Kennedy's classification
should have been reversed. According to them, Class II
situation should have been grouped as Class I.
• It is based on incidence of clinical situation requiring
removable prosthesis (Class I is the most frequent
situation).
• As the number of teeth missing is not specified, support
cannot be analyzed.
• It does not mention about the condition of the abutment
teeth.
• It is not applicable in single standing tooth.
• It tells about spaces, but not about teeth to be replaced.
Applegates Contribution
Applegate in 1960 attemped to expand the Kennedy's clas-
sification based on the condition of abutments.
He added class V and class VI.
Class V: An edentulous area bounded anteriorly and poste-
riorly by natural teeth, but in which the anterior abutment is
not suitable for support.
Class VI: An edentulous condition in which the teeth adja-
cent to the space are capable of giving total support to the
prosthesis.
Quick Review Series for BOS 4th Year: Prosthodontics
Drawbacks of class V and class VI
• It is not accepted universally.
• It is not truly indicative of special design considerations.
The following eight rules are for the easy application of the
Kennedy's method given by Applegate. This is known as
Applegate 's rules for Kennedy's classification.
Rule 1: Classification should follow rather than precede any
extractions of teeth that might alter the original classifica-
tion.
Rule 2: If a third molar is missing and not to be replaced,
then it is not considered in the classification.
Rule 3: If a third molar is present and is to be used as an
abutment, then it is considered in the classification.
Rule 4: If a second molar is missing and is not to be re-
placed, then it is not considered in the classification.
Rule 5: The classification is always determined by the most
posterior edentulous area or areas.
Rule 6: Edentulous areas other than those determining the
classification are referred to as modifications and are desig-
nated by their number.
Rule 7: The extent of the modification is not considered.
Only the number of additional edentulous areas is consid-
ered.
Rule 8: There can be no modification areas in Class IV
arches. (Another edentulous area lying posterior to the
'single bilateral area crossing the midline' would determine
the classification).
Q. 2. Swing lock dentures.
Ans.
Swing lock Dentures
• Swing lock residual partial dentures (RPDs) were first
designed by Dr. Joe J. Simmons in the year 1963.
• Swing lock RPDs are used, when number of remaining
teeth is too few to support a conventional design.
• This denture has a labial bar extending labially all along
the arch like a major connector.
• The labial bar is connected to the remaining parts of the
denture by a hinge in one side and a lock on the other.
The labial bar can be unlocked during insertion and
locked after insertion.
Indications
• Missing key abutments.
• When the number of remaining natural teeth are less.
• When the remaining teeth are too mobile to serve as
abutments.
• When the soft tissue and the tooth are in unfavourable
contours.
• To provide retention and stability for maxillofacial pros-
thesis, such as obturators.
Section I I Topic Wise Solved Questions of Previous Years

• For retention of prosthesis in case of loss of large
segments of teeth and alveolar ridge, due to trauma or
infection.
Contraindications
• When the vestibule is shallow.
• High labial frenal attachment.
• Patient with poor oral hygiene.
Advantages
• The remaining teeth can be used for the retention and
stabilization of the prosthesis.
• The construction is relatively simple and inexpensive.
Disadvantages
• It is unaesthetic in patients with short lips.
• Tipping is seen in the remaining anterior teeth in the
distal extension case.
Fabrication
The following steps are involved:
• Selection of metal for swing-lock framework
• The metal of choice is chrome alloy. Gold alloys
wear off due to constant movement.
• Surveying and designing
• The cast is mounted on the surveyor. The path of
insertion is from a lingual direction with the labial
arm open.
• Lingual plate
• The lingual plate should be designed to end
above the survey line. It prevents the tissueward
displacement.
• Occlusal rest
• This also helps to prevent tissueward displacement of
the denture.
• Major connector
• The mandibular major connector extends above the
survey line with scallops extending up to contact
points.
• The maxillary major connector is the complete
palatal or closed horseshoe with borders extending
up to or above the survey line.
• Labial arm design
• The vertical projection of the labial bar should be
designed to touch the teeth below the height of
contour.
• Conventional design
• This consists of a labial bar with metallic verticall-
bar or T-bars attached to it.
• Using acrylic resin retention loop
• This is indicated for patients with short lips and
where aesthetics is of concern.
• Selection of impression material
• Heavy-bodied alginate is best preferred.
• Tray selection
• A custom tray should be used for recording maxi-
mum labial and buccal vestibular depths.
For the secondary impression, 5--6 mm space should be
given between the teeth and the tray when placed in the mouth.
• Making the impression.
• It is similar to conventional dentures. Dual impressions
may be required for distal extension.
• Framework fabrication.
Master cast is poured and waxed and undercuts are
blocked out before duplication. Then, refractory cast is formed.
After design transfer, the wax pattern is fabricated on
the refractory cast. The cast is invested, wax is burned out,
and casting is done. Finishing and polishing are done.
• Fitting the framework
• The fit of the labial bar and the rest of the framework are
checked separately.
• Arranging artificial teeth to occlusion.
The arrangement of the artificial teeth is done on the mod-
elling wax denture base. Flasking and acrylization are done.
• Insertion
• Lingual path of insertion is done.
• Postinsertional care.
Oral hygiene should be maintained by the patient.
Distal extension RPD has to be frequently relined.

SHORT ESSAYS
Q. 1. Kennedy's classification of partially edentulous Kennedy's Classification
arches.
The Kennedy's classification is based on the relationship of
Or the saddles to the natural teeth.
Kennedy's classification has four main groups with
Kennedy's classification. modifications of each of the first three of these.
Class I: Bilateral free-end edentulous spaces posterior to
Ans. the natural teeth.

Class II: Unilateral free-end edentulous space posterior to
the natural teeth.
Class III: A bounded unilateral edentulous space having
natural teeth at each end.
Class IV: A bounded edentulous space anterior to the natu-
ral teeth.
Modifications of Kennedy's Classification
All classes, except Class IV, have modifications. Each
modification is an additional edentulous area.
Examples of modifications:
• An additional edentulous area in Class I would be called
as Class I modification 1.
• If two additional edentulous areas are present, then it
could be called as Class I modification 2.
• A unilateral saddle with one additional edentulous area
is Class II modification 1.
• A unilateral bounded edentulous area with three addi-
tional edentulous areas is Class III modification 3.
• Class IV has no modifications.
The following are the criteria for the Kennedy's classifi-
cation:
• The most posterior edentulous area determines the
class.
• The size of the modification is not important.
• If a third molar is missing and not to be replaced, then
it is not considered in determining the class.
Q. 2. State Kennedy's classification and Applegate's
rules.
Or
Describe Applegate-Kennedy's classification.
Ans.
Kennedy's Classification
The Kennedy's classification is based on the relationship of
the saddles to the natural teeth.
Kennedy's classification has four main groups with
modifications of each of the first three of these.
Class I: Bilateral free-end edentulous spaces posterior to
the natural teeth.
Class II: Unilateral free-end edentulous space posterior to
the natural teeth.
Class III: A bounded unilateral edentulous space having
natural teeth at each end.
Class IV: A bounded edentulous space anterior to the natu-
ral teeth.
Modifications of Kennedy's Classification
All classes, except Class IV, have modifications. Each
modification is an additional edentulous area.
Quick Review Series for BOS 4th Year: Prosthodontics
Examples of modifications:
• An additional edentulous area in Class I would be called
as Class I modification 1.
• If two additional edentulous areas are present, then it
could be called as Class I modification 2.
• A unilateral saddle with one additional edentulous area
is Class II modification 1.
• A unilateral bounded edentulous area with three addi-
tional edentulous areas is Class III modification 3.
• Class IV has no modifications.
The following are the criteria for the Kennedy's classification:
• The most posterior edentulous area determines the class.
• The size of the modification is not important.
• If a third molar is missing and not to be replaced, then
it is not considered in determining the class.
The following eight rules are for the easy application of
the Kennedy's method given by Applegate. This is known
as Applegate 's rules for Kennedy's classification.
Rule 1: Classification should follow rather than precede
any extractions of teeth that might alter the original clas-
sification.
Rule 2: If a third molar is missing and not to be replaced,
then it is not considered in the classification.
Rule 3: If a third molar is present and is to be used as an
abutment, then it is considered in the classification.
Rule 4: If a second molar is missing and is not to be
replaced, then it is not considered in the classification.
Rule 5: The classification is always determined by the most
posterior edentulous area or areas.
Rule 6: Edentulous areas other than those determining
the classification are referred to as modifications and are
designated by their number.
Rule 7: The extent of the modification is not considered. Only
the number of additional edentulous areas is considered.
Rule 8: There can be no modification areas in Class IV
arches. (Another edentulous area lying posterior to the
"single bilateral area crossing the midline" would deter-
mine the classification).
Q. 3. Ideal classification system in RPD.
Ans.
Ideal Classification System in RPO
I. Depending on the Retention Obtained
lntracoronal
Frictional resistance between key located on the RPD and
key-way located within an artificial crown on a remaining
tooth.
Extracoronal
Retention device lies outside the clinical crown of natural
teeth.
Section I I Topic Wise Solved Questions of Previous Years
II. Depending on the Support
Tooth-supported: (Class I, III/Short-Span)
Tooth and tissue supported: (Class I, II, IV/Long-
Span)
Ill. Depending on the Treatment Modality
Interim denture
It is a temporary partial denture used for a short time for
reasons of aesthetics, masticatory efficiency, and/or conve-
nience, until a more definitive form of treatment can be
rendered.
Transitional denture
It is a partial denture which may be used when loss of ad-
ditional teeth is inevitable, but immediate extractions are
not advised or desirable.
Artificial teeth may be added to the treatment den-
ture when natural teeth are extracted, either singly or
in groups, until all teeth to be removed have been ex-
tracted.
Once all the teeth to be removed are extracted, the treat-
ment denture becomes an interim denture, until a more
complete prosthodontic treatment is provided.
SHORT NOTES
Q. 1. Kennedy's classification.
Or
Classification of partially edentulous arches.
Ans.
Kennedy's Classification
• The Kennedy's classification is based on the relation-
ship of the saddles to the natural teeth.
Kennedy's classification has four main groups with modifi-
cations of each of the first three of these.
Class I: Bilateral free-end edentulous spaces posterior to
the natural teeth.
Class II: Unilateral free-end edentulous space posterior to
the natural teeth.
Class III: A bounded unilateral edentulous space having
natural teeth at each end.
Class IV: A bounded edentulous space anterior to the natu-
ral teeth.
Treatment denture
It is a partial denture which is used as a carrier for treatment
material, when the soft tissues have been abused by ill-fit-
ting prosthetic devices or may be used after surgeries to
protect a surgical site.
Q. 4. Discuss the principles in designing of tooth and
tissue supported and tooth-supported removal partial
denture prosthesis.
Ans.
The following are the principles of design developed by
A. H. Schmit in 1956:
i. The dentist must have a proper knowledge of both
the mechanical and biological factors involved in
removable partial denture design.
ii. The treatment plan must be based on a complete
examination and diagnosis of the individual patient.
iii. Dentist must determine a proper plan of treatment.
iv. The prosthesis should restore form and function with-
out injury to the remaining oral structures.
v. A removable prosthesis is a form of treatment and not
a cure.
vi. It should be easy to insert and easy to remove.
vii. It should resist the dislodging forces during function.
viii. It should be aesthetically improved.
Modifications of Kennedy's Classification
All classes, except Class IV, have modifications. Each
modification is an additional edentulous area.
Examples of modifications:
• An additional edentulous area in Class I would be called
as Class I modification I.
• If two additional edentulous areas are present, then it
could be called as Class I modification 2.
• A unilateral saddle with one additional edentulous area
is Class II modification I.
• A unilateral bounded edentulous area with three addi-
tional edentulous areas is Class III modification 3.
• Class IV has no modifications.
The following are the criteria for the Kennedy's classification:
• The most posterior edentulous area determines the
class.
• The size of the modification is not important.
• If a third molar is missing and not to be replaced, then
it is not considered in determining the class.

Q. 2. Define immediate partial denture.
Or
Immediate partial denture.
Ans.
Immediate Partial Denture
Immediate partial denture is defined as a removable partial
denture constructed for insertion immediately following the
removal of natural teeth (GPT).
Immediate partial denture is fabricated before all the
remaining teeth have been removed and the denture is in-
serted immediately after the extraction of teeth.
Classification
There are two types of immediate dentures:
a. Immediate denture.
b. Interim denture.
Advantages
• It helps in wound healing of the extraction area.
• Patient's appearance is maintained, as the denture is
given immediately after extraction.
• The shape and height of the ridge is preserved.
• It is psychologically beneficial to the patient.
• It is easy to get the idea of the vertical dimension of the
jaw relation of the patient.
• Less resorption and better preservation of the residual ridge,
as the ridge area is better adapted to support a denture.
Disadvantages
• It requires more chair time, and it is more expensive.
• Due to the different positions of the teeth, centric rela-
tion and centric occlusion are difficult to record.
• It cannot restore the stimulation that was supplied to
bone by the natural teeth.
Indication
• A dentulous patient whose teeth are indicated tor
extraction.
Contraindications
• Patient with poor health.
• Uncooperative patients.
Q. 3. Advantages of tooth-supported prosthesis.
Ans.
• It preserves the residual ridge and maintains the integ-
rity of the ridge.
Quick Review Series for BOS 4 th Year: Prosthodontics
• It improves the retention and stability of the denture.
• It gets excellent support by the abutments.
• It improves the proprioception leading to better neuro-
muscular control. This helps in regulating the biting
force over the denture.
Q. 4. Fulcrum line.
Ans.
Fulcrum Line
Fulcrum line is defined as an imaginary line around which
a partial denture tends to rotate.
There are two types offulcrum lines:
a. Retentive fulcrum line
It is defined as the imaginary line connecting the reten-
tive points of the clasp arm, around which the denture
tends to rotate when subjected to forces, such as pull of
sticky foods (GPT).
b. Stabilizing fulcrum line
It is defined as an imaginary line connecting occlusal
rest, around which the denture tends to rotate under masti-
catory forces (GPT).
Q. 5. Give the requirements of acceptable classification
system in partially edentulous arches.
Ans.
Requirements of an Acceptable Method of
Classification
a. It should permit immediate visualization of the type of
partially edentulous arch being considered.
b. It should allow immediate differentiation between the
tooth-borne and tooth-tissue supported removable par-
tial denture.
c. It should be universally acceptable.
Need for the Classification
• To formulate a good treatment plan.
• To communicate about the case with professional
dentist.
• To design the denture according the occlusal load.
Q. 6. Limitations of Kennedy's classification of partially
edentulous spaces.
Ans.
Disadvantages of Kennedy's Classification of
Partially Edentulous Spaces
• Kennedy's classification is a positional or anatomic clas-
sification which conveys a tooth saddle relationship, but
gives little information of teeth present and their positions.
Section I I Topic Wise Solved Questions of Previous Years
• Without Applegate's modifications, Kennedy's classifi-
cation could have been meaningless.
• Critics argue that grouping of Kennedy's classification
should have been reversed. According to them, Class II
situation should have been grouped as Class I.
• It is based on incidence of clinical situation requiring re-
movable prosthesis (Class I is the most frequent situation).
• As the number of teeth missing is not specified, support
cannot be analyzed.
• It does not mention about the condition of the abutment
teeth.
• It is not applicable in single standing tooth.
• It tells about spaces, but not about teeth to be replaced.
Q. 7. Indications of swing lock partial denture prosthesis.
Ans.
Swing Lock Partial Denture Prosthesis
Swing lock RPD was first designed by Dr. Joe J. Simmons
in the year 1963.
------------------- <( Topic 2)
Diagnosis Planning and Mouth Preparation
LONG ESSAYS
Q. 1. Discuss mouth preparation in removable partial
dentures.
Or
Define removable partial denture prosthesis. Describe
in detail mouth preparation for removable partial den-
ture.
Or
Describe in brief the various types of mouth prepara-
tion procedures undertaken in a case of removable par-
tial denture service.
Ans.
Removable Partial Denture Prosthesis
Removable partial denture prosthesis is defined as 'the re-
placement of missing teeth and supporting tissues with a
prosthesis designed to be removed by the wearer'.
Mouth preparation forms the second phase of treatment
plan.
Swing lock RPDs are used when number of remaining
teeth is too few to support a conventional design. This den-
ture has a labial bar extending labially all along the arch
like a major connector. The labial bar is connected to the
remaining parts of the denture by a hinge in one side and a
lock on the other. The labial bar can be unlocked during
insertion and locked after insertion.
Indications
• Missing key abutments.
• When the number of remaining natural teeth are less.
• When the remaining teeth are too mobile to serve as
abutments.
• When the soft tissue and the tooth are in unfavourable
contours.
• To provide retention and stability for maxillofacial
prosthesis, such as obturators.
• For retention of prosthesis in case of loss of large
segments of teeth and alveolar ridge due to trauma or
infection.
The procedures involved in mouth preparation are
• Surgical procedures.
• Periodontal procedures.
• Orthodontic realignment, if necessary.
• Treatment of abused tissues.
• Preparation of guide planes and rest seats.
• Prosthetic rehabilitation.
i. Surgical Procedures
• These procedures should be carried out at least
six weeks before impression making.
• The surgical procedures include:
• Extraction of teeth with poor prognosis.
• Removal of residual roots.
• Extraction of impacted and malposed teeth.
• Muscle and frenal attachment should be examined.
• All abnormal white, red, or ulcerative lesions should be
sent for biopsy.
• Dentofacial deformities such as cleft lip, etc., should be
treated in this phase.
• Ridge augmentation is also done in this phase.

ii. Periodontal Procedures
• After the surgical procedures, periodontal procedures
are carried out.
• Objectives of periodontal therapy include:
• Removal of all aetiological factors which causes the
periodontal problems.
• Reduction and elimination of all the pockets such
that the gingival sulcus is free of inflammation.
• Establishment of functional occlusal relationship.
• Development of plaque control programme and de-
finitive maintenance schedule.
• Evaluation of abutment tooth for periodontal support
• Pocket depth should be evaluated in the abutment
tooth.
• Bleeding on probing should be checked for sulcular
health.
• Presence of mobility should be checked.
• Evaluation should also be done regarding any trau-
matic occlusion.
iii. Orthodontic Realignment
• It is usually done for the correction of malalignment.
• This procedure is usually avoided in cases with inade-
quate anchorage.
iv. Treatment of Abused Tissues
• Treatment of the abused tissues should be done prior to
primary impression making. As with tissue healing, tis-
sue contour is likely to be changed.
• Treatment should be done for the symptoms, such as
• Irritation and inflammation of soft tissues in denture-
bearing areas.
• Burning sensations in the cheeks, lips, tongue, and
residual ridge.
• Distortion of anatomical structures.
• These symptoms can also be caused due to ill-fitting
dentures, nutritional deficiencies, diabetes, blood dys-
crasias, etc.
• In case of ill-fitting dentures producing the symptoms,
patient is asked to stop wearing the dentures and tissue
conditioners can be given to provide cushioning effect
on the tissues.
• Other treatment procedures such as saline mouth rinse,
soft tissue massage, and multivitamin tablets can be
given.
v. Preparation of Guide Planes and Rest Seats
• Guide planes is defined as 'two or more vertically parallel
surfaces of abutment teeth so oriented as to direct the path
of placement and removal of removable partial denture'.
Quick Review Series for BOS 4th Year: Prosthodontics
• Guide planes are prepared by selective grinding of the
teeth or by appropriate shaping of the wax patterns,
crowns, or cast restoration on the abutment teeth.
• Rest seats are done on the prepared surface of the abut-
ment to receive the rest.
• The primary function of the rest is to provide vertical
support for the partial denture.
• Other functions of rest include:
• It maintains components in their planned positions.
• It maintains an established occlusal relationship.
• It helps to prevent impingement of soft tissues.
vi. Prosthetic Rehabilitation
• Mouth preparation is done to suit a simple design.
• The fabrication of new prosthesis should be done after
the oral tissues return to the healthy state.
• The abutment teeth are evaluated according to the path
of placement, the areas of teeth to be altered, and tooth
contours to be changed.
Q. 2. Discuss importance of diagnosis and treatment
planning in removable partial denture prosthodontics.
Ans.
Diagnosis and Treatment Planning in
Removable Partial Denture Prosthodontics
Diagnosis is defined as the examination of the physical
state, evaluation of mental or psychological makeup, and
understanding the needs of each patient to ensure a predict-
able result.
Treatment planning is defined as a means of developing
a course of action that encompasses the ramifications and
sequelae of treatment to serve the patient's needs.
Diagnosis
Oral examination
i. Evaluation of carious lesions and defective restora-
tions.
ii. Testing the vitality of the pulp.
iii. Test for sensitivity to percussion.
iv. Evaluation of mobility.
v. Evaluation of any pocket depth, inflammation, and
amount of attached gingiva of the abutment teeth.
vi. Evaluation of presence of any tori, exostoses, sharp or
prominent bony areas, soft or hard tissue undercuts, and
enlarged tuberosities.
Evaluation of caries and existing restorations
i. All carious lesions should be restored with intracoronal
restoration.
Section I I Topic Wise Solved Questions of Previous Years

ii. Any extruded tooth present above the occlusal plane iii. Epulis fissuratum.
should be restored with an extra coronal restoration to iv. Denture stomatitis.
improve the occlusal plane. v. Trauma from occlusion.
iii. For preparation of rest seat, a cast metallic restoration vi. Soft tissue displacement.
is preferred as restoration.
Evaluation of soft tissue abnormalities
Evaluation of pulp i. Soft tissue is evaluated for high frenal attachment of
• An electric pulp tester and thermal tests are used for labial frenum.
detection of pulpal necrosis or pulpitis. ii. Cases of hypertrophic lingual frenum.
• Endodontically treated tooth when used as an abut- iii. Vestibular extension or ridge augmentation procedures
ment, should be evaluated for the success of endodontic can be done.
treatment. iv. Patients with xerostomia.

Evaluation of sensitivity to percussion sensitivity Evaluation of hard tissue abnormalities

i. It can be due to tooth movement caused by a prosthesis • Torus palatinus: In this case, a major connector can be
or the occlusion. selected and designed to circumvent the torus.
ii. A tooth or restoration in traumatic occlusion. • Torus mandibularis: In case of bilaterally involvement
iii. Because of periapical or pulpal abscess. on the lingual surface of the mandible, it needs to be
iv. In case of acute pulpitis. surgically removed before construction of a removable
v. In case of gingivitis or periodontitis. partial denture.
vi. In patient with cracked tooth syndrome. • Exostoses and undercuts: It is a surgical correction by
simple alveolectomy.
Evaluation of mobile teeth
• Maxillary tuberosities: It needs to be surgically
A mobile tooth which is used as an abutment tooth usually corrected, if support and stability of the prosthesis is
will have poor prognosis, unless mobility is eliminated. affected.
• Mandibular tuberosity: The mandibular lingual tuberosity
Causes of mobility
is a bony protuberance at the distal end of the mylohyoid
i. Due to trauma from occlusion (reversible). ridge in the third molar area. This should be surgically
ii. In case of inflammatory changes in the periodontal reduced.
ligament (reversible).
iii. Due to loss of alveolar bone support (not reversible). Radiographic evaluation of abutment teeth
i. Evaluation should be done regarding the root length,
Evaluation of periodontium
size, and form.
Periodontal treatment is required in cases, such as ii. For any abutment tooth, crown/root ratio of at least 1: 1
i. Pocket depth in excess of I mm along with the furca- is required.
tion involvement. iii. Lamina dura: It should be checked for absence, discon-
ii. In case of gingivitis. tinuity, partial loss, or thickening of lamina dura.
iii. Marginal exudate. iv. Periodontal ligament space: In case of widening of the
iv. Presence of less than 2 mm of attached gingiva. periodontal ligament space with a thickening of the
v. When there is high frenal attachment. lamina dura, it indicates occlusal trauma and heavy
Periodontal treatments include: function.
• Root scaling and root planning with good home oral
hygiene procedures. Treatment Planning
• Gingivectomy, periodontal flap procedures, and free
gingival grafts. The treatment of the partially edentulous patient can be
divided into five phases as follows:
Evaluation of oral mucosa
Oral mucosa is evaluated for ulceration, swelling, or colour Phase I
change as red or white lesions. i. Collection and evaluation of the diagnostic data.
Tissue reactions usually seen in prosthesis wearing ii. Treatment to control pain or infection.
patients are: iii. Biopsy or referral of patient.
i. Palatal papillary hyperplasia. iv. Development of a treatment plan.
ii. Inflammatory papillary hyperplasia. v. Education and motivation of patient.

Phase II
i. Removal of all deep caries and placement of the tem-
porary restorations.
ii. Extirpation of inflamed or necrotic pulp tissues.
iii. Removal of non-retainable teeth.
iv. Periodontal treatment.
v. Construction of interim prosthesis for function or aes-
thetics.
vi. Occlusal equilibration.
vii. Reinforcement of education and motivation of patient.
Phase Ill
i. Preprosthetic surgical procedures.
ii. Definitive endodontic procedures.
SHORT ESSAYS
Q. 1. Splints.
Ans.
Splints
Splint is defined as a prosthesis which maintains a hard and/
or soft tissue in a predetermined position.
Splinting of abutment is defined as joining of two or
more teeth into a rigid unit by means of fixed restoration.
Full mouth coverage splinting is more beneficial as wide
distribution of occlusal load is achieved. It also ensures even
occlusal contacts to avoid any traumatic occlusion.
Types of Splinting
• Removable.
• Fixed.
• Overdenture abutment.
Splints can be made up of rigid material such as wood,
metal, or plastic or it can be made up of flexible material,
such as fabrics or adhesive tapes.
Splinting is done to protect, immobilize, support, brace,
or restrict motion in a part.
• Removable splinting
It is done to stabilize the weak abutment tooth, which is
splinted to the adjacent tooth for strength and stability.
• Fixed splints
It utilizes several single rooted teeth and then by the
effect of splinting, it transforms them into single multi-
rooted unit.
• Overdenture abutment
A tooth which has lost 50% of bone support can be con-
verted into overdenture abutment.
Quick Review Series for BOS 4th Year: Prosthodontics
iii. Definitive restoration of teeth, such as cast metallic
restorations.
iv. Fixed partial denture construction.
v. Reinforcement of education and motivation of patient.
Phase IV
i. Construction of removable partial denture.
ii. Reinforcement of education and motivation of
patient.
Phase V
i. Postinsertion care.
ii. Periodic recall.
iii. Reinforcement of education and motivation of patient.
Uses of Splints
• It is used to stabilize the periodontally weak tooth.
• It aids in healing.
• It helps in maintaining the continuity of the arch.
• It helps in supporting the prosthesis.
• It helps control haemorrhage.
• It helps in immobilization of the tooth.
• It provides uniform distribution of forces.
• It is used to hold the fractured segments together.
Q. 2. Mouth preparation for removable partial denture.
Ans.
Mouth Preparation for Removable Partial
Denture
The procedures involved in mouth preparation are:
• Surgical procedures.
• Periodontal procedures.
• Orthodontic realignment, if necessary.
• Treatment of abused tissues.
• Preparation of guide planes and rest seats.
• Prosthetic rehabilitation.
Surgical Procedures
• These procedures should be carried out at least six
weeks before impression making.
• The surgical procedures include:
• Extraction of teeth with poor prognosis.
• Removal of residual roots.
• Extraction of impacted and malposed teeth.
Periodontal Procedures
• After the surgical procedures, periodontal procedures
are carried out.
Section I I Topic Wise Solved Questions of Previous Years
• Objectives of periodontal therapy include:
• Removal of all aetiological factors which causes the
periodontal problems.
• Reduction and elimination of all the pockets, such
that the gingival sulcus is free of inflammation.
Orthodontic Realignment
• It is usually done for the correction of malalignment.
• This procedure is usually avoided in cases with inade-
quate anchorage.
Treatment of Abused Tissues
• Treatment of the abused tissues should be done prior to
primary impression making, as with tissue healing, tis-
sue contour is likely to be changed
• Treatment should be done for the symptoms, such as
• Irritation and inflammation of soft tissues in denture-
bearing areas.
• Distortion of anatomical structures.
Preparation of Guide Planes and Rest Seats
• Guide planes is defined as 'two or more vertically paral-
lel surfaces of abutment teeth so oriented as to direct the
path of placement and removal of removable partial
denture'.
• Guide planes are prepared by selective grinding of the
teeth, or by appropriate shaping of the wax patterns,
crowns, or cast restoration on the abutment teeth
• Rest seats are done on the prepared surface of the abut-
ment to receive the rest.
• The primary function of the rest is to provide vertical
support for the partial denture.
Prosthetic Rehabilitation
• Mouth preparation is done to suit a simple design.
• The fabrication of new prosthesis should be done after
the oral tissues return to the healthy state.
SHORT NOTES
Q. 1. Refractory cast.
Ans.
Refractory Cast
Refractory cast is formed by duplicating the master cast
after block out and relief.
It has following characteristics:
• Blocked out undercuts are invisible in refractory cast.
• Spacer relief appears as elevation on the edentulous ridge.
Q. 3. Uses of diagnostic casts in removable partial den-
tures.
Or
Diagnostic cast and its uses.
Ans.
Diagnostic Cast
• A diagnostic cast should be an accurate reproduction of
the teeth and adjacent tissues.
• The diagnostic cast is poured in dental stone, due of its
strength and abrasion resistance.
• The impression for the diagnostic cast is made with ir-
reversible hydrocolloid (alginate) in a perforated im-
pression tray.
• The size of the tray will be according to the size of the arch.
Uses of Diagnostic Cast
• Diagnostic casts helps to view the occlusion from the
lingual and buccal aspect.
• It helps to analyze the existing occlusion in case when
there is a need for occlusal adjustment and occlusal
reconstruction.
• It aids in diagnostic wax up to determine the occlusion
before starting of any definitive treatment.
• Diagnostic casts helps in surveying the dental arch as a
whole.
• It also helps in surveying of the cast, to determine the
existing soft tissue undercuts and parallelism of teeth as
for overdenture cases.
• It also aids in mouth preparation decisions, as to the
removal of soft tissue undercuts.
• It helps in showing and discussing with the patient
regarding treatment plan and corrections, if any.
• It aids to select and fabricate trays.
• If needed, diagnostic cast can also be duplicated in case
an undercut has to be blocked.
• Diagnostic casts can also be used as a constant reference.
• Stopper holes on the spacer appear as a depression on
elevated saddle areas.
• Gingival relief appears as an elevated band on refractory
cast.
Q. 2. Disinfection of impressions.
Ans.
Impression is usually disinfected by using iodophor or
2% glutaraldehyde. It is then to be left undisturbed for
30 min.
 Quick Review Series for BOS 4th Year: Prosthodontics

Q. 3. Name the mouth preparation procedures prior to Q. 4. Preprosthetic surgery.

RPD services.
Ans.
Ans.
Preprosthetic surgical procedures include
The procedures involved in mouth preparation are • Removal of pathosis.
• Surgical procedures. • Removal of undercuts.
• Periodontal procedures. • Orthodontic realignment.
• Orthodontic realignment, if necessary.
• Treatment of abused tissues. The term preprosthetic indicates all the treatment proce-
• Preparation of guide planes and rest seats. dures carried out in order to eliminate interference and/or
• Prosthetic rehabilitation. acts as an adjunct to the success of prosthetic treatment.

------------------ -<( Topic 3)

Major and Minor Connectors

LONG ESSAYS
Q. 1. Write briefly on the requirements of major con- v. Combination anterior and posterior palatal strap-type
nectors. Add notes on the advantages and disadvantages connector (Closed horseshoe-shaped).
of maxillary major connectors. vi. Palatal plate-type connector (Complete coverage).

Or Single palatal bar

What is major connector? Describe the different types
of maxillary major connectors.
Or
Enumerate the various components of a removable par-
tial denture and discuss maxillary major connectors.
Or
Mention the parts of a cast partial denture and describe
the different maxillary major connectors.
Ans.
• It is a narrow half-oval-shaped bar with the maximum
thickness at the centre.
• It gently curves along the palatal contour with the junc-
tions smoothly joining with the denture base.
Disadvantages
i. To maintain rigidity, it requires bulk causing tongue
interference.
ii. There is decreased vertical support to prosthesis.
iii. It cannot replace more than two teeth on each side of
the arch.
iv. It cannot be used in distal extension bases.

Advantages
Major Connector
• Design for interim partial denture.
A major connector is the unit of the partial denture that
Single palatal strap
connects the parts of the prosthesis located on one side of
the arch with those on the opposite side. It is that unit of the • It is a wide, thin band of metal that crosses the palate.
partial denture to which all other parts are directly or indi- The minimum thickness of palatal strap is 8 mm.
rectly attached. • The palatal strap can be made wider depending on the
edentulous space.
• It can be also used for unilaterally edentulous situation.
Types of Maxillary Major Connectors
Advantages
i. Single posterior palatal bar.
ii. Single palatal strap. i. It has greater resistance to displacing forces than a
iii. Anterior posterior palatal bar (Double palatal bar). palatal bar.
iv. U-shaped palatal connector (Horseshoe). ii. It also provides better patient comfort.
Section I I Topic Wise Solved Questions of Previous Years
Disadvantages
i. Less rigidity compared to complete coverage major
connector.
ii. Papillary hyperplasia may occur.
Anterior posterior palatal bar (Double palatal bar)
• It contains a flat narrow anterior bar positioned in the
valleys of rugae.
• It also consists of a half oval posterior bar.
• The anterior and posterior bars are joined by flat longi-
tudinal elements in the lateral slopes of palate.
Advantages
i. It is rigid.
ii. It can replace anterior and posterior abutments.
iii. It has less palatal coverage, which is comfortable to the
patient.
iv. It is an ideal design for patients with large palatal tori.
Disadvantages
i. It provides less support.
ii. It can be used only when there is good periodontal sup-
port.
iii. It cannot be used in high palatal vaults.
iv. Tongue interferences are present.
Li-shaped palatal connector (Horseshoe-shaped)
• This is a thin band of metal along the lingual surfaces of
tooth extending to the palatal slopes. Thickness of the
plate should be minimum 6-8 mm.
• The borders of this connector can either extend from gin-
gival margin to palatal slopes or from lingual aspect of the
tooth to palatal slopes. The palatal borders must end at the
junction of horizontal and vertical slopes of the palate.
Advantages
i. It is ideal for replacement of missing anterior tooth.
ii. This design provides some vertical support and indirect
retention.
iii. It can be designed in case of palatal tori.
Disadvantages
i. It cannot be given in distal extension partial denture, as
it flexes on loading.
ii. It causes difficulty in speech and patient discomfort can
occur.
Anterior and posterior palatal strap-type connector
(Closed horseshoe-shaped)
• It consists of an anterior strap, which can be placed on the
lingual aspect of tooth; or it must be placed 6 mm away
from gingival margin, if anterior tooth are not replaced.
• It also consists of a posterior strap, which should be
placed posteriorly but without contacting the soft palate.
Advantages
i. It is rigid and it can replace anterior and posterior tooth.
ii. It can be given in cases of palatal tori.
Disadvantage
i. Speech problems and tongue interferences can occur.
Palatal plate-type connector (Complete coverage)
• The anterior border must either extend to the cingula of
the tooth surface or be kept 6 mm short of gingival margin.
• The posterior border should extend to the junction of
soft and hard palate.
Types
a. All acrylic resin.
b. Combination of metal and acrylic (rugae area anteriorly
in metal and posteriorly in acrylic).
c. All cast metal.
Advantages
i. It provides good rigidity and support.
ii. It has better retention.
iii. It has maximum tissue coverage.
iv. It can be given for bilateral distal extension.
v. It provides better stability in flat or flabby ridges.
vi. It can be designed in obturator patients.
vii. It has design for transitional dentures (All acrylic).
viii.It gives natural sensation during eating and drinking as
in 'All metal'.
ix. It cannot be relined later.
Disadvantages
i. Large area of tissue coverage can cause tissue reactions,
as hyperplasia.
ii. Speech difficulties may occur.
Q. 2. Define major connectors in removable partial den-
ture. Discuss with diagrams different mandibular major
connectors.
Or
Discuss the requirements of major connectors. Explain
the indications, contraindications, advantages, disad-
vantages, and design features of mandibular major
connectors.
Or
Describe mandibular major connectors and write in
detail about lingual bar.

Ans.
Major Connector
A major connector is the unit of the partial denture that
connects the parts of the prosthesis located on one side of
the arch with those on the opposite side. It is that unit of the
partial denture to which all other parts are directly or indi-
rectly attached.
Types of Mandibular Major Connectors
i. Lingual bar.
ii. Lingual bar with continuous bar retainer (Kennedy
bar).
iii. Linguoplate.
iv. Labial bar.
i. Lingual bar
Shape and size
A 6-gauge half-pear-shaped bar (5 mm) in width is located
above moving tissues, but as far below the gingival tissues
as possible.
Borders
This bar has two borders: Superior and inferior.
• The superior border should be tapered to the tissues above,
with its greatest bulk at the lower border. It is flat on the
tissue side and has the greatest bulk in the inferior third.
• Inferior border of the lingual bar is slightly rounded, so
that it will not impinge on the lingual tissue when the
denture bases rotate inferiorly under occlusal loads. The
major connector must not have sharp margins.
Location
The inferior border should be located in such a way that it
does not impinge on the tissues in the floor of the mouth
during swallowing, speaking, and other normal functions.
The location should not be interfering with the resting
tongue and must not cause trapping of food.
The superior border should be located 3 mm away from
gingival margins of teeth.
Minimum space required is at least 8 mm of vertical
space between the floor of mouth and gingival margin.
Measuring the height of floor
• The first method is to measure the height of the floor
with a periodontal probe in relation to the lingual gingi-
val margins of adjacent teeth with the tip of the patient's
tongue lightly touching the vermilion border of the up-
per lip (more accurate).
• The second method is to use an individualized impression
tray with its lingual borders 3 mm short of the elevated
Quick Review Series for BOS 4th Year: Prosthodontics
floor of the mouth and then use an impression material that
will be accurately moulded as the patient licks the lips.
• The inferior border of the lingual bar can be located at
the height of the lingual sulcus of the cast resulting from
such an impression.
Advantages
i. It is simple.
ii. It has minimal tissue contact.
iii. It has less plaque accumulation.
Disadvantages
i. These connectors need precise lab work.
ii. They cannot be placed, when there is less than 8 mm of
lingual space.
Modifications
i. The thickness of the connector can be altered depending
on the clinical situation to acquire more rigidity. This is
accomplished by underlying the ready-made form with
a sheet of 24-gauge casting wax.
Sublingual bar
The bar shape is similar as that of a lingual bar.
Location
• It lies over and parallel to the anterior floor of the mouth.
• Sublingual bar can be used along with a lingual plate, if
the lingual frenum does not interfere.
• It can be used when an anterior lingual undercut exists,
where lingual bar cannot be used.
Contraindications
i. When lingual tori exist.
ii. In cases with high lingual frenal attachment.
iii. When there is high elevation of the floor of the mouth
during functional movements.
ii. Continuous bar retainer (Kennedy's bar) or
Double lingual bar
• A continuous bar retainer is located on or slightly above
the cingula of the anterior teeth along with a lingual bar.
The upper bar is also pear-shaped and is 2-3 mm high
with 1 mm thickness. The bar should dip into the contact
points of teeth downward, till upper limits of cingula.
• The two bars are joined by minor connector located in in-
terproximal spaces usually between canine and premolar.
Indications
i. In cases when a linguoplate cannot be given or if it re-
quires excessive block out of interproximal undercuts,
then a continuous bar can be used.
ii. In cases of wide diastema between the lower anterior teeth.
Section I I Topic Wise Solved Questions of Previous Years
Advantages
i. It enhances indirect retention.
ii. It also provides horizontal stabilization to the prosthesis.
iii. Marginal gingiva receives natural stimulation. It can be
used in large interproximal embrasures.
Disadvantages
i. Tongue annoyance occurs.
ii. It causes entrapment of food.
iii. Proper fit is difficult to achieve with upper bar of
double bar.
Modifications (Step back design)
The upper bar can be step backed in between each tooth, as
in cases of diastema. Hence, it is aesthetically pleasing.
iii. Linguoplate
Shape
• It is a pear-shaped lingual bar with a thin solid piece of
metal extending upward from superior border of bar to
the lingual surfaces of teeth.
• A linguoplate should be contoured, such that it follows
the contours of the teeth and the embrasures.
• The upper border should follow the natural curvature of
the supracingular surfaces of the teeth also covering
interproximal spaces to the contact points (Scalloped
appearance).
• All gingival crevices and deep embrasures should be
blocked out parallel to the path of placement to avoid
gingival irritation and wedging effect between the
teeth.
• The linguoplate should have a terminal rest at each end
(commonly, cingulum rest on canines or mesial fossae
rest on first premolars).
• Material of choice is cobalt-chrome alloy.
Modification
It is a cut back or step back design to hide metal between
wide spaced teeth without compromising the rigidity of the
connector. Here, the upper bar drops gingivally along the
marginal ridge of tooth to cross gingiva to the other tooth
and rises up the marginal ridge to the contact point.
Indications
i. It is indicated when the lingual frenum is high or the
space available for a lingual bar is limited.
ii. It is indicated in Class I situations, in which the residual
ridges have undergone excessive vertical resorption.
Here, linguoplate will use remaining teeth to resist
horizontal rotations.
iii. For stabilizing periodontally weakened teeth (A con-
tinuous bar retainer).
iv. When the future replacement of one or more incisor
teeth will be facilitated by the addition of retention
loops to an existing linguoplate.
v. It is indicated in wide diastema.
Advantages
i. It can be used in Class 1 situation, when indirect reten-
tion is required.
ii. In periodontally weak tooth, lingual plate acts as splint.
iii. It can be used with some modification to prevent supra-
eruption of mandibular anterior teeth.
iv. Of all the mandibular major connectors, lingual plate
has maximum retention, support, and stability.
Disadvantages
i. It causes irritation of soft tissues.
ii. It is caries-prone.
iv. Labial bar
Shape
• It is half-pear-shaped similar to lingual bar extending on
to the labial surface and some time to the facial surface
of the posterior tooth.
• Relief is required below the bar.
Indications
i. In cases with extreme lingual inclination of the remain-
ing lower premolar and incisor teeth. This should be
rectified by mouth preparation and restoration before
planning for a labial bar.
ii. Presence of large mandibular tori.
Modifications
• It includes swing-lock design, which consists of a
labial or buccal bar that is connected to the major
connector by a hinge on one end and a latch at the
other end.
• Support is by multiple rests on the remaining natural
teeth.
• Stabilization and reciprocation by linguoplate contact-
ing the remaining teeth and by the labial bar with its
retentive struts.
• Retention is by bar-type retentive clasp arms projecting
from the labial or buccal bar.
Contraindications
i. In cases of poor oral hygiene.
ii. In the presence of a shallow buccal or labial vestibule.
iii. In the presence of high frenal attachment.

Disadvantages
i. Bulk of connector distorts lower lip.
ii. It causes patient discomfort.
Design of mandibular major connector
i. Outline of the basal seat areas on the diagnostic cast.
ii. Outline of the inferior border of the major connector.
iii. Outline of the superior border of the major connector.
iv. Unification by minor connector.
Q. 3. Explain in detail the various types of minor con-
nectors. Add a note on the function of minor connectors.
Or
Write an essay on minor connectors.
Ans.
Minor Connectors
Minor connector is that component that joins other units of
the prosthesis, such as clasps, rests, indirect retainers, and
denture bases to the major connector.
Types of Minor Connectors
i. It joins the clasp assembly to the major connector.
ii. It joins indirect retainers or auxiliary rests to major
connector.
iii. It joins the denture base to the major connector.
iv. It serves as an approach arm for a vertical projection or
bar-type clasp.
i. Minor connectors that join clasp assembly to the
major connector
• They must be rigid, as they support the retentive clasp
and occlusal rest.
• To have rigidity, sufficient bulk is required.
Location
Minor connectors that support clasp assemblies are located
on proximal surfaces of teeth adjacent to edentulous areas
or in the embrasure between two teeth.
Shape
• Broad buccolingually and thin mesiodistally.
• The thickest portion buccolingually, should be at the
lingual line angle of the tooth and taper evenly to its
thinnest point at the buccal line angle of the tooth.
ii. Minor connectors that join indirect retainers or
auxiliary rests to major connector
• They arise from auxiliary rests and should join the ma-
jor connector at right angle.
• The joining junction should be a gentle curve.
Quick Review Series for BOS 4th Year: Prosthodontics
Location
• It is located in the embrasure between teeth to prevent
tongue annoyance.
iii. Minor connectors that join denture base to major
connector types of denture base
a. Latticework construction.
b. Mesh construction.
c. Bead, wire, or nail-head minor connectors.
Open latticework construction
It consists of two longitudinal struts with smaller struts con-
necting the two longitudinal struts.
Maxillary design: This consists of two metal struts of
12 and 16 gauge thick.
The first extends longitudinally along the edentulous
buccal ridge in maxillary arch.
The border of the major connector acts as the second strut.
Mandibular design: In the mandibular arch, one strut should
be positioned buccal to the crest of the ridge and the other
lingual to the crest of the ridge.
Smaller struts: 16 gauge thick smaller struts, connect
the two struts and form the latticework.
They run over the crest of the ridge and are positioned
in such a way that there is no interference to arrangement
of the artificial teeth.
Number of small struts: Commonly one cross strut between
each tooth is to be replaced.
Advantages
i. It has strongest attachment of the acrylic resin denture
base to the removable partial denture.
ii. It is easy to reline.
iii. It can be used for multiple teeth replacement.
Mesh construction
It is a thin sheet of metal with multiple small holes that
extends over the crest of the residual ridge to the same buc-
cal, lingual, and posterior limits, as does the latticework
minor connector.
Indication
• In cases when multiple teeth are to be replaced.
Disadvantages
• It is difficult for the acrylic resin to flow through the
small holes.
• Mesh type is a weak attachment.
Relief
• After the wax forms of the struts are positioned on the
refractory cast, a relief space must be provided over the
edentulous ridges for both the latticework and the mesh
minor connectors.
Section I I Topic Wise Solved Questions of Previous Years
• This relief is provided to create a space between the
struts and the underlying ridge around which the acrylic
resin denture base will be retained.
Tissue stop: In distal extension partial dentures using lattice-
work or mesh retention, the framework has to be stabilized
during the acrylic resin packing and processing.
As the acrylic resin requires some pressure to be forced
through the latticework and mesh minor connectors, the
framework can displace or distort, so a tissue stop is required
to support the terminal portion of the minor connector.
Method
i. Tissue stop is made by removal of 2 mm2 of the relief
wax beneath the latticework.
ii. The wax is removed from the point where the posterior
end of the minor connector crosses the centre of the ridge.
iii. While waxing of the framework, this depression is
waxed as a projection of the latticework or mesh.
iv. After the framework has been cast, this projection will
contact the edentulous ridge of the cast and will prevent
the framework from being distorted during acrylic resin
packing procedures.
Bead, wire, or nail-head retention
• The bead, wire, or nail-head minor connector is used
with metal denture bases.
• No relief is provided beneath the minor connector, as
the acrylic resin mechanically bonds with the nail-head
or bead of the minor connector.
Mechanical retention
• This can be made by placing beads of acrylic resin poly-
mer on the waxed denture base and investing and cast-
ing these beads.
• Wires or form of nail-heads that project from the metal
base can be used.
Disadvantages
i. It is difficult to adjust the metal base.
ii. It cannot be relined in case of ridge resorption.
iii. It is the weakest of the three types of attachment.
iv. It can be only on tooth-supported and well-healed
ridges.
v. It cannot be used when interarch space is limited.
vi. There is no strength to withstand the forces of occlusion.
Advantages
i. It is hygienic, because of better soft tissue response to
metal.
ii. It functions successfully, as there is better fit than
acrylic denture base.
Attachment of minor connector to major connector
• It should be joined to major connector with adequate bulk
to withstand occlusal forces and to prevent from breakage.
• The acrylic resin processed around the latticework and
mesh minor connector must join the major connector in
a smooth, even joint.
• A space for a butt joint is placed in the design to prevent
acrylic resin from being thinned in order to produce a
smooth joint.
• The butt joint aids the acrylic resin to blend evenly with
the major connector.
Finish lines/Butt joints
As acrylic resin is processed around the latticework
and minor connectors, space for these butt joints are
made on both internal and external surfaces of the major
connector.
In the case of nail-head minor connector, the acrylic
resin is processed only on the external surface, so only a
single finish line is required.
Types
• External finish lines.
• Internal finish lines.
External finish lines
• If they occur on the outer aspect of the major connector.
• External finish line must be sharp and definite with a
slight undercut to retain acrylic resin to the major
connector.
• The angle, the finish lines form with the major connec-
tor should be less than 90 degrees.
Method of placement
It is formed by placement of the wax during the waxing
procedure and by carving the wax.
Location
i. It should extend onto the proximal surfaces of the teeth
adjacent to the edentulous space.
ii. It should begin at the lingual extent of the rest seat and
continue down the lingual aspect of the minor connector
on the proximal surface of the tooth.
Internal finish lines
They are on the tissue side of the major connector.
Method of placement
• It is formed from the relief wax used over the edentu-
lous ridges on the master cast before duplication on
which the framework will be waxed.
• A 24-26 gauge relief wax, placed under latticework or
mesh minor connectors creates space for acrylic.
• The same relief waxes margins will become the internal
finish line.
• The ledge which is created by the margin of the wax
must be sharp and definite.
 Quick Review Series for BOS 4th Year: Prosthodontics

iv. Minor connectors that serve as approach arm for
vertical projection or bar-type clasp
• It need not be rigid unlike other minor connectors.
• It supports a gingivally approaching direct retainer.
• It should have a smooth, even taper from its origin to
its tip.
• It must not cross a soft tissue undercut.
Functions of Minor Connector
i. Primary function is to join all the other components
like clasps, rests, indirect retainers, and denture bases
to the major connector.
ii. It also aids in efficient functioning of all components.
iii. It helps to retain rests in their rest seats. This will serve
to transfer forces occurring against the prosthesis
down the long axis of the abutment teeth.
iv. Minor connector aids in uniform distribution of the
stresses. Hence, it should be rigid.
v. The minor connector distributes forces on the edentu-
lous ridge to the ridge and the remaining teeth by
transferring it to several other minor connectors that
serve as attachments for clasps, rests, or indirect re-
tainers.
vi. It helps in the preservation of bone.
vii. In distal extension base, the minor connector is part of
the saddle and so it holds the artificial tooth in proper
alignment.
viii. It also aids in retention, stability, and support in a denture.
Force Distribution
A minor connector distributes forces by:
i. In tissue-supported prosthesis, the occlusal forces ap-
plied to the artificial teeth are transmitted through the
base to the underlying ridge tissues.
ii. In tooth-supported situation, the occlusal forces applied
to the artificial teeth are transferred to the nearest abut-
ment through the occlusal rest.
iii. The minor connector distributes the entire forces to
auxiliary rests and to the remaining abutment teeth.
iv. The minor connector is the major component of partial
denture that transfers the effect of force to the retain-
ers, rests, and stabilizing components of the denture.
v. The effect of occlusal rests on supporting tooth sur-
faces, the functions of retainers, reciprocal clasp arms,
guiding planes, and other stabilizing components all
resist forces and transfer it to the major connector
through the minor connector.
Requirements of Minor Connector
i. It should be rigid to transfer stresses uniformly and to
aid in the functioning of other components.
ii. It must be located within an embrasure space.
iii. It should jo in the major connector at right angle.
iv. It should be thickest toward the lingual surface and ta-
pering toward the contact area.
v. The junctions of minor connectors that join the major
connector should be butt-joints.

SHORT ESSAYS
Q. 1. Mandibular major connectors. Write in brief about the different types of mandibular
Or major connectors.
Ans.

Types of mandibular major connectors

Type of Major
Connector DesiRn Advanta15es Disadvanta15es Uses
1. Lingual bar • Half-pear-shaped with its bulk- • Simplicity in • It can not be used • It is used when
iest portion inferiorly located. construction. when lingual sul- sufficient space is
cus depth is less present.
• Superior border should be at • Minimal or no
than 8 mm.
least 4 mm inferior to gingi- contact with oral • It is used in
val margin and tapered to soft tissues. Kennedy's class Ill.
tissues.
• No contact with • It is the connector
• Connector should be minimum teeth, so no decal- of choice in most
5 mm wide. cification. of the cases.
• Inferior border is located at de-
termined depth within patient's
tolerance level.

Continued
Section I I Topic Wise Solved Questions of Previous Years

Type of Major
Connector Desi1n Advanta1es Disadvanta1es Uses
2. Linguoplate
(Lingual strap,
• Most rigid, half-pear-shaped
with its bulkiest portion inferi-
• Effective stabilizer
for anterior teeth.
• Extensive tooth • It is used when
coverage. inadequate space
shield, and orly located. exists.
apron). • No interference in • Decalcification of
• Thin metal apron extends superi- tongue movement. enamel. • Class I arch with
orly to contact cingulum of ante- resorption.
rior teeth (contoured to follow
• Aids in indirect re- • Irritation, if oral

Ii ngua I surface).
tention. hygiene is not • To stabilize peri-
maintained. odontally weak
• More rigid than
• Apron extends interproxinally lingual bar. • Display of metal. teeth.
and has seal loned contours.
• To prevent extru-
• Free gingival margin is
relieved.
sion of mandibular
anteriors.

• High lingual fre-

num and presence
of tori.

3. Mandibular • Half-pear-shaped lower bar. • Indirect retention. • Food entrapment. • It is mainly used if
lingual bar with • Upper bar is half oval, 2-3 mm • Horizontal stabi Ii- • Difficulty in fitting. teeth require
cingulum bar wide and 1 mm thick. zation. • Tongue indirect retention
(Double lingual
or Kennedy bar)
• Area between the two should
be s81f cleansing and both
• Since there is
no coverage of
annoyance . (Periodontal
involvement).
should be attached by minor marginal gingiva, • 'Step-back' design
connector. free flow of saliva is used for dia-
• Rests are given at each end of gives a natural stema cases .
the bar. stimulation.

4. Mandibular
labial bar
• Runs across mucosa labial to
anterior teeth or facial to ante-
• It can be used
when lower ante-
• Bulk distorts the
lower lip.
• Gross non-correct-
able interferences.
rior teeth. rior and premolars • Patient's discomfort. • Lingual tori .
• Half-pear-shaped. are severely tilted • It cannot be used • Malposed lin-
• Height and thickness greater towards lingual. in cases with gually inclined
than lingual bar. shallow labial teeth.
• Superior bar located at least
4 mm inferior to gingival margin.
vestibule. • Severe lingual
tissue undercuts.

Q. 2. Maxillary major connectors. Major connectors in maxilla.

Or Ans.

Types of maxillary major connectors

Major Connectors Desisn Advantases Disadvantases Uses
1. Single palatal
• Narrow • No significant ad- • Difficult for patient to • It is used when
bar vantage, hence adjust. edentulous spaces
• Half oval in shape
used in the past • No support from palate. are tooth-bounded
• Greatest thickness in the
mainly for interim • It can be used only to re- (class Ill) and when
centre
dentures. place one or two teeth. minimal support is
• Smooth joint with
denture base • It cannot be placed needed from the
anterior to second palate.
premolar.
• Bulky.

2. Palatal strap • Anatomic replica form.
• Anterior border follows
the valley between rugae.
• Posterior border at right
angles to median sutural
line.
• Strap should be mini-
mum 8 mm wide.
• Located in three • Excessive palatal • Class Ill
planes, therefore
greater resistance
coverage and
discomfort.
• Class II (with increased
coverage)
• It can be thin, yet • Adverse soft tissue • Class I cases when
strong. reaction. ridges have undergone
• Retention is little vertical resorption.
enhanced by • U- or V-shaped palate.
intimate contact. • It is used when direct
• It is most widely retention is not a prob-
lem and when no tori
used.
are present

Continued

Major Connectors Desisn
3. Anteroposterior • Flat anterior bar placed
or double pala- between valleys of the
tal bar rugae (edge should be
at least 6 mm from
gingiva margin).
• Posterior bar half oval
and located as far
posteriorly as possible.
• Both should cross mid-
line at right angles.
4. Horseshoe • Anterior border well
or U-shaped supported by rests.
connector • Should be thin, wide,
and rigid, and reproduce
the anatomy of rugae.
• Posterior border should
be in close contact with
mucosa and should not
impinge on the tissues.
• Portion anterior to rest
must have support from
an indirect retainer.
5. Maxillary major • Para I lelogram-shaped
connectors - • Straps are relatively
disadvantages narrow.
• Lateral straps follow the
contour of the palate.
• Anatomic replica
(matted surface).
6. Complete • Anatomic replica
palate casting supported
anteriorly by rests.
• It contacts almost all
remaining teeth.
• Posterior border
terminate at junction
of hard and soft palate.
• Posterior part could be
1. All acrylic resin
2. All cast metal.
3. Metal and resin
combination.
Q. 3. Lingual bar.
Or
Describe designing a lingual bar with diagrams. Name
two indications of the same.
Or
Mandibular major connector used with high lingual
frenum.
Ans.
Quick Review Series for BOS 4th Year: Prosthodontics
Advantases Disadvanta1es Uses
• Rigidity. • Limited support from • It is used when
• Less palatal palate. anterior and posterior
coverage. • It cannot be used in abutments are widely
• Good support. high narrow vaults. separated .
• It can be used • Bar thickness is • When tori are present.
even when torus uncomfortable. • Kennedy's class I, II, IV.
palatinus is
present.
• Distal extension
case with anterior
replacements .
• It can be used • No cross arch • It is rarely used except
when torus palati- stabi I ization. to avoid a torus.
nus extends on to • Lack of rigidity. • Kennedy's class IV.
soft palate. • Inadequate support. • When anterior teeth
• It stabilizes weak • Interference in speech need stabilization .
anterior teeth. pattern .
• Gingival and peri-
odontal damage.
• Derives support • Interference in speech • It is used when numer-
from palate. pattern . ous teeth are to be
• Corrugated (Altered phonetics). replaced and when
surface adds to • Tongue annoyance, tori are present.
the strength. because of long • Kennedy's class I and II
• Enhanced rigidity, borders. with good abutments .
because of circle • Discomfort. Class II modification I.
effect. • Kennedy's class IV.
• Very good rigidity • Extensive coverage. • Kennedy's class I and II
and support. • Discomfort. • Kennedy's class II
• Remaining teeth • Altered taste and with large posterior
are stabilized. phonetics. modification .
• It can be used in • Absence of tori.
extreme ridge • Cleft palate cases.
resorption cases. • Poor abutment support
• It can be used in and extreme ridge
cleft palate cases. resorption cases .
Lingual Bar
This is a mandibular major connector. A major connector is
the unit of the partial denture that connects the parts of the
prosthesis located on one side of the arch with those on the
opposite side. It is that unit of the partial denture to which
all other parts are directly or indirectly attached.
Shape and Size
A 6-gauge half-pear-shaped bar, 5 mm in width, is located above
moving tissues but as far below the gingival tissues as possible.
Section I I Topic Wise Solved Questions of Previous Years
Borders
• There are two borders-superior and inferior.
• The superior border should be tapered to the tissues above,
with its greatest bulk at the lower border. It is flat on the
tissue side and has the greatest bulk in the inferior third.
• Inferior border of the lingual bar is slightly rounded in
the framework, so it does not impinge on the lingual
tissue when the denture bases rotate inferiorly under
occlusal loads. The major connector should not have
sharp margins.
Location
• The inferior border should be located in such a way that
it does not impinge on the tissues in the floor of the
mouth during swallowing, speaking, licking the lips,
and other normal functions.
• The location should not interfere with the tongue at rest
causing trapping of food.
• The superior border should be located 3 mm away from
gingival margins of teeth.
Minimum Space Required
At least 8 mm of vertical space between the floor of mouth
and gingival margin is required.
Measuring the Height of Floor
i. The first method is to measure the height of the floor
with a periodontal probe in relation to the lingual gingi-
val margins of adjacent teeth with the tip of the patient's
tongue lightly touching the vermilion border of the
upper lip (more accurate).
ii. The second method is to use an individualized impression
tray with its lingual borders 3 mm short of the elevated
floor of the mouth and then use an impression material that
will be accurately moulded as the patient licks the lips.
The inferior border of the lingual bar can be located at
the height of the lingual sulcus of the cast resulting from
such an impression.
Advantages
i. It is simple.
ii. It has minimal tissue contact.
iii. There is less plaque accumulation.
Disadvantages
i. It requires precise lab work.
ii. It cannot be placed when there is less than 8 mm of
lingual space.
Contraindications
i. When lingual tori exist.
ii. In cases of high lingual frenal attachment.
iii. High elevation of the floor of the mouth during func-
tional movements.
Modifications
i. The thickness can be altered depending on the clinical
situation to acquire more rigidity. This is accomplished
by underlying the ready-made form with a sheet of
24-gauge casting wax.
Sublingual Bar
The bar shape is same as that of a lingual bar.
Location
It lies over and parallel to the anterior floor of the mouth.
Uses
i. Sublingual bar can be used along with a lingual plate, if
the lingual frenum does not interfere.
ii. It can also be used when an anterior lingual undercut
exists, where lingual bar cannot be used.
Q. 4. Define major connector. Enumerate the indica-
tions for use of linguoplate major connector.
Or
Advantages of lingual plate major connector.
Or
Give the advantages and disadvantages of lingual plate
major connector.
Ans.
Major Connector
A major connector is the unit of the partial denture that
connects the parts of the prosthesis located on one side of
the arch with those on the opposite side. It is that unit of
the partial denture to which all other parts are directly or
indirectly attached.
Linguoplate Major Connector
Shape
• It is a pear-shaped lingual bar with a thin solid piece of
metal extending upward from superior border of bar to
the lingual surfaces of teeth.
• A linguoplate should be contoured to follow the contours
of the teeth and the embrasures.

• The upper border should follow the natural curvature of the
supracingular surfaces of the teeth also covering inter-
proximal spaces to the contact points (scalloped appear-
ance).
• All gingival crevices and deep embrasures must be
blocked out parallel to the path of placement to avoid
gingival irritation and wedging effect between the
teeth.
• There should be a terminal rest at each end of linguo-
plate (commonly cingulum rest on canines or mesial
fossae rest on first premolars).
• Material of choice is the cobalt-chrome alloy.
Modification
Cut back or step back design to hide metal between wide
spaced teeth without compromising the rigidity of the con-
nector. Here, the upper bar drops gingivally along the mar-
ginal ridge of tooth to cross gingiva to the other tooth and
rises up the marginal ridge to the contact point.
Indications
i. It is indicated when the lingual frenum is high or the
space available for a lingual bar is limited.
ii. It is indicated in class I situations in which the residual
ridges have undergone excessive vertical resorption.
Here, linguoplate will use remaining teeth to resist
horizontal rotations.
iii. For stabilizing periodontally weakened teeth (a contin-
uous bar retainer).
iv. When the future replacement of one or more incisor
teeth will be facilitated by the addition of retention
loops to an existing linguoplate.
v. It is indicated in wide diastema cases.
Advantages
i. It can be used in class 1 situation, when indirect reten-
tion is required.
ii. In periodontally weak tooth, lingual plate acts as splint.
iii. It can be used with some modification to prevent supra-
eruption of mandibular anterior teeth.
iv. Of all the mandibular major connectors, lingual plate
has maximum retention, support, and stability.
Disadvantages
i. Irritation of soft tissues occurs.
ii. It is caries-prone.
Q. 5. Minor connectors.
Or
Different types of minor connectors.
Or
Define and explain the various types of minor connectors.
Ans.
Quick Review Series for BOS 4th Year: Prosthodontics
Minor Connectors
Minor connector is that component that joins other units of
the prosthesis such as clasps, rests, indirect retainers, and
denture bases to the major connector.
Types of Minor Connectors
i. Joins the clasp assembly to the major connector.
ii. Joins indirect retainers or auxiliary rests to major connector.
iii. Joins the denture base to the major connector.
iv. Serves as an approach arm for a vertical projection or
bar-type clasp.
i. Minor connectors that join clasp assembly to the
major connector
• They must be rigid, as they support the retentive clasp
and occlusal rest.
• To have rigidity, sufficient bulk is required.
Location
Minor connectors that support clasp assemblies are located
on proximal surfaces of teeth adjacent to edentulous areas
or in the embrasure between two teeth.
Shape
• Broad buccolingually and thin mesiodistally.
• The thickest portion buccolingually, should be at the
lingual line angle of the tooth and taper evenly to its
thinnest point at the buccal line angle of the tooth.
ii. Minor connectors that join indirect retainers or
auxiliary rests to major connector
• They arise from auxiliary rests and should join the
major connector at right angle.
• The joining junction should be a gentle curve.
Location
It is located in the embrasure between teeth to prevent
tongue annoyance.
iii. Minor connectors that join denture base to major
connector types of denture base
a. Latticework construction.
b. Mesh construction.
c. Bead, wire, or nail-head minor connectors.
Attachment of minor connector to major connector
• It should be joined to major connector with adequate bulk
to withstand occlusal forces and to prevent from breakage.
• The acrylic resin processed around the latticework and
mesh minor connector must join the major connector in
a smooth, even joint.
Section I I Topic Wise Solved Questions of Previous Years
• A space for a butt joint is placed in the design to prevent
acrylic resin from being thinned, in order to produce a
smooth joint.
• The butt joint aids the acrylic resin to blend evenly with
the major connector.
Finish lines/Butt joints
As acrylic resin is processed around the latticework and
minor connectors, space for these butt joints are made on
both internal and external surfaces of the major connector.
In the case of nail-head minor connector, the acrylic
resin is processed only on the external surface, so only a
single finish line is required.
iv. Minor connectors that serve as approach arm for
vertical projection or bar-type clasp
• It need not be rigid, unlike other minor connectors.
• It supports a gingivally approaching direct retainer.
• It should have a smooth, even taper from its origin to
its tip.
• It must not cross a soft tissue undercut.
Q. 6. Requirements of major connector.
Ans.
Requirements of Major Connector
• Major connectors must be rigid to transfer forces uni-
formly over the entire supporting structure.
• It should prevent movement of the denture base by its
rigidity.
• It must aid the other components of the partial denture
to function effectively.
• It should not be placed on excessively movable tissues.
• It should be placed 4 mm away from gingival margin in
mandibular and 6 mm away from gingival margin in
maxillary.
• It should not be placed on bony and soft tissue promi-
nences.
• Relief must be provided beneath a major connector, if
necessary.
• The borders of the palatal connector should be 6 mm
away from gingival margins and should be parallel to
their mean curve.
• The anterior and posterior borders should cross the mid-
line at right angles.
• Minor connectors must cross gingival tissues, at nearly
a right angle while joining the major connector.
• An anterior palatal strap or the anterior border of a pala-
tal plate should be located as far posteriorly to avoid
interference with the tongue.
• The anterior border of such palatal major connectors
should follow the valleys between the rugae.
• It should maintain oral health.
• All borders should taper towards soft tissue.
• It must be made from an alloy compatible with oral
tissues.
• Thickness of metal should be uniform throughout.
• Finished borders should curve gently.
• Metal should not be highly polished on the tissue surface.
• All borders on soft tissue should be beaded fading out
near gingival margins.
• It should not interfere and irritate the tongue.
• It must not alter the natural contour of the lingual sur-
face of the mandibular alveolar ridge or palatal vault.
• It should not impinge on oral tissues during function
and should not retain or trap food particles.
• It should aid in support, retention, and stability.
Q. 7. U-shaped or horseshoe-shaped major connector.
Or
U-shaped maxillary major connector.
Ans.
U-shaped Palatal Connector (Horseshoe)
• It is a thin band of metal along the lingual surfaces of
tooth extending to the palatal slopes. Thickness of the
plate should be minimum 6-8 mm.
• The borders can either extend from gingival margin to
palatal slopes or from lingual aspect of the tooth to
palatal slopes. The palatal borders should end at the
junction of horizontal and vertical slopes of the palate.
Advantages
• This is ideal for replacement of missing anterior tooth.
• This design provides some vertical support and indirect
retention.
• It can be designed in case of palatal tori.
Disadvantages
• It cannot be given in distal extension partial denture, as
it flexes on loading.
• Difficulty in speech and patient discomfort may even
occur.
Anterior and Posterior Palatal Strap-type
Connector (Closed Horseshoe-shaped)
• It consists of an anterior strap, which can be placed on
the lingual aspect of tooth, or it should be placed 6 mm
away from gingival margin, if anterior tooth is not re-
placed.
• It also consists of a posterior strap, which should be
placed posteriorly but without contacting the soft palate.
~ Quick Review Series for BOS 4th Year: Prosthodontics
Advantages
• It is rigid and can even replace anterior and posterior tooth.
• It can also be given in cases of palatal tori.
Disadvantage
• Speech problems and tongue interference can occur.
Q. 8. Posterior palatal bar.
Ans.
Single Palatal Bar
• It is a narrow half-oval-shaped bar with the maximum
thickness at the centre.
• It gently curves along the palatal contour with the junc-
tions smoothly joining the denture base.
Disadvantages
• To maintain rigidity, it should possess bulk causing
tongue interference.
• It decreases the vertical support to prosthesis.
• It cannot replace more than two teeth on each side of
the arch.
SHORT NOTES
Q. 1. Functions of minor connector.
Ans.
Functions of minor connector are as follows:
i. Primary function is to join all the other components
like clasps, rests, indirect retainers, and denture bases
to the major connector.
ii. It also aids in efficient functioning of all components.
iii. It helps to retain rests in their rest seats. This will serve
to transfer forces occurring against the prosthesis
down the long axis of the abutment teeth.
iv. Minor connector aids in uniform distribution of the
stresses. Hence, it should be rigid.
v. The minor connector distributes forces on the edentu-
lous ridge to the ridge and the remaining teeth by trans-
ferring it to several other minor connectors that serve as
attachments for clasps, rests, or indirect retainers.
vi. It helps in the preservation of bone.
vii. In distal extension base, the minor connector is part of
the saddle and so it holds the artificial tooth in proper
alignment.
viii. It also aids in retention, stability, and support in a
denture.
• It cannot be used in distal extension bases.
Advantage
• Design for interim partial denture.
Single Palatal Strap
• It is a wide, thin band of metal that crosses the
palate. The minimum thickness of palatal strap is
8mm.
• Depending on the edentulous space, the palatal strap
can be made wider.
• It can be used for unilaterally edentulous situation.
Advantages
• There is greater resistance to displacing forces than a
palatal bar.
• It provides better patient comfort.
Disadvantages
• It is less rigid compared to complete coverage major
connector.
• Papillary hyperplasia may occur.
Q. 2. Maxillary major connectors.
Ans.
Major Connector
A major connector is the unit of the partial denture that
connects the parts of the prosthesis located on one side of
the arch with those on the opposite side. It is that unit of
the partial denture to which all other parts are directly or
indirectly attached.
Maxillary Major Connectors
i. Single posterior palatal bar.
ii. Single palatal strap.
iii. Anterior posterior palatal bar (Double palatal bar).
iv. U-shaped palatal connector (Horseshoe).
v. Combination anterior and posterior palatal strap-type
connector (Closed horseshoe-shaped).
vi. Palatal plate-type connector (Complete palate).
Q. 3. Lingual bar.
Ans.
Section I I Topic Wise Solved Questions of Previous Years

Lingual Bar Q. 4. Mandibular major connectors.

Lingual bar is a mandibular major connector. A major Ans.
connector is the unit of the partial denture that connects
the parts of the prosthesis located on one side of the arch Major Connector
with those on the opposite side. It is that unit of the partial
A major connector is the unit of the partial denture that connects
denture to which all other parts are directly or indirectly
the parts of the prosthesis located on one side of the arch with
attached.
those on the opposite side. It is that unit of the partial denture to
which all other parts are directly or indirectly attached.
Advantages
• It is simple. Mandibular Major Connectors
• It has minimal tissue contact. i. Lingual bar.
• It has less plaque accumulation. ii. Lingual bar with continuous bar retainer (Kennedy Bar).
iii. Linguoplate.
iv. Labial bar.
Disadvantages
Q. 5. Minor connectors.
• It requires precise lab work.
• It cannot be placed when there is less than 8 mm of Ans.
lingual space.
Minor Connector
Contraindications Minor connector is that component that joins other units of
the prosthesis such as clasps, rests, indirect retainers, and
• When lingual tori exist and in cases of high lingual
denture bases to the major connector.
frenal attachment.
• High elevation of the floor of the mouth during func-
tional movements. Types of Minor Connectors
Minor connector which
Uses i. Joins the clasp assembly to the major connector.
ii. Joins indirect retainers or auxiliary rests to major
• Sublingual bar can be used along with a lingual plate if connector.
the lingual frenum does not interfere. iii. Joins the denture base to the major connector.
• It can also be used when an anterior lingual undercut iv. Serves as an approach arm for a vertical projection or
exist, where lingual bar cannot be used. bar-type clasp.

---------------------,( Topic 4)
Rests and Rest Seats
LONG ESSAYS
Q. 1. Classify 'rests' in removable partial denture. De- Classification of Rest
scribe the function and topography of occlusal rest, il-
lustrating with diagram the occlusal rest seat. Rest can be classified as follows:
• Based on the location it is classified as
Ans. i. Occlusal rest.
ii. Cingulum rest/lingual rest.
Rest
iii. Incisal rest.
Rest is a rigid extension of a fixed or removable partial • Based on the function it is classified as
denture. which contacts a remaining tooth or teeth to dis- i. Primary rest.
sipate vertical or horizontal forces. ii. Secondary or auxiliary rest.

Functions of Occlusal Rest
• It transmits stresses along the long axis of the tooth.
• It helps in distribution of occlusal loads.
• It provides resistance to lateral displacement.
• It prevents extrusion of the abutment.
• It helps avoid plunging of food between the tooth and
the clasp.
Design of Occlusal Rest
• The occlusal rest seat is a triangular shape depression
and its base is at the marginal ridge and the apex is at
the centre of the tooth.
SHORT ESSAYS
Q. 1. Rests and rest seats.
Or
Rest seat preparation.
Ans.
Rest
Rest is defined as a rigid extension of a fixed or removable
partial denture, which contacts a remaining tooth or teeth to
dissipate vertical or horizontal forces.
Rest Seat
It is defined as the prepared surface of an abutment to re-
ceive the rest.
Rules for rest seat preparation are as follows:
• Rest seat should be prepared in enamel.
• Guide plane should be prepared for effective function-
ing of the rest.
• The preparation of occlusal rest seat should be done
after proximal preparation.
• Occlusal rest seat preparations in existing restoration
are treated as same as the preparation on tooth.
• Secondary occlusal rest should be prepared on the op-
posite side of the tooth, if the primary rest seat prepara-
tion is not adequate in function.
• Occlusal rest seats in new restorations should be placed
in wax pattern.
• In crowns and inlays, occlusal rest seats are generally
made larger than those in enamel.
Q. 2. Functions of occlusal rest.
Or
Define occlusal rest and rest seat and describe the
preparation of occlusal rest.
Quick Review Series for BOS 4th Year: Prosthodontics
• The design should follow the contour of the mesial or
distal marginal ridge and the triangular fossa.
• The size of the occlusal rest should be one half of the
buccolingual width between the cusp tips and one third
to one half the mesiodistal width of the tooth.
• The line drawn along the proximal surface of the tooth
and the floor of the rest seat should be less than 90°.
• Improper preparation of the marginal ridge can lead to
fracture.
• The thickness of the rest seat should be 0.5 mm at the
thinnest portion and I .0- I .5 mm thick, where it crosses
the marginal ridge.
• On amalgam and cast gold, rest seat also can be pre-
pared.
Or
Write the characteristics of occlusal rest seat.
Or
Define occlusal rest and explain designing of occlusal
rest seat.
Ans.
Occlusal Rest
An occlusal rest is defined as a rigid extension of a partial
denture, which contacts the occlusal surface of the tooth.
Functions of Occlusal Rest
• It transmits stresses along the long axis of the tooth.
• It helps in the distribution of occlusal loads.
• It provides resistance to lateral displacement.
• It prevents extrusion of the abutment.
• It helps avoid plunging of food between the tooth and
the clasp.
Design of Occlusal Rest
• The occlusal rest seat is a triangular shape depression
and its base is at the marginal ridge and the apex is at
the centre of the tooth.
• The design should follow the contour of the mesial or
the distal marginal ridge and the triangular fossa.
• The size of the occlusal rest should be one half of the
buccolingual width between the cusp tips and one third
to one half the mesiodistal width of the tooth.
• The line drawn along the proximal surface of the tooth
and the floor of the rest seat should be less than 90°.
• Improper preparation of the marginal ridge can lead to
fracture.
Section I I Topic Wise Solved Questions of Previous Years
• The thickness of the rest seat should be 0.5 mm at the
thinnest portion and 1.0--- 1.5 mm thick, where it crosses
the marginal ridge.
• On amalgam and cast gold, rest seat also can be prepared.
Preparation of Occlusal Rest
• Occlusal rest is prepared using a diamond point of size
no. 6 and no. 8 round burs or with carbide burs.
SHORT NOTES
Q. 1. What are the different components of cast partial
denture.
Ans.
Components of Cast Partial Denture
The different components of cast partial denture include:
• Major connector.
• Minor connector.
• Rest.
• Direct retainers.
• Reciprocal or stabilizing components.
• Indirect retainers.
Q. 2. What are the requirements of an occlusal rest seat
preparation for a premolar?
Ans.
Rules for Occlusal Rest Seat Preparation
• Rest seat should be prepared in enamel.
• Guide plane should be prepared for effective function-
ing of the rest.
• The preparation of occlusal rest seat should be done
after proximal preparation.
• Occlusal rest seat preparations in existing restoration
are treated as same as the preparation on tooth.
• Secondary occlusal rest should be prepared on the oppo-
site side of the tooth, if the primary rest seat preparation
is not adequate in function.
• Occlusal rest seats in new restorations should be placed
in wax pattern.
• In crowns and inlays, occlusal rest seats are generally
made larger than those in enamel.
Q. 3. Rests and functions of rest in RPD.
Ans.
Rest
• Rest is defined as a rigid extension of a fixed or remov-
able partial denture, which contacts a remaining tooth or
teeth to dissipate vertical or horizontal forces.
• The larger diamond is used to prepare the marginal
ridge and for establishing the outline form of the occlu-
sal rest.
• Smaller diamond point is used to deepen the floor of the
occlusal rest seat.
• The remaining unsupported enamel rods are planed by
round bur.
• Lastly, an abrasive rubber point is used for finishing and
polishing of the preparation.
Functions of Rest
• Its primary function is to provide vertical support for the
partial denture.
• It helps maintain components in their planned posi-
tions.
• It prevents soft tissue impingement.
Q. 4. Define occlusal rest and rest seat and describe the
steps in the preparation of occlusal rest.
Ans.
Rest and Rest Seat
An occlusal rest is defined as a rigid extension of a par-
tial denture, which contacts the occlusal surface of the
tooth.
Rest seat is defined as the prepared surface of an abut-
ment to receive the rest.
Steps in the Preparation of Occlusel Rest
• Occlusal rest is prepared using diamond points of
size no. 6 and no. 8 round burs or with carbide
burs.
• The larger diamond is used to prepare the marginal
ridge and for establishing the outline form of the occlu-
sal rest.
• Smaller diamond point is used to deepen the floor of the
occlusal rest seat.
• The remaining unsupported enamel rods are planed by
round bur.
• Lastly, an abrasive rubber point is used for finishing and
polishing of the preparation.
Q. 5. Define rests and rest seats.
Ans.
• Rest is defined as a rigid extension of a fixed or remov-
able partial denture, which contacts a remaining tooth or
teeth to dissipate vertical or horizontal forces.
• Rest seat is defined as the prepared surface of an
abutment to receive the rest.
 Quick Review Series for BOS 4th Year: Prosthodontics

--------------------- -<( Topic 5 )

Direct and Indirect Retainers

LONG ESSAYS
Q. 1. Define direct retainer. Write the various principles consists of two units, one of which is a receptacle that is
of designing a clasp. built into a crown or inlay constructed for an abutment
tooth and the second unit is an insert that is attached to
Or
the RPD.
Classify extracoronal retainers in removable partial
dentures. Discuss the factors which influence the quality
Extracoronal Direct Retainers
and efficiency of clasp.
• Types of direct retainers which are placed on or attached
Or
to the external surface of an abutment tooth.
Define direct retainers. Classify extracoronal direct re- • The extracoronal retainers operate on the principle of
tainers. Discuss the application and design of RH clasp. the 'resistance of metal to deformation'.
Or
Types of Extracoronal Retainers
Define direct retainers. Classify them and discuss the
principles of designing them for a successful removable i. Manufactured units, e.g., Dalbo attachment.
partial denture. ii. Extracoronal spring-loaded plunger devices, e.g.,
Hannes anchor/IC plunger.
Ans.
iii. Flexible clips and rings.
iv. Clasps: These are most widely used.
Direct Retainer • It is designed such a way that one terminal of each
A direct retainer is that unit of the RPD, which engages an clasp assembly will be in an undercut.
abutment tooth in such a manner as to resist displacement • This retainer will help to prevent partial denture
of the prosthesis away from the basal seat. from being dislodged during function.
• Before designing the clasp, areas of an abutment
that provide retention and stabilization must be
Types of Direct Retainers identified by using a surveyor.
These cannot be strictly classified as either extracoronal
or intracoronal, but mostly depend on internal locking Components of Clasp Assembly
devices.
i. Rest
Examples of direct retainers It is the part of the clasp that lies on the occlusal, lingual,
i. Retaining devices or incisal edge of a tooth and provides support for prosthe-
• Zest anchor. sis, by resisting tissueward movement of the clasp (clasp
• Servo anchor. remains fixed).
• Bona ball.
• Rotherman. ii. Body
ii. Magnets for partial denture retention. It connects rest and clasp arms to minor connector.
iii. Spring-loaded plungers, e.g., Hannes anchor/IC plunger.
iv. Hader bar assembly (Splinted crowns). iii. Reciprocal arm
v. Sterngold GL attachments. It reciprocates/resists the tipping forces generated by the
retentive clasp. Therefore, reciprocal clasp must be rigid
and lie above the height of contour.
lntracoronal Direct Retainers
• The intracoronal retainer or internal attachment was iv. Retentive clasp arm
first developed by Dr Herman E S Chayes in 1906. It It includes shoulder and retentive terminal.
Section I I Topic Wise Solved Questions of Previous Years
v. Retentive terminal
It is the distal third of the retentive clasp, which is posi-
tioned below height of contour for direct retention.
vi. Minor connector
It joins body of clasp assembly to the remainder of frame-
work.
vii. Approach arm
It is a non-rigid minor connector that joins body and reten-
tive terminal of clasp to framework.
Criteria for Clasp Retention
i. Survey line location and degree of undercut.
ii. Based on the requirements of retention and stability,
depending on the number and configuration of edentu-
lous areas.
iii. Nature of support.
iv. Root size and form.
v. Oral hygiene and caries.
vi. Aesthetic requirements.
Following are the factors that determine the amount of
retention a clasp is capable of generating:
i. Size of angle of convergence (depth of undercut)
ii. The location and depth of a tooth undercut available for
retention are only relative to the path of placement and
removal of the partial denture.
iii. How far into the angle of cervical convergence the
clasp terminal is placed.
iv. Flexibility of the clasp arm ( flexibility - retention)
a. Length of the clasp arm: Longer the arm, more flex-
ible it will be because, as length increases, flexibility
increases which decreases the retentive ability of the
clasp.
b. Diameter of the clasp arm
• Greater the diameter less is the flexibility.
• Average diameter will be a point midway be-
tween its origin and its termination.
c. Cross-sectional form of the clasp arm
That is, shape of the clasp, whether it is rounded,
half-rounded, etc.
• Round cross-section clasps are most flexible.
• Half round forms show flexibility in one direc-
tion only.
• Therefore, they are more accepted in tooth-
supported partial dentures in which they are
called on to flex only during placement and re-
moval of prosthesis.
• In distal extension cases, round clasp is preferred,
because flexibility is needed not only during
placement and removal; but also during func-
tional movements of the denture base.
d. Materials used for the clasp arm
• Wrought clasp arms are more flexible.
• Cast clasps are less flexible.
• Gold has less modulus of elasticity, therefore,
more flexible but less retentive.
• Chrome-cobalt has more modulus of elasticity,
therefore it is less flexible but more retentive.
e. Stabilizing reciprocal clasp arm
• The reciprocal clasp arms are rigid and are usu-
ally cast clasps and hence decrease the flexibility.
Basic Principles of Clasp Design (Basic
Requirements)
i. Retention
The basic function of the retentive clasp arm is to provide
retention for total prosthesis against dislodging forces.
The retentive clasp is divided into three parts.
I Part (f) - Terminal third - It is flexible and engages
undercut area.
II Part (m) - middle third - It has limited flexibility
and may engage a minimal amount of undercut.
III Part (r) - Proximal third (shoulder) - It is rigid and
must be positioned above the height of contour.
ii. Support
Support is the property of a clasp that resists displacement
of the clasp in a gingival direction. The rests must be de-
signed in such a way that movement of the clasp arm cervi-
cally is prevented.
iii. Stability
Stability is resistance to horizontal displacement of prosthe-
sis. All clasp components except the retentive clasp termi-
nals contribute to this property. The cast circumferential
clasps offer greatest amount of stability, because of its rigid
shoulder when compared to wrought clasps which have a
flexible shoulder.
iv. Reciprocation
Each retentive arm should be opposed by a reciprocal com-
ponent capable of resisting any orthodontic pressure ex-
erted by retentive arm.
Functions of reciprocal arm
• It provides stabilization/reciprocation against the action
of the retentive arm.
• It also stabilizes the denture against horizontal move-
ments.
• The reciprocal arm may act as an indirect retainer to a
certain extent, i.e., when it rests on a suprabulge sur-
face of an abutment tooth lying anterior to the fulcrum
line.

Design specifications for a reciprocal arm
• It is positioned on the side of tooth opposite to the reten-
tive arm.
• The reciprocal arm must be rigid and should not be
tapered.
• It is positioned on a tooth surface that is reasonably
parallel to the denture's path of insertion and with-
drawal.
• It is ideally located at the junction of gingival and
middle third of abutment tooth.
Some special reciprocal elements
• At times, linguoplate can be used to provide recipro-
cation.
• Sometimes, an occlusal rest positioned on the opposite
side of the tooth will provide reciprocation.
v. Encirclement
Each clasp must be designed to encircle more than 180°
(more than half the circumference) of the abutment tooth. A
clasp that fails to provide encirclement will act like an orth-
odontic appliance exerting pressure on the abutments.
Encirclement may be of the following types:
i. Broken encirclement.
ii. Used with bar clasps.
vi. Passivity
Amount of retention should always be the minimum neces-
sary to resist dislodging forces, i.e., a clasp in place should
be completely passive. The retentive function is activated
only when dislodging forces are applied.
vii. Bilateral opposition
Retentive clasps should always be bilaterally opposed,
e.g., buccal retention on one side of the arch should be op-
posed by buccal retention on the other.
viii. Stress breaking
Clasp retainers on abutment teeth should be designed, so
that they will avoid direct transmission of forces to the
abutment, i.e., they must act as stress breakers. This is ac-
complished by proper location of the retentive terminal or
by the use of a more flexible clasp arm.
ix. Location of components
Ideally, reciprocal elements of the clasp assembly should
be located at the junction of the gingival and middle thirds
of the abutment crowns. The terminal end of retentive arm
is optimally placed in the gingival third of the crown.
x. Enclaspment
Path of enclaspment of the retentive terminal must be other
than parallel to the path of removal.
Q. 2. Define direct retainers in removable partial den-
tures. Classify them and discuss their indications.
Or
Quick Review Series for BOS 4th Year: Prosthodontics
Classify direct retainers in removable partial denture.
Explain different occlusally approaching clasp.
Or
What is direct retainer? Describe the parts of direct re-
tainer. What are the requirements of an ideal clasp design?
Or
Define direct retainer. Discuss in detail the extracoronal
direct retainer.
Ans.
Direct Retainer
A direct retainer is that unit of the RPD, which engages an
abutment tooth in such a manner as to resist displacement
of the prosthesis away from the basal seat.
Types of Clasps
I. Circumferential clasps
(Synonyms: Circlet, Occlusally approaching clasp, Pull-
type clasp, Ackers clasp, or Encircling clasp).
Advantages
• This is the easiest clasp to design and construct.
• It is the most logical clasp of choice for tooth-supported
partial denture, because of its excellent support, brac-
ing, and retentive qualities.
• It is also easiest to repair.
• There are fewer problems of food retention compared to
bar-type.
Disadvantages
• More tooth surface is covered compared to bar-type.
• Occlusal approach may increase the width of the occlu-
sal surface of the teeth.
• There are more chances of decalcification of enamel
surface and caries.
• In the mandibular arch, more metal may be displayed
than bar-type.
• As the normal buccolingual contour of the tooth is al-
tered, normal food flow pattern is hampered and could
also lead to damage of the gingival tissue, because of
lack of physiologic stimulation.
Types of circumferential clasps
i. Ring clasp
Encircle nearly all of a tooth from its point of origin. It should
always be used with a supporting stunt on the non-retentive side.
Uses
• It can be used on tilted molars.
• Isolated/Single tooth.
Section I I Topic Wise Solved Questions of Previous Years
• When proximal undercut cannot be approached by other
means.
Advantages
• It is an excellent bracing.
• It has decreased leverage.
• It has less stress on the abutment.
Disadvantages
• It has excessive coverage.
• It is difficult to repair.
ii. Back-action clasp
• Biologically and mechanically unsound.
• Least used, but has the advantage of very less display
and coverage.
iii. 'c'-clasp (also called fishhook clasp)
Indications
• Tooth-borne partial dentures.
• When bar clasp is contraindicated.
iv. Embrasure clasp
(Bonwilli's rib, double Akers, modified crib, back to back)
• It is used in cases where there is edentulous span on op-
posite side, i.e., unmodified class II and class III cases.
• They must have retentive and reciprocal arms, which are
bilateral or diagonally opposed.
• Embrasure clasp should always be used with double oc-
clusal rests to avoid interproximal wedging.
v. Multiple clasp
• This clasp consists of two opposing circumferential
clasps.
• It is used when additional retention is needed.
• For multiple clasping, when the prosthesis replaces an en-
tire half of the dental arch, as the retention needed is more.
vi. Half and half clasp
• It consists of circumferential retentive arm from one
direction and reciprocal arm arising from another.
• This clasp is used for dual retention in unilateral partial
denture design.
vii. Reverse action (or) hairpin clasp
• It is also called reverse approach circlet clasp.
• It is used when the retentive undercut is located on the
surface of abutment tooth adjacent to the edentulous space.
• In such cases, usually bar-type clasps and ring clasps
are used, but there are some instances when they are
contraindicated.
For example,
i. When proximal undercuts are located on a posterior
abutment or when teeth are tilted.
ii. When there is no space, ring clasp cannot be accom-
modated. Here again, reverse action clasp is indicated.
Disadvantages of reverse action clasp
• Clasp covers considerable amount of tooth surface and
may lead to food entrapment.
• Increases the functional load on teeth.
• It has limited flexibility.
• It cannot be used in the anterior region (aesthetically poor).
viii. Onlay clasp
• It is an extended occlusal rest with buccal and lingual
clasp arms.
• This clasp is generally indicated when the occlusal sur-
face of the abutment tooth is below the occlusal plane,
because of the tooth being tipped or rotated.
• The onlay clasp is basically used to restore the normal
occlusal plane.
II. Bar-type clasps
(Synonyms: Roach clasp; Push-type; or Gingivally ap-
proaching clasp).
• The bar clasps approach the undercut or retentive area
on the tooth from a gingival direction, resulting in a
'push-type' of retention. This push retention of
bar clasps is more effective than the 'pull' retention of
circumferential clasps.
• Because of the gingival approach of the bar clasp, it is
usually more aesthetic than a circumferential clasp.
Disadvantages of bar clasps
• It has tendency to collect foot debris.
• Because of increased flexibility, it does not contribute as
much to bracing and stabilization as most circumferen-
tial clasps do.
Types of bar clasps
• T-clasp.
• Modified
• I-clasp.
• Y-clasp.
(As classified by the shape of retentive terminal)
Current Concept: RPI System
• RPI concept introduced by Dr Kratochvil and Krol
(1973).
• Basis for RPI philosophy.
• Distribution of load applied to tooth and edentulous ridge.
 Quick Review Series for BOS 4th Year: Prosthodontics

• Location of rest and location of retentive arm.
• Design of minor connector, as it relates to guiding
planes.
RPI Concept (Rest, Proximal plate, /-Bar)
RPI consists of:
i. Mesio-occlusal rest with minor connector in the mesio-
lingual embrasure, but not contacting adjacent tooth.
ii. Distal guiding plane extending from marginal ridge to
the junction of middle and gingival thirds of abutment
tooth (prepared to receive proximal plate).
iii. I-bar located in gingival third of buccal or labial surface
of the abutment (0.01 inch undercut).
Indications
i. When a small degree of undercut (0.01 inch) exists in
the cervical third of the abutment tooth, which may be
approached from gingival direction.
ii. On abutment teeth for tooth-supported RPD and tooth-
supported modification areas.
When the undercut is on the side of the abutment away
from the extension base, the tapered wrought wire retentive
arm offers greater flexibility and thus dissipates functional
stresses.
Indications
• Abutment tooth adjacent to distal extension base (me-
siolingual undercut; large tissue undercut).
• Weak abutment (when greater flexibility is desired).
• When bar-type clasp is contraindicated.
• On maxillary canines/premolars for aesthetic reasons.
Advantages
• Flexibility.
• Adjustability.
• Aesthetics.
• Minimum tooth surface coverage.
• There are less chances of failure.
• It can be used on weak abutments.

Contraindications Disadvantages
• Extra steps in fabrication.
i. Deep cervical undercuts.
• Distorted by careless handling.
ii. Severe tooth/tissue undercut.
• Bent by hand, i.e., finger nails to be applied to its point
iii. Shallow vestibule.
of origin.
iv. Excessive buccal/lingual tilt of abutment tooth.
Q. 3. Write in detail about the various modifications of
Special Types of Clasps circumferential clasps and add a note on intracoronal
direct retainers.
i. lnfrabulge clasp
• Type of bar clasp arm which arises from the border of Ans.
denture base, either as an extension of the cast base or
attached to border of resin base. Types of Circumferential Clasps
• It is more flexible than usual bar clasp arm.
Ring Clasp
Types It encircles nearly all of a tooth from its point of origin. It
• Saw cut. should always be used with a supporting stunt on the non-
• Wrought. retentive side.
• Cast.
Uses
Advantages
• Tilted molars.
• Aesthetically good because of interproximal location. • Isolated/single tooth.
• Increased retention. • When proximal undercut cannot be approached by other
• Less chances of accidental distortion. means.
ii. Combination clasp
Advantages
• Combination clasp consists of a wrought wire retentive
clasp arm and a cast reciprocal arm. • It has excellent bracing.
• It also has decreased leverage.
Mechanism of action of a combination clasp • Less stress on the abutment.

The greatest flexibility of the wrought wire acts as a stress Disadvantages

equalizer, preventing the undesirable forces created by • It has excessive coverage.
lever action of the retentive clasp tip. • It is difficult to repair.
Section I I Topic Wise Solved Questions of Previous Years
Back-action Clasp
• This clasp is biologically and mechanically unsound.
• This is least used, but has the advantage of very less
display and coverage.
/C'-CLASP (also called FISHHOOK CLASP)
Indications
• Tooth-borne partial dentures.
• When bar clasp is contraindicated.
Embrasure Clasp (Bonwilli's rib, Double Akers,
Modified Crib, Back to Back)
• It is used in cases where there is edentulous span on op-
posite side, i.e., unmodified class II and class III cases.
• It should have retentive and reciprocal arms which are
bilateral or diagonally opposed.
• Embrasure clasp should always be used with double oc-
clusal rests to avoid interproximal wedging.
Multiple Clasp
• It consists of two opposing circumferential clasps.
• It is used when additional retention is needed.
• It is used for multiple clasping when the prosthesis re-
places an entire half of the dental arch, as the retention
needed is more.
Half and Half Clasp
• It consists of circumferential retentive arm from one
direction and reciprocal arm arising from another.
• It is used for dual retention in unilateral partial denture
design.
Reverse Action (or) Hairpin Clasp
• It is also called as reverse approach circlet clasp.
• It is used when the retentive undercut is located on the
surface of abutment tooth adjacent to the edentulous
space.
• In such cases, usually bar-type clasps and ring clasps
are used, but there are some instances when they are
contraindicated.
For example,
• When proximal undercuts are located on a posterior
abutment or when teeth are tilted,
• Therefore reverse action clasps are indicated.
• When there is no space, ring clasp cannot be accom-
modated. Here again, reverse action clasp is indicated.
Disadvantages of reverse clasp
• Clasp covers considerable amount of tooth surface and
may lead to food entrapment.
• It increases the functional load on teeth.
• It has limited flexibility.
• It cannot be used in the anterior region (aesthetically
poor).
Onlay Clasp
It is an extended occlusal rest with buccal and lingual clasp
arms.
• This clasp is generally indicated when the occlusal sur-
face of the abutment tooth is below the occlusal plane,
because of the tooth being tipped or rotated.
• The onlay clasp is basically used to restore the normal
occlusal plane.
lntracoronal Retainers
• The intracoronal retainer or internal attachment was
first developed by Dr Herman E S Chayes in I 906. It
consists of two units, one of which is a receptacle that is
built into a crown or inlay constructed for an abutment
tooth and the second unit is an insert that is attached to
the RPD.
• Types of intracoronal retainers - See Classification of
intraoral retainers.
Advantages
i. Elimination of visible retentive and support compo-
nents.
ii. Better vertical support through rest seat located
favourably.
iii. Stimulation of underlying tissues.
iv. Horizontal stabilization.
Disadvantages
i. It requires prepared abutment and castings.
ii. Complicated clinical and lab procedures.
iii. Wear-out eventually leading to loss of friction.
iv. It is difficult to repair and replace.
v. It is effective in proportion to length (Cannot be used
in short tooth).
vi. It is difficult to place within the circumference of the
abutment.
vii. It is costly.
viii. It cannot be used in younger individuals with large
pulp chambers.
 Quick Review Series for BOS 4 th Year: Prosthodontics

SHORT ESSAYS
Q. 1. RPI concept. Indirect Retainer
Ans. Indirect retainer is a unit of the removable partial denture
that assists the direct retainers in preventing displacement
of distal extension denture bases, by functioning through
I-Bar - A Part of the RPI System (Rest,
lever action on the opposite side of the fulcrum line.
Proximal Plate, I-Bar)
• This clasp assembly consists of a mesio-occlusal rest Forms of Indirect Retainers
with the minor connector placed into the mesiolingual
embrasure. Auxiliary occlusal rests.
i.
• A distal guiding plane extending from the marginal Canine extension from occlusal rests.
ii.
ridge to the junction of the middle and gingival thirds of iii.Canine rests.
the abutment is prepared to receive a proximal plate. iv.Continuous bar retainers and linguoplates.
The proximal plate in conjunction with the minor con- v. Modification areas.
nector supporting the rest provides the stabilizing and vi. Rugae support.
reciprocal aspects of the clasp assembly
• The I-bar should be located in the gingival third of the Functions of Indirect Retainers
buccal or labial surface of the abutment in 0.01 inch
Principal function
undercut.
• Activation of direct retainers to prevent movement of
distal extension base (prevention of denture rotation
RPI about an axis).
The clasp system includes the three elements (Kratochvil's
Auxiliary function
system) Mesia! rest, proximal plate, and I-bar.
i. It reduces anteroposterior tilting leverages on the prin-
cipal abutments, especially when an isolated tooth is
Krol's Criteria being used as an abutment.
i. Rest preparations are less extensive in the RPI system. ii. It helps in stabilization.
The mesial rest prepared on molars and canines are iii. It acts as an auxiliary guiding plane.
often circular concave depressions prepared in the me- iv. It splints the anterior teeth against lingual movement.
sial marginal ridge. v. It may act as an auxiliary rest to support a portion of the
ii. Proximal plate is diminished in all directions and I-bar major connector.
retentive tips are placed mesial to the mesiodistal height vi. It may provide the first visual indication to reline an
of contour. extension base.
iii. Occlusal force on extension base disengages proximal
plate into gingival concavity and- I-bar disengages into Mode of Action of Indirect Retainers
interproximal embrasure. How an indirect retainer prevents denture rotation?
Tipped abutments and tissue impingement are treated with Movement of distal extension base towards the tissuew
a further modification, the RP A clasp (rest, proximal plate,
and Akers clasp).
When the Akers clasp arm is used, careful attention is
l
Rotational movement about an axis away from the tissue
paid to relieve all undercuts except at the retentive tip.
The requirements of a partial denture clasp system
(vertical support, horizontal stabilization, retention,
reciprocation, and passivity) are all met by the I-bar
l
Displacement of the entire denture occurs around an
system. imaginary axis passing through teeth and component parts
Q. 2. Describe briefly the indirect retainers. of the RPD. This imaginary axis is called 'fulcrum line'.

Or Location of fulcrum lines for different classes

Functions of indirect retainers in RPD. Class I: Fulcrum line passes through most posterior abutments.
Class II: Fulcrum line is diagonal (abutment on distal ex-
Ans. tension side and most posterior tooth on opposite side).
Section I I Topic Wise Solved Questions of Previous Years
Class III: Fulcrum line is diagonal, passing through two
principal abutments.
Class IV: Fulcrum line passes through two abutments adja-
cent to the edentulous space.
Action of Indirect Retainers
Indirect retainers prevent displacement of denture base in
two ways. They are:
a. Resistance is provided by rests, extensions, rugae
support, etc.
b. Activation of direct retainer assembly (leverage
advantage).
Principles for Using Indirect Retainers
i. More than one fulcrum line may be present for some
dentures.
ii. Indirect retainers must be placed as far as possible
from the distal extension base, for best leverage ad-
vantage.
iii. Most effective location for indirect retainer is in the
incisor region, but owing to its poor strength, a canine
or premolar is taken
iv. Whenever possible, two indirect retainers, closer to the
fulcrum line are taken to compensate for the compro-
mise in distance.
Factors Influencing Effectiveness of Indirect
Retainers
i. Effectiveness of direct retainer: The retentive arms of
the direct retainer must hold the principal occlusal rests
properly, in order to make them effective.
ii. Distance from fulcrum line
a. Length of distal extension base.
b. Location of fulcrum line.
c. How far beyond the fulcrum line the indirect
retainer is placed.
iii. Rigidity of connector supporting the indirect retainer.
iv. Effectiveness of supporting tooth surface: Tooth in-
clines and weak teeth should never be used for support
of indirect retainers.
Q. 3. Describe briefly cast circumferential clasp.
Ans.
Cast Circumferential Clasp
Cast circumferential clasp is the method of choice for
tooth-supported partial dentures. The retentive arm should
originate above occlusal half, with the retentive terminal
placed below height of contour and pointing occlusally.
Advantages
i. It provides good support, retention, and reciprocation.
ii. It is easy to repair.
iii. There is less food retention compared to bar clasp.
Disadvantages
i. Large amount of tooth surface covered that can cause
decalcification and caries.
ii. Minimum flexibility and cannot be used in distal exten-
sion bases.
iii. It interferes with normal food flow pattern.
iv. It is not aesthetic.
Types of Cast Circumferential Clasp
i. Simple circlet clasp
It is the choice for tooth-supported partial denture. The
clasp approaches undercut from edentulous area and
engages undercut opposite to edentulous space.
Advantages
i. It provides good support, stability, encirclement, and
very good passivity.
ii. It is the most widely used clasp.
Disadvantages
i. Large amount of tooth surface is covered that can cause
decalcification and caries.
ii. There is minimum flexibility and cannot be used in
distal extension bases.
iii. It interferes with normal food flow pattern.
ii. Reverse circlet clasp
This clasp is used when undercuts are present near the
edentulous space. Ideally bar clasp is the choice; but in
situations as soft tissue undercuts where bar clasp cannot be
used, reverse clasp is used.
Advantage
It is good for distal extension partial dentures.
Disadvantages
i. It is difficult to obtain occlusal clearance where
there is tight occlusion between upper and lower
teeth.
ii. It may cause food entrapment, if occlusal rest is not
well prepared.
iii. Wedging effect, as it is placed between two teeth.
iv. It is not aesthetic.
iii. Multiple circlet clasp
• It consists of two opposing simple circlet clasps joined
at the terminal end of reciprocal arms.
• Used as a splinting effect of weak tooth.
 Quick Review Series for BOS 4th Year: Prosthodontics

Disadvantages Disadvantages
i. Large amount of tooth surface covered that can cause i. It only can be used in tooth with adequate occlusogin-
decalcification and caries. gival height.
ii. Minimum flexibility and cannot be used in distal exten- ii. There tends to be food accumulation between the upper
sion bases. and lower clasp arms.
iii. It interferes with normal food flow pattern. iii. The upper arm can cause occlusal interference in tight
iv. It is not aesthetic. occlusion of upper and lower arch.
iv. It can cause caries.
iv. Embrasure clasp v. It is not aesthetic.
• It consists of two simple circlet clasps joined at the body. vi. Large amount of tooth surface covered that can cause
• The clasp crosses the marginal ridge and the facial decalcification and caries.
surface of both the teeth. And, engages undercuts on vii. Minimum flexibility and cannot be used in distal
the opposite sides of the respective teeth. extension bases.
• This clasp is used on side, where there is no edentu- viii. It interferes with normal food flow pattern.
lous space.
• Embrasure clasps should have two retentive clasp vii. Onlay clasp
arms and two reciprocal clasp arms, either bilater- • It covers the entire occlusal surface with buccal and
ally or diagonally opposed. lingual clasp arms.
• It should be made in patients with good oral hygiene.
Disadvantages • Occlusal surface should be of gold or acrylic.
i. Occlusal rest should be prepared on both the teeth.
ii. It is difficult to get occlusal clearance. Indication
iii. Large amount of tooth surface covered that can cause • To correct occlusal plane discrepancies, as in tooth
decalcification and caries. tipping or rotation.
iv. Minimum flexibility and cannot be used in distal exten-
sion bases. viii. Combination clasp
v. It interferes with normal food flow pattern.
• This clasp consists of a wrought wire retentive terminal
vi. It is not aesthetic.
and cast reciprocal arm.
• The wrought wire can be incorporated during wax up or
Indication can be soldered later on.
• When spacing is present between two teeth.
Indications
v. Ring clasp
i. In distal extension, partial denture with mesiobuccal
• It encircles nearly all of a tooth from its point of origin. undercut.
• It is used when a proximal undercut cannot be approached ii. It can be used in deeper undercuts due to its flexibility.
by other means as in a distobuccal or distolingual undercut.
• The ring-type clasp should be used on protected abut-
ments, as it covers such a large area of tooth surface. Disadvantages
i. It requires additional work during laboratory fabrication.
Disadvantages ii. There are chances of breakage.
iii. It can be easily distorted during normal handling.
i. It is not aesthetic. iv. It has less bracing and stabilization compared to other
ii. Large amount of tooth surface covered that can cause circumferential clasp.
decalcification and caries.
iii. Minimum flexibility and cannot be used in distal exten-
Advantages
sion bases.
iv. It interferes with normal food flow pattern. i. Flexibility.
ii. Adjustability.
vi. Fish hook or Hairpin clasp iii. Aesthetic advantage over other retentive circumferen-
• It is a simple circlet clasp in which the retentive arm crosses tial clasp arms.
the facial surface of the tooth and loops back in a hairpin iv. Minimum of tooth surface is covered compared to a
turn, to engage the undercut below its point of origin. cast clasp arm.
• The upper arm acts as a minor connector and is rigid; v. Fatigue failures are less compared to a cast, half-round
the lower arm is tapered and is flexible. retentive arm.
Section I I Topic Wise Solved Questions of Previous Years

Q. 4. Bar clasp. Parts of Bar Clasp

Or i. Approach arm.
ii. Minor connector.
Roach clasp.
iii. Two terminals.
Ans. a. The retentive terminal leaves the approach arm and
extends into the undercut.
Bar Clasp b. The other terminal is positioned above height of
contour opposite to the edentulous area.
• The bar clasp arm has been classified by the shape of the
retentive terminal as T, modified T, I, Y, or almost any
letter clasp arm. Location
They originate from the framework or base and approach They originate from the framework or base and approach
the undercut from a gingival direction. the undercut from a gingival direction.
Flexibility is adjusted depending on the taper and length
of the approach arm.
Rules of Use
Advantages i. The approach arm should not impinge on the soft
tissue, as it crosses the soft tissues. The tissue side
• It is more aesthetic. of the approach arm should be smooth and well
polished.
Disadvantages ii. Minor connector attaching occlusal rest to the
• It causes food entrapment. framework should be strong and rigid to provide
• Less bracing and stabilization compared to C-clasp. bracing.
iii. The taper of approach arm should be uniform from its
attachment to the clasp terminal.
Rules of Use
iv. The approach arm must never cross a soft tissue un-
i. Approach arm should not impinge on soft tissues. dercut.
ii. Minor connector attached to bar clasp should be v. The approach arm should cross the gingival margin
rigid. at a 90° angle.
iii. Approach arm should be uniformly tapered and should vi. The retentive terminal should be placed in the under-
cross the gingival margin at 90°. cut adjacent to the edentulous area.
iv. Approach arm should extend to the height of contour. vii. The approach arm should extend on the abutment
v. The bar clasp is used, only if the retentive area is tooth to the height of contour.
adjacent to edentulous. viii. The other terminal should be positioned above the
vi. Retentive terminal of bar clasp should point towards height of contour.
the occlusal surface. ix. The bar clasp should also be placed as low on the tooth
vii. Bar clasp should be placed as low on tooth as possible. to reduce the leverage-induced stress to the abutment
tooth.
Bar or Roach Clasp
The component that engages an abutment tooth and in do- Types of Bar Clasps
ing so, resists dislodging forces applied to a removable
partial denture is called the direct retainer. i. T-clasp
Other names • It is used often along with cast circumferential recip-
• Vertical projection clasp. rocal arm.
• Gingivally approaching clasp. • The retentive terminal and its opposing terminal project
• Push-type retainer. laterally from the approach arm to form a T.
• Both terminals should point toward the occlusal surface
of the abutment tooth.
Types of Bar Clasp
• The retentive terminal must cross the height of contour
It is classified by the shape of the retentive terminal as: to engage the retentive undercut, while the other termi-
i. T, I, and Y shape. nal is placed on the suprabulge of the tooth.
ii. Modified T, Y, and I bar. • The approach arm contacts the tooth only at the height
iii. Other shapes are also used. of contour.
 Quick Review Series for BOS 4th Year: Prosthodontics

Uses Disadvantage
• In distal extension ridge with distobuccal undercut. • Encirclement and horizontal stabilization are compro-
• It can also be used for tooth-supported partial denture, mised.
if the retentive undercut is located adjacent to the eden-
Q. 5. Ring clasp.
tulous space.
Ans.
Disadvantages
Ring Clasp
i. The T-clasp can never be used when soft tissue undercut
is present (If used causes food retention and irritation to Ring clasp encircles nearly all of a tooth from its point of
the lips and cheeks). origin. It should always be used with a supporting stunt on
ii. Never to be used when the height of contour is close to the non-retentive side.
the occlusal surface of an abutment tooth.
iii. Not to be used in mesiobuccal undercuts. Uses
ii. Modified T-clasp • Tilted molars.
The modified T-clasp is a clasp in which only one terminal • Isolated/Single tooth.
is present (only the retentive terminal). • When proximal undercut cannot be approached by other
The non-retentive (usually mesial) finger is omitted. means.

Advantages
Uses
• Excellent bracing.
Used on canines or premolars for aesthetics.
• Decreased leverage.
• Less stress on the abutment.
Disadvantage
180° coverage is not present which compromises bracing Disadvantages
and reciprocation.
• Excessive coverage.
iii. Y-clasp • Difficult to repair.
• This is commonly used when the height of contour on Q. 6. Combination clasp.
the facial surface of the abutment tooth is high on the
Ans.
mesial and distal line angles, but low on the centre of
the facial surface.
• If recontouring can help to bring the survey line to the Combination Clasp
middle, a T-clasp can be used. Combination clasp is one type of extra coronal direct re-
iv. I-clasp and I-bar tainer consisting of a wrought wire retentive terminal and
cast reciprocal arm. The wrought wire can be incorporated
• It is used on the distobuccal surface of maxillary canines.
during wax up or can be soldered later on.
• I-bar is a part of the RPI system (Rest, Proximal plate,
I-bar).
• This clasp assembly consists of a mesiocclusal rest with Parts of Combination Clasp
the minor connector placed into the mesiolingual em-
a. Reciprocal arm.
brasure.
b. Occlusal rest.
• A distal guiding plane, extending from the marginal
c. Retentive arm.
ridge to the junction of the middle and gingival thirds of
d. Flexible retentive terminal made of wrought wire.
the abutment, is prepared for proximal plate. The proxi-
mal plate, along with the minor connector supporting
the rest, provides stabilization and reciprocation for the Rules of Use
clasp assembly. i. The cast reciprocal arm of a combination clasp is a
• The I-bar should be located in the gingival third of the circumferential clasp. A bar clasp also can be used.
buccal or labial surface of the abutment in 0.01 inch ii. The wrought wire retentive arm is a circumferential
undercut. clasp arm.
Section I I Topic Wise Solved Questions of Previous Years
iii. Depending on the choice of material for combination
clasp, the technique for joining the clasp to the retentive
arm varies.
iv. If the partial denture framework is constructed of
gold or low-heat chrome alloy, the wrought wire
clasp can be waxed up along with framework and
the alloy can be cast directly to the wrought wire
clasp.
v. If a high-heat chrome alloy is used, then the wrought
wire has to be soldered to the framework.
Indications
• In distal extension partial denture with mesiobuccal
undercut.
• In deep undercuts.
Advantages
i. Flexibility.
ii. Adjustability.
iii. It can be placed in the gingival third of the clinical
crown of the abutment tooth, for better aesthetics.
iv. Minimum of tooth surface is covered compared to a
cast clasp arm.
v. Fatigue failures are less compared to a cast, half round
retentive arm.
vi. The round wrought wire makes only a line contact
with the surface of the abutment tooth, which makes it
less caries-prone.
vii. It dissipates torque forces exerted on the abutment
tooth efficiently due to its flexibility.
viii. It can be used in distal extension bases.
ix. It can be placed in deeper undercuts.
Disadvantages
i. It requires additional work during laboratory fabrication.
ii. There are chances of breakage.
iii. It is easily distorted during normal handling.
iv. Less bracing and stabilization compared to other
circumferential clasp.
Q. 7. Factors governing clasp design.
Ans.
Following are the factors that determine the amount of
retention a clasp is capable of generating:
i. Size of angle of convergence (depth of undercut)
The location and depth of a tooth undercut available for
retention are only relative to the path of placement and
removal of the partial denture.
ii. How far into the angle of cervical convergence the
clasp terminal is placed.
iii. Flexibility of the clasp arm
a. Length of the clasp arm
Longer the arm, more flexible it will be because, as
length increases, flexibility increases which decreases
the retentive ability of the clasp.
b. Diameter of the clasp arm
• Greater the diameter less is the flexibility.
• Average diameter will be a point midway be-
tween its origin and its termination.
c. Cross-sectional form of the clasp arm
That is, shape of the clasp, whether it is rounded,
half-rounded, etc.
• Round cross-section clasps are most flexible.
• Half round forms show flexibility in one direc-
tion only.
Therefore, they are more accepted in tooth-supported
partial dentures in which they are called on to flex
only during placement and removal of prosthesis.
• In distal extension cases, round clasp is pre-
ferred, because flexibility is needed not only
during placement and removal but also during
functional movements of the denture base.
d. Material used for the clasp arm
• Wrought clasp arms are more flexible.
• Cast clasps are less flexible.
• Gold has less modulus of elasticity, therefore
more flexible but less retentive.
• Chrome-Cobalt has more modulus of elasticity,
therefore it is less flexible but more retentive.
e. Stabilizing reciprocal clasp arm
• The reciprocal clasp arms are rigid and are usu-
ally cast clasps and hence decrease the flexibility.
Basic Principles of Clasp Design (Basic Requirements)
i. Retention
The basic function of the retentive clasp arm is to provide
retention for tile prosthesis against dislodging forces.
The retentive clasp is divided into three parts.
I Part (f) - Terminal third - It is flexible and engages
undercut area.
II Part (m) - Middle third - It has limited flexibility
and may engage a minimal amount of undercut.
III Part (r) - Proximal third (shoulder) - It is rigid and
must be positioned above the height of contour.
ii. Support
Support is the property of a clasp that resists displacement
of the clasp in a gingival direction. The rests must be
designed in such a way that movement of the clasp arm
cervically is prevented.
iii. Stability
Stability is resistance to horizontal displacement of prosthe-
sis. All clasp components except the retentive clasp terminals
 Quick Review Series for BOS 4 th Year: Prosthodontics

contribute to this property. The cast circumferential clasps iv. Reciprocation

offer greatest amount of stability, because of its rigid shoul- Each retentive arm should be opposed by a reciprocal com-
der when compared to wrought clasps which have a flexible ponent capable of resisting any orthodontic pressures ex-
shoulder. erted by retentive arm.

SHORT NOTES
Q. 1. Direct Retainers. Types of Bar Clasp
Ans. It is classified by the shape of the retentive terminal as:
i. T, I, and Y shape.
ii. Modified T, Y, and I bar.
Direct Retainer
iii. Other shapes are also used.
A direct retainer is that component that engages an abutment
Q. 4. What is indirect retainer? And what are the different
tooth and in doing so, resists dislodging forces applied to a
forms of indirect retainer?
removable partial denture. A clasp, an attachment is applied
to an abutment tooth for the purpose of holding a RPD in Or
position.
Indirect retainers.

Ans.
Classification
i. lntracoronal retainers. Indirect Retainer
ii. Extracoronal retainers.
a. Circumferential or Akers clasp (occlusally approaching). Indirect retainer is a unit of the removable partial denture
b. Vertical projection or Roach clasp. that assists the direct retainers in preventing displacement
of distal extension denture bases, by functioning through
Q. 2. Functions of reciprocal arms. lever action on the opposite side of the fulcrum line.

Ans.
Forms of Indirect Retainers
i. Auxiliary occlusal rests.
Functions of Reciprocal Arm
ii. Canine extension from occlusal rests.
• It provides stabilization/reciprocation against the action iii. Canine rests.
of the retentive arm. iv. Continuous bar retainers and linguoplates.
• It stabilizes the denture against horizontal move- v. Modification areas.
ments. vi. Rugae support.
• The reciprocal arm may act as an indirect retainer to
Q. 5. Extracoronal retainers.
a certain extent, i.e., when it rests on a suprabulge
surface of an abutment tooth lying anterior to the Ans.
fulcrum line.
Extracoronal Direct Retainers
Q. 3. Roach clasp.
• Types of direct retainers which are placed on or attached
Ans. to the external surface of an abutment tooth.
• The extracoronal retainers operate on the principle of
Roach Clasp the 'resistance of metal to deformation'.
The component that engages an abutment tooth and in do-
Types of Extracoronal Retainers
ing so, resists dislodging forces applied to a removable
partial denture is called the direct retainer. i. Manufactured units, e.g., Dalbo attachment.
Other names ii. Extracoronal spring-loaded plunger devices, e.g.,
• Vertical projection clasp. Hannes anchor/IC plunger.
• Gingivally approaching clasp. iii. Flexible clips and rings.
• Push-type retainer. iv. Clasps: These are most widely used.
Section I I Topic Wise Solved Questions of Previous Years

Q. 6. Parts of clasp. Precision Attachment

Or A precision attachment is a mechanical device for fixation,
retention, and stabilization of dental prosthesis.
Clasp assembly.

Ans.
Classification
Components of Clasp Assembly a. Based on fabrication
• Semi-precision.
i. Rest: Part of the clasp that lies on the occlusal, lingual,
• Precision.
or incisal edge of a tooth and provides support for pros-
b. Based on function
thesis by resisting tissueward movement of the clasp
• Resilient.
(clasp remains fixed).
• Non-resilient.
ii. Body: Connects rest and clasp arms to minor connector.
c. Based on location/placement
iii. Reciprocal arm: Reciprocates/resists the tipping forces
• Intracoronal.
generated by the retentive clasp. Therefore, reciprocal
• Extracoronal.
clasp must be rigid and lie above the height of contour. d. Based on E M Selector.
iv. Retentive clasp arm: Includes shoulder and retentive
terminal.
v. Retentive terminal: It is the distal third of the retentive Functions
clasp which is positioned below height of contour for
i. It relieves dental stress from occlusal forces and redi-
direct retention.
rects those forces to other bearing areas that can tolerate
vi. Minor connector: Joins body of clasp assembly to the
stresses better.
remainder of framework.
ii. It provides cross-arch stabilization required for weak
vii. Approach arm: It is a non-rigid minor connector
periodontal teeth.
that joins body and retentive terminal of clasp to
framework.
Q. 7. Indications of embrasure clasp. Indications
Ans. i. It is used for tooth-supported dentures.
ii. When other direct retainers cannot be used.
Embrasure Clasp or Modified Crib Clasp iii. Overdentures.
iv. In combination with implants.
It is a type of extracoronal direct retainer. v. For stress equalization.

Design Advantages
• Two simple circlet clasps are joined at the body. The i. Aesthetic.
clasp crosses the marginal ridge and facial surface of ii. Retention in overdenture.
both the teeth and engages undercuts on the opposite iii. Improved leverage management.
sides of the respective teeth. iv. No need for indirect retention.
• It is used on side, where there is no edentulous space.
• Embrasure clasps should have two retentive clasp arms
and two reciprocal clasp arms, either bilaterally or di- Disadvantages
agonally opposed.
i. Expensive, bulky, and requires more chair-time.

Q. 9. Infrabulge.
Indication
Ans.
This is indicated, when spacing is present between two teeth.
Q. 8. Precession attachment. lnfrabulge Clasp
Or • This is a type of bar clasp arm, which arises from the
Precision attachments/semi-rigid connectors. border of denture base, either as an extension of the cast
base or attached to border of resin base.
Ans. • It is more flexible than usual bar clasp arm.
 Quick Review Series for BOS 4th Year: Prosthodontics

Types Types of Circumferential Clasps

• Saw cut. i. Ring clasp.
• Wrought. ii. Back-action clasp.
• Cast. iii. 'C'-clasp (also called fish hook clasp).
iv. Embrasure clasp (Bonwilli's rib, double Akers, modi-
fied crib, back to back).
Advantages
v. Multiple clasp.
• Aesthetically good, because of interproximal location. vi. Half and half clasp.
• Increased retention. vii. Reverse action ( or) hairpin clasp.
• Less chances of accidental distortion. viii. Onlay clasp.
Q. 10. Name the types of bar clasps. Q. 12. Intracoronal retainers.
Ans. Ans.

Types of Bar Clasp lntracoronal Attachments

Bar clasp is classified by the shape of the retentive ter- Parts: A flange and a slot.
minal as: The flange is joined to one section of the prosthesis and
i. T, I, and Y shape. the slot unit is embedded in a restoration forming part of
ii. Modified T, Y, and I-bar. another section of the prosthesis.
iii. Other shapes are also used.
Q. 11. Cricumferential clasp. Types of lntracoronal Attachments
Ans. • Retention entirely by friction (McCollum intracoronal
unit).
Circumferential Clasps • Retention by a mechanical lock (Schatzmann unit).
Synonyms: Circlet, occlusally approaching clasp, pull-type
clasp, Akers clasp, or encircling clasp.

------------------- <( Topic 6)

Denture Base Considerations

LONG ESSAYS
Q. 1. Discuss how you will minimize the stress on abut-
ment in case of distal extension partial denture.
Ans.
Minimizing the Stress on Abutment in Distal
Extension Partial Denture
• In order to minimize the stress in case of distal exten-
sion partial denture, devices like stress breakers are
used.
• Stress breaker is defined as a device, which relieves the
abutment tooth of all or part of the occlusal forces
(GPT).
• Other names for stress breakers are broken stress par-
tial dentures or articulated prostheses or semi-rigid
connectors.
• Since the tissues are more compressible, the amount of
stress acting on the abutments is increased. To protect
the abutment from such stress, a stress breaker is incor-
porated into a denture.
Types of Stress Breakers
There are two types of stress breakers:
A. Type I.
B. Type II.
Section I I Topic Wise Solved Questions of Previous Years
A. Type I
i. In this type, a movable joint is placed between the di-
rect retainer and denture base.
ii. This joint can be a hinge, a ball and socket, a sleeve, or
a cylinder.
iii. By adding these stress breakers to the junction of the
direct retainer and the denture base, it allows the den-
ture base to move independently and decreases the
amount of force acting on the abutment.
iv. The combined resiliency of the periodontal ligament
and the stress director will be equal to that of the oral
mucosa overlying the ridge. Example of hinges - Dalbo
and Crismani.
B. Type II
i. This type consists of a flexible connection between the
direct retainer and the denture base.
ii. It can be a wrought wire connector, divided or split
major connector, or a movable joint between two major
connectors.
iii. In a divided or split major connector, the major connec-
tor is split by an incomplete cut parallel to the occlusal
surface of teeth into two units, viz., the upper unit
(nearer to the tooth) and the lower unit.
iv. The denture base is connected to the lower unit and the
rests and direct retainers are connected to the upper unit.
SHORT ESSAYS
Q. 1. Describe briefly the types of stress breakers.
Ans.
Types of Stress Breakers
• Stress breaker is defined as a device, which relieves
the abutment tooth of all or part of the occlusal
forces (GPT).
• Dentures which have a stress breaker are also called
as broken stress partial dentures or articulated pros-
theses.
• There are two types of stress breakers: type I and
type II.
Type I
i. In this type, a movable joint is placed between the
direct retainer and denture base.
ii. This joint can be a hinge, a ball and socket, a sleeve, or
a cylinder.
iii. By adding these stress breakers to the junction of
the direct retainer and the denture base, it allows the
Advantages
i. Preservation of the alveolar support of abutment tooth
due to reduction of stress on it.
ii. Balanced stress on residual alveolar ridge and abut-
ment.
iii. Weak abutment tooth are well splinted even when the
denture base is moved.
iv. Even if relining is not done properly, abutment teeth
are not damaged.
v. Direct retention is less required.
vi. A massaging effect is produced on the soft tissues dur-
ing movement of denture base.
vii. This lessens the need for frequent relining and rebasing.
Disadvantages
i. Complicated design and expensive.
ii. Weak assembly and fractures easily.
iii. It distorts due to rough handling.
iv. It is difficult to repair
v. It can counter only the vertical forces on the denture.
vi. Reduced stability against horizontal forces.
vii. Inappropriate relining leads to excessive ridge resorption.
viii. Reduced indirect retention.
ix. The split major connector tends to collect food debris
at the area of split.
denture base to move independently and decreases the
amount of force acting on the abutment.
iv. The combined resiliency of the periodontal ligament
and the stress director will be equal to that of the oral
mucosa overlying the ridge. Example of hinges - Dalbo
and Crismani.
Type II
i. This type consists of a flexible connection between the
direct retainer and the denture base.
ii. It can be a wrought wire connector, divided or split
major connector, or a movable joint between two major
connectors.
iii. In a divided or split major connector, the major connec-
tor is split by an incomplete cut parallel to the occlusal
surface of teeth into two units, viz., the upper unit and
the lower unit.
iv. The denture base is connected to the lower unit and
the rests and direct retainers are connected to the up-
per unit.
 Quick Review Series for BOS 4th Year: Prosthodontics

Advantages iii. Even if relining is not done properly, abutment teeth are
not damaged.
i. Preservation of the alveolar support of abutment tooth
iv. Direct retention is less required.
due to reduction of stress on it.
ii. Balanced stress on residual alveolar ridge and abutment.

SHORT NOTES
Q. 1. Denture bases for cast RPD. • Stress breaker is defined as a device, which relieves the
abutment tooth of all or part of the occlusal forces
Ans.
(OPT).
• There are two types of stress breakers:
Denture Base for Cast RPO
Denture base is defined as that part of a complete or partial Type I
denture which rests upon the basal seat and to which teeth
are attached. • In this type, a movable joint is placed between the direct
The types of denture bases usedfor cast removable partial retainer and denture base.
dentures are • This joint can be a hinge, a ball and socket, a sleeve, or
• Acrylic. a cylinder.
• Metal.
• Combination. Type II
Q. 2. What is the concept of stress breakers? Write dif- • This type consists of a flexible connection between the
ferent types of stress breakers. direct retainer and the denture base.
Ans. • It can be a wrought wire connector, divided or split
major connector, or a movable joint between two major
Stress Breakers and their Types connectors.

• Stress breakers are devices used in order to minimize

the stress in case of distal extension partial denture.

---------------------,( Topic 7)
Principles of RPO Design
LONG ESSAYS
Q. 1. Describe the principles involved in RPD designing. • The treatment plan must be based on a complete exami-
nation and diagnosis of the individual patient.
Or
• Dentist must determine a proper plan of treatment.
Discuss the principles of removable partial denture de- • The prosthesis should restore form and function without
sign. injury to the remaining oral structure.
• A removable prosthesis is a form of treatment and not
Ans.
a cure.
• It should be easy to insert and easy to remove.
Principles of Removable Partial Denture • It should resist the dislodging forces during function.
Design • It should be aesthetically improved.
These were developed by A H Schmidt in I 956. The following four design concepts are used to distrib-
The following are the principles in removable partial ute the force evenly along the soft tissues and supporting
denture design: tooth structure:
• The dentist must have a proper knowledge of both the I. Conventional rigid design.
mechanical and the biological factors involved in re- II. Stress equalization.
movable partial denture design. III. Physiologic basing.
IV. Broad stress distribution.
Section I I Topic Wise Solved Questions of Previous Years
I. Conventional Rigid Design
The denture is designed by rigid components, which evenly
distribute the force on the supporting tissue. The retentive
component is the only fixed component of this denture.
Advantages
• It is economical.
• It is easy to construct.
• Equal distribution of stress between the abutment and
the residual ridge.
• Much of relining is not required, as the ridge and the
abutment share the load.
• It is less susceptible to distortion.
Disadvantages
• Increased torque forces on the abutment teeth.
• Rigid continuous clasping may damage the abutment
teeth.
• Dovetail intracoronal retainers cannot be used in these
cases, as tipping forces from the denture base will be
directly transmitted to the abutment teeth.
• Tapered wrought wire retentive arm (combination clasp)
cannot be used, as it is difficult to construct.
• Relining is difficult and inappropriate relining leads to
damage of the abutment teeth.
II. Stress Equalisation
A stress breaker is defined as, 'A device which relieves
the abutment teeth of all or part of the occlusal forces'
(GPT).
'A stress director is a device that allows movement be-
tween the denture base and the direct retainer, which may
be intracoronal or extracoronal'.
Dentures with a stress breaker are also called as broken
stress partial dentures or articulated prostheses.
As the tissues are more compressible, the amount of
stress acting on the abutments is increased. This can pro-
duce harmful effects on the abutment teeth.
In order to protect the abutment from such conditions,
stress breakers are incorporated in to a denture.
There are two types of stress breakers:
Type I
Here, a movable joint is placed between the direct retainer
and the denture base. There, the joint may either be a hinge,
a ball and socket, or a sleeve and cylinder. This decreases
the amount of force acting on the abutment.
Type II
It has a flexible connection between the direct retainer and
the denture base. It can be a wrought wire connector, di-
vided or split major connector, or a movable joint between
two major connectors.
In a split major connector, the major connector is split
by an incomplete cut parallel to the occlusal surface of the
teeth into two units, namely, the upper unit which is more
near to the tooth and the lower unit. The denture base is
connected to the lower unit and the rests and direct retainers
are connected to the upper unit.
Advantages
• The alveolar support of the abutment teeth is pre-
served, as the stress acting on the abutment teeth are
reduced.
• There is a balance between the stress on the residual
ridge and the abutment teeth.
• Weak abutment teeth are well splinted even during the
movement of the denture base.
• Abutment teeth are not damaged after the denture
wears out.
• Direct retention is of minimal requirement.
• Movement of the denture base produces a massaging
effect on the soft tissues.
• This avoids the frequent need for relining and rebasing.
Disadvantages
• Its design is complicated and expensive.
• The assembly is very weak and tends to fracture
easily.
• It is difficult to repair.
• It can be used only to counter the vertical forces on the
denture. Inability to counteract lateral stress acting on
the ridge, leads to ridge resorption.
• Reduced stability against horizontal forces.
• Both vertical and horizontal forces are concentrated
on the ridge leading to resorption.
• Inappropriate relining leads to excessive ridge re-
sorption.
• Reduced indirect retention.
• Food debris gets collected in split major connector at
the area of splint.
Ill. Physiologic Basing
Physiologic basing technique distributes the occlusal load
between the abutment teeth and the soft tissues, by fabricat-
ing a denture, based on a functional record.
In this technique, an impression of the soft tissues is
taken in a compressed state.
But one major disadvantage is the denture tends to com-
press the soft tissues even at rest and this can lead to excess
ridge resorption.
Following are the requirements for physiologic
basing:
• A rigid metal framework.
• Functional occlusal rests.
• Indirect retainers to provide additional stability.
• Well-adapted, broad coverage denture bases.
 Quick Review Series for BOS 4th Year: Prosthodontics

Advantages I. Major Connector

• It has good adaptation of the denture base. It is defined as a part of a removable partial denture,
• The design is simple and economical. which connects the components on one side of the
• Minimal direct retention decreases the functional stress arch to the components on the opposite side of the
on the abutment tooth. arch (GPT).
Following are the general ideal requirements for maxillary
Disadvantages and mandibular major connectors:
• Decrease in the number of retentive components pro- • Rigidity: A major connector should not be flexible. This
vides less stability. allows stress that is applied to any part of partial denture
• The denture tends to lift at rest, which leads to prema- to be distributed over entire supporting area.
ture contacts. • It should be comfortable to the patient.
• Indirect retention is decreased due to vertical movement • It should not allow any food accumulation.
of the denture due to tissue rebounce at rest.
Following are the general design considerations:
Intentional relief: The border of the major connector should
JV. Broad Stress Distribution be 6 mm away from gingival margins in the maxillary arch,
in order to avoid any injury to the highly vascular marginal
According to this philosophy of design, the occlusal load gingiva.
acting on the denture should be distributed over a wider In the mandible, the border of the major connector is
soft tissue area and maximum number of teeth. This is placed 3 mm away from the marginal gingiva.
achieved by increasing the number of direct retainers, indi- If this is not possible, it is extended across the marginal
rect retainers, and rests; and by increasing the area of the gingiva as a lingual plate.
denture base. The borders of the major connector should be parallel to
Advantages of broad stress distribution are as the gingival margins.
follows: The metal framework should cross the gingival margin
• This design with multiple clasps acts as a form of re- only at right angles.
movable splinting. • The part of the framework adjoining the tooth sur-
• It increases the health of the abutment teeth (due to face should be hidden in the embrasures to avoid
splinting action). discomfort.
• It is easier to construct and economical. • The borders of the major connector should be rounded
to avoid interference to the tongue.
Disadvantages
• The major connector should be symmetrical and should
• Less comfortable. cross the palate in a straight line.
• Difficult to maintain adequate oral hygiene. • The anterior border of the maxillary major connector
Q. 2. Enumerate the components of removable partial should end in the valley of the rugae, but it should not
denture. Discuss the principles of partial denture de- cover the rugae area.
sign. a. Maxillary major connectors
Ans. Major connectors used in the fabrication of a maxillary
prosthesis are termed as maxillary major connectors. Types
of maxillary major connectors are as follows:
Components of Removable Partial Denture • Single posterior palatal bar.
Following are the components of removable partial • Palatal strap.
denture: • Single broad palatal major connector or palatal plate-
I. Major connector type major connector.
a. Maxillary major connector. • Double or anteroposterior palatal bar.
b. Mandibular major connector. • Horseshoe or U-shaped connector.
II. Minor connectors. • Closed horseshoe or anteroposterior palatal strap.
III. Rest and rest seats. • Complete palate.
IV. Direct retainers.
V. Indirect retainers. Single posterior palatal bar
VI. Denture base. It is a bar running across the palate. It has a narrow half-
VII. Tooth replacement. oval cross-section, which is thickest at the centre.
Section I I Topic Wise Solved Questions of Previous Years
Disadvantages
• Due to a narrow anteroposterior width, there is poor
bony support from the hard palate.
• It cannot be used anterior to the premolar area, due to
tongue interference.
Palatal strap
It comprises of a wide, thin band of metal plate that runs
across the palate. Width can be decreased depending on
edentulous span. It should be at least 8 mm wide for ade-
quate rigidity.
Indications
• Unilateral distal extension partial denture.
• Bilateral short-span edentulous spaces in a tooth-sup-
ported prosthesis (Kennedy's class III).
Single broad palatal major connector
• It has a thin broad contoured palatal coverage.
Indications
• It is indicated for class I cases with little vertical ridge
resorption.
• It is indicated for cases with 'V' - or 'U' -shaped palate.
• It is indicated for cases with strong abutments.
• It is indicated for cases with more than six remaining
anterior teeth.
Anteroposterior or double palatal bar
It is a combination of an anterior palatal strap and a poste-
rior palatal bar.
The anterior strap is narrower than a conventional pala-
tal strap.
Indications
• When anterior and posterior abutment teeth are widely
separated.
• Cases with large palatal tori, which cannot be operated.
• Patient who does not want complete palatal coverage.
• In long edentulous span in class II modification 1 arch.
• In class IV conditions.
Horseshoe or U-shaped connector
This major connector is 'U' -shaped running along the arch.
It has a thin metal band running along lingual surface of
posterior teeth. Anteriorly, it becomes more like a thin plate
that covers the cingula of the teeth. The posterior border
extends 6-8 mm onto the palatal tissue.
Indications
• It is used when many anterior teeth are to be re-
placed.
• It is used in the presence of tori extending to the posterior
border of the hard palate or a prominent median suture.
• Excessive vertical overlap (overbite) of the anterior
teeth.
Closed horseshoe or anteroposterior palatal strap
In this design, a strap of metal extends between the two
open ends of the horseshoe. The centre of the palate is left
uncovered. The border should be 6 mm away from the gin-
gival margin. The straps should be of uniform thickness.
The posterior strap should be placed more posteriorly, but
it should not touch the soft palate.
Indications
• It is used when numerous teeth are to be replaced and a
torus is present.
• It is used in Kennedy's class I and class II cases with
anterior tooth replacement.
Complete palate
This major connector covers whole of the palate. Anterior
border should be 6 mm away from the gingival margin or
extend up to the cingulae of the anterior teeth. The posterior
border of complete palate should extend to the junction of
the hard and the soft palate.
Indications
• It is used when many posterior teeth are replaced.
• In cases where anterior teeth are to be replaced along
with a Kennedy's class I condition.
• For patients with well developed muscles of mastication
or presence of all mandibular teeth. In such cases there
will be excessive load and displacing forces, which can
only be distributed by a complete palate.
• In cases with flat ridges and shallow vaults, where high
stability is required.
Design procedure for a maxillary major connector
Following are the five basic steps for designing a maxillary
major connector:
• Step 1: The primary stress-bearing areas that are to
be covered by the denture base should be marked on
the cast.
• Step 2: Using a different colour, the nonstress-bearing
areas like palatal gingiva, mid-palatine raphae, and tis-
sues posterior to the vibrating line should be marked on
the cast.
• Step 3: Next the connector-areas (areas where the major
connector is to extend) that are available to place the
components of the major connectors should be marked
on the cast.
• Step 4: An appropriate connector is selected.
• Step 5: Unification
 Quick Review Series for BOS 4th Year: Prosthodontics

• All the markings on the master cast are connected. IV. Direct retainers
This gives the design and extent of the major It is that component part of a removable partial denture that
connector. is used to retain and prevent dislodgement consisting of a
clasp assembly or precision attachment (GPT).
b. Mandibular major connector
The major connectors used in mandibular partial dentures Classification
are called mandibular major connectors. They should have Direct retainers are broadly classified as:
adequate clearance for the tongue. a. Extracoronal direct retainers (clasps)
• Manufactured retainer.
Design considerations
• Custom-made retainer.
• They are longer and narrower than the palatal connec- b. lntracoronal direct retainers (attachments)
tors, due to the interference from the tongue. • Internal attachments.
• Relief is given in all cases. The amount of relief varies • External attachments.
based on: • Stud attachments.
a. Type of major connector. • Bar attachments.
b. The amount of slope in the tissue lingual to the ante- • Special attachments.
rior teeth.
c. Additional relief should be given for distal extension Principles of clasp design
cases, because rotational movement of the denture
The basic principle of clasp design is encirclement,
base can traumatize the gingiva.
i.e., to obtain more than 1800 of continuous contact for
Following are the six common types of mandibular major Aker's clasp and a minimum of 3-point contact for
connector: Roach clasps.
• Lingual bar. Other principles of design include:
• Lingual plate. • Occlusal rest should be designed to prevent tissueward
• Kennedy bar or double lingual bar. displacement of the denture.
• Sublingual bar. • Each retentive terminal should be opposed by a recipro-
• Mandibular cingulum bar (continuous bar). cal component.
• Labial bar. • Balanced retention should be present.
• Only the minimum necessary amount of retention
II. Minor connectors should be used.
A minor connector is defined as the connecting link be- • The reciprocal should be placed at the height of contour
tween the major connector or base of a removable partial and the retentive element below the height of contour.
denture and other units of the prosthesis, such as clasps,
indirect retainers, and occlusal rests. V. Indirect retainers
There are four types of minor connector: It is defined as a part of a removable partial denture, which
• Joining the clasp assembly to major connectors. assists the direct retainers in preventing displacement of
• Joining the indirect retainer or auxiliary rest to the distal extension denture base by functioning through lever
major connector. action on the opposite side of the fulcrum line.
• Joining the denture base to the major connector.
• Approach arm in bar-type clasp. VI. Denture base
It is defined as that part of a denture, which rests on the oral
111. Rest and rest seats mucosa) and to which teeth are attached.
A rest is defined as a rigid extension of a fixed or removable Types of denture base
partial denture, which contacts a remaining tooth to dissi- • Acrylic.
pate vertical or horizontal forces (GPT). • Metal.
Rest seat is defined as that portion of a natural tooth or • Combination.
cast restoration of a tooth, selected or prepared to receive an
occlusal, incisal, lingual, internal, or semi-recision rest VII. Tooth replacement
(GPT). The term refers to the replacement of artificial tooth in the
Rest is classified as: denture base.
• Occlusal rest. a. Anterior teeth replacement
• Incisal rest. • Acrylic teeth.
• Cingulum rest or lingual rest. • Porcelain teeth.
Section I I Topic Wise Solved Questions of Previous Years

• Plastic teeth. • Metal panties.

• Metal teeth with facing. • Tube teeth.
• Tube teeth. • Reinforced acrylic panties.
• Reinforced acrylic panties. • Bonding between the teeth and the denture base.
b. Posterior teeth replacement
• Plastic teeth.
• Porcelain teeth.

------------------ -<( Topic 8)

Surveying and Preparation of Mouth for RPD

LONG ESSAYS
Q. 1. Discuss the role of surveyor in removable partial Objectives of Surveying
denture treatment.
a. To design a RPD, such that it's rigid and flexible com-
Or ponents are appropriately positioned to obtain good re-
Write in brief the importance of dental cast surveyor in tention and bracing.
designing biologically acceptable removable partial b. To determine the path of insertion of a prosthesis.
c. To mark the height of contour of the area (hard or soft
denture.
tissues) above the undercut.
Or d. To mark the survey lines (height of contour of a
Define dental cast surveyor. Enumerate the functions. tooth).
Describe the surveying procedure. e. To mark the undesirable undercuts into which the pros-
thesis should not extend.
Or
What is a surveyor? Mention its uses and describe step Types of Surveyor
by step procedure of surveying a diagnostic cast.
There are three types of surveyors commonly used:
Or • Ney surveyor (widely used).
Define a surveyor. Mention its parts. Explain in detail • Jelenko or Will's surveyor.
step-by-step procedure in surveying. • Willarn's surveyor.

Ans.
Surveyor
A surveyor is defined as an instrument used in the construc-
tion of a removable partial denture to locate and delineate
the contours and relative positions of abutment teeth and
associated structures (GPT).
Parts of a Surveyor
• Surveying platform
It is a metal plate parallel to the floor, where a cast
holder can be placed. This forms the base of the surveyor
onto which all the other components are attached and
supported.

• Cast holder/surveying table
It is a stand placed over the surveying platform. It has a
locking device. Here, the cast can be locked in any position
on the table with the help of the locking device. The table
is attached to the base with the help of a ball and socket
joint. This joint facilitates to tilt the table.
• Vertical arm
It arises vertically from the surveying platform. It supports
the superstructure (horizontal arm and the surveying arm).
• Horizontal arm
This extends horizontally from the top of the vertical arm.
It is designed to support the surveying arm at its free end.
In Ney surveyor, the horizontal arm is fixed, whereas it
can be revolved horizontally in a Jelenko surveyor.
• Surveying arm
It extends vertically from the free end of the horizontal arm.
It is parallel to the vertical arm. It can move upward and
downward.
• Surveying tools
These are tools attached to the mandrel of the surveying
arm and are used for surveying.
They are of different types:
a. Analyzing rod,
b. Carbon marker,
c. Undercut gauges, and
d. Wax knife.
a. Analyzing rod
• It is a diagnostic surveying tool.
• It acts like a tangent to the convex surface of the object
being surveyed. It is more of a diagnostic survey tool.
• It helps to analyze the location of the height of contours
and the presence and absence of favourable and unfa-
vourable undercuts for a particular path of insertion.
• It is a solid cylindrical metal rod and was the first to be
used during surveying.
b. Carbon markers
• They are similar to the lead points commercially avail-
able for the microtip pencils.
• In Ney surveyor, it is circular in cross-section and in
Jelenko surveyor, it is triangular in cross-section.
• After analyzing the teeth with an analyzing rod, it is
replaced with a carbon marker.
c. Undercut gauges
• They are used to measure the linear dimension of any
structure.
• Undercut gauges are used to measure the depth and
location of the undercuts on the analyzed tooth in three
dimensions.
Quick Review Series for BOS 4 th Year: Prosthodontics
• Stewart states the availability of undercut gauges in
three standard sizes namely, 0.010 inch, 0.015 inch, and
0.020 inch.
• McCracken states the availability of undercut gauges at
0.010 inch, 0.020 inch, and 0.030 inch. All these gauges
have the same shank and only the size of the tip or bead
varies.
d. Wax knife
• It can be attached to the mandrel of the surveying arm.
• It is used to directly trim the excess wax while survey-
ing the wax.
Set-up for Surveying
i. Mounting the caste.
ii. Positioning the surveying arm.
iii. Analyzing the caste.
i. Mounting the caste
• The primary cast should be mounted on the surveying
table. The cast can be fixed tightly to the clamps on the
surveying table.
• The cast should be mounted, such that the occlusal sur-
faces of the remaining teeth are parallel to the base.
ii. Positioning the surveying arm
• The horizontal arm is positioned in the surveyor in such
a way that it is vertically adjusted, such that the survey-
ing arm can contact at least three different spaced out
points on the cast.
• After the proper position of the horizontal arm is deter-
mined, it is locked to the vertical arm with the help of a
thumbscrew.
iii. Analyzing the caste
• The cast is rotated against the analyzing rod to analyze
the presence of undercuts (favourable and unfavour-
able).
• Favourable undercuts should be present on the abutment
teeth, to place the retentive components of a clasp.
• Unfavourable undercuts (soft tissue, bony undercuts)
should be eliminated.
• If favourable undercuts are absent during analyzing,
then undercuts favourable to that path of insertion
should be created. Enamel is contoured using a bur-
dimpling) or by slightly tilting the cast (not preferred -
tilting the cast is done only to improve the placement of
the non-retentive claps).
Uses of Surveyor
i. To survey the diagnostic and primary casts.
ii. For tripoding the cast (recording the cast position).
iii. To transfer the tripod marks to another cast.
Section I I Topic Wise Solved Questions of Previous Years
iv. To contouring wax patterns.
v. To contour crowns and cast restorations.
vi. To placing internal attachments and rests.
vii. To perform mouth preparation directly on the cast to
determine the outcome of treatment.
viii. To survey the master cast.
ix. To survey ceramic veneers, before final glazing.
i. Surveying the diagnostic and primary cast
• The diagnostic cast should be surveyed before treatment
planning, whereas the primary cast is surveyed after
completion of preprosthetic mouth preparation.
• Basically, the primary cast is surveyed to determine the
required amount of prosthetic mouth preparation, de-
sign, and to mark the outline of the prosthesis.
Objectives of surveying the primary cast
• To mark the undercut, height of contour, and soft tissue
and bony interference.
• To determine the most accepted path of placement that
has the least interference and the best aesthetics. 'Path of
placement is the direction in which the restoration moves
from the point of initial contact of its rigid parts with the
supporting teeth to its terminal resting position with rest
seated and the denture base in contact with the tissues'.
Surveying the primary cast (or any cast) includes:
• Analyzing the cast
• Surveying the teeth
• Surveying the soft tissue contours on the cast.
Analyzing the cast
• The cast is rotated against the analyzing rod to analyze the
presence of undercuts both favourable and unfavourable.
• Favourable undercuts should be present on the abutment
teeth, to place the retentive components of a clasp.
• Unfavourable undercuts (soft tissue and bony under-
cuts) should be eliminated.
• If favourable undercuts are absent during analyzing,
then undercuts favourable to that path of insertion
should be created. Enamel is contoured using a bur-
dimpling or by slightly tilting the cast.
Surveying the teeth
The teeth are surveyed for the following reasons:
a. To determine the height of contour.
b. To determine the depth of the undercut.
c. To determine the location of undesirable undercuts.
d. To determine the parallelism of the abutments.
e. To determine the path of insertion of the denture.
a. Determining the height of contour of teeth
• The height of contour is marked using the flat surface of
a carbon marker attached to the mandrel of the survey-
ing arm. This forms the survey line.
b. Determining the depth of the undercut
• This is done using undercut gauges. The depth of the
undercut is not always measured at the level of the gin-
gival crevice. Instead, it is measured at a level where the
operator plans to place the retentive terminal of the re-
tentive arm.
• A more flexible material should be used to engage a
deeper undercut. Hence, the alloy for the partial denture
is chosen based on this measurement during this proce-
dure.
c. Determining the location of undesirable undercuts
• Undesirable undercuts should be blocked out (filled) to
avoid interference. Block out is done using wax or block
out material.
• The block out of the cast is done before duplicating it to
form the refractory cast. The resulting refractory cast is
used exclusively for casting the partial denture frame-
work and will not have all the undercuts that were
blocked out in the master cast.
• Undesirable undercuts should be filled (blocked out) till
the height of contour for that path of insertion is at-
tained. The excess block out material is trimmed flush,
to the height of contour using a surveying wax knife.
d. Determining the parallelism of the abutment teeth
• The path of insertion of a residual partial denture (RPD)
is usually parallel to the long axis of the abutment teeth.
• Parallelism is essential for easy insertion and removal of
the prosthesis. If it is absent, then it should be estab-
lished by contouring the enamel surfaces or by placing
restorations on one or more teeth.
• The undesirable undercuts in the teeth should be identi-
fied and eliminated.
e. Determining the path of insertion of the denture
• While surveying to check for the parallelism of the
abutment teeth, the cast is tilted, till the long axis of the
abutment tooth is parallel to the vertical axis.
• This tilt gives the angle of path of insertion of the
denture. Tilting can be done in anterior, posterior, right,
or left directions. The established tilt should not exceed
10 degrees.
ii. Tripoding the cast
• Tripoding is a procedure where, three different widely
spaced out points of a single plane are marked on
the cast.
• These tripod points are used as a reference point and
it should not be altered, until the treatment is com-
pleted.
iii. Transferring the tripod marks
It is done to orient the master cast using the same angula-
tion of the primary cast.

The commonly used additional reference points are:
• Distal marginal ridge of the first premolar.
• Incisal edge of lateral incisor.
• Lingual cusp tip of the first premolar on the oppo-
site side.
iv. Contouring wax patterns
• A sharp instrument attached to the mandrel of the surveying
arm can be used to contour the wax pattern, if necessary.
• If a cast restoration is to be prepared for an abutment
tooth, then the wax pattern on the cast should be
mounted on the surveyor to check and modify it to
obtain an ideal contour.
• Surveying wax knife (a surveying tool) is mounted on
the surveying arm to contour the wax pattern.
• Guiding planes or guide planes on the wax pattern are
prepared, until they are parallel to the path of insertion.
• The height of contour of the pattern may also be altered
to facilitate proper positioning of the rigid and flexible
parts of the clasp.
v. Contouring crowns and cast restorations
• Wax pattern is contoured using a sharp instrument like
wax knife.
• Crowns and cast restorations (metal) can be trimmed
using rotary instruments attached to the surveyor.
• The working cast along with the restorations are placed
on the surveyor at the established plane of orientation.
• A handpiece holder is attached to the surveying arm.
vi. Placing internal attachments
• lntracoronal retainers and occlusal rests are usually cre-
ated on wax patterns using a rotary handpiece and then
it is later refined on the cast restorations.
• The intracoronal retainer is similar to a hook and a loop.
The loop-like structure is placed within the crown and
the hook is attached to the prosthesis.
• During insertion, the hook gets locked into the loop to
provide retention.
vii. Placing internal rest seats
• Internal rests are large box-shaped metallic extensions
that functions as a intracoronal retainer.
viii. Surveying the master cast
• The master cast is fabricated after prosthetic mouth
preparation.
• It is usually surveyed to check whether the desired re-
sults have been obtained in mouth preparation.
ix. Surveying ceramic veneer crowns
• When a removable partial denture abutment is to be re-
stored with a ceramic crown, the contour of the facial
surface of the crown is developed in a surveyor.
Quick Review Series for BOS 4th Year: Prosthodontics
Q. 2. Guiding planes.
Ans.
Guiding Planes
• Guiding planes or guide planes are defined as, 'Two or
more vertically parallel surfaces of abutment teeth so
oriented as to direct the path of placement and removal
of removable partial dentures' (GPT).
• They are prepared on the proximal and axial surfaces of
primary and secondary abutment teeth.
• The minor connector that connects the auxiliary rest to
the major connector should lie within the embrasure and
adapt closely to the tooth that supports the auxiliary
rest.
• The surface of the minor connector that contacts the
secondary abutment is known as a proximal plate of the
minor connector.
• Similarly, the body of a clasp lies very close to the
proximal surface of the abutment tooth. The surface of
the body of the clasp or direct retainer is known as the
proximal plate of the direct retainer.
• The surface of the tooth along which the proximal plates
slide is called a guide plane.
• It is so called, because they guide the prosthesis (proximal
plates) during insertion and removal.
• The guiding plane and the proximal plate will be in in-
timate contact, when the denture is seated in place.
• This contact can be on the occlusal or gingival third of
the tooth.
• Since the area near the marginal ridge can be recon-
toured, the contact with the occlusal third of the tooth
near the marginal ridge is preferred easily.
• This relationship prevents action of destructive lateral
forces on the tooth.
• Guiding planes play an important role in retention of the
prosthesis.
Structure
• Guide planes are usually 2-3 mm in occlusogingival
height parallel to the path of insertion.
• They should be flat and contain no undercuts.
• Guide planes do not occur naturally on the abutment
teeth, but they should be prepared by the clinician dur-
ing prosthetic mouth preparation.
• They are prepared by selective grinding of teeth
(enameloplasty) or by appropriate shaping of guide
planes.
• Guide planes are classified based on their function and
location as follows:
i. Guide planes on abutment teeth supporting a tooth
supported partial denture, ping of wax patterns,
crowns, or cast restorations on the abutment teeth.
Section I I Topic Wise Solved Questions of Previous Years

ii. Guide planes prepared on the lingual surfaces of Functions of Guiding Planes
abutment teeth.
• To decreas the wedging stress on the abutments.
iii. Guide planes on anterior abutment.
• For easy insertion and removal.
• To help in stabilizing the prosthesis against horizontal
Advantages of Guiding Planes on Anterior Teeth stress.
• They provide parallelism and help in stabilization. • To stabilize individual tooth.
• They reduce the wedging action between the teeth. • To reduce block out area and to eliminate space between
• They reduce the space between the abutment tooth and minor connector and tooth.
denture. • To give indirect retention and frictional retention.
• They increase retention.
• They enhance aesthetics.

SHORT ESSAYS
Q. 1. Survey lines. Q. 2. Define surveyor. What are the objectives and uses
of surveying?
Or
Ans.
Surveying line.

Ans. Surveyor
A surveyor is defined as, 'An instrument used in the con-
Surveying Line
struction of a removable partial denture to locate and
Surveying line is a line drawn on a tooth or teeth of a cast delineate the contours and relative positions of abutment
by means of a surveyor, for the purpose of determining the teeth and associated structures' (GPT).
positions of the various parts of a clasp or clasps.
Types of Surveyor
Classification of Surveying Lines
There are three types of surveyors commonly used:
According to Blatterfein system, survey lines are classified as: • Ney surveyor (widely used).
A. High survey lines. • Jelenko or Will's surveyor.
B. Medium survey lines. • Willam's surveyor
C. Diagonal survey lines.
D. Low survey lines.
Objectives of Surveying
A. High survey line • To design a RPD, such that it's rigid and flexible com-
• It passes from occlusal third in the near zone to occlusal ponents are appropriately positioned to obtain good
third in the far zone. retention and bracing.
• It is commonly found in the inclined teeth. • To determine the path of insertion of a prosthesis.
• To mark the height of contour of the area (hard or soft
B. Medium survey line tissues) above the undercut.
• It passes from occlusal third in the near zone to the • To mark the survey lines (height of contour of a
middle third in the far zone. tooth).
• To mark the undesirable undercuts into which the pros-
C. Low survey line thesis should not extend.
• This survey line is usually closer to the cervical third of
the tooth in both near and far zone.
Uses of Surveyor
D. Diagonal survey line a. To survey the diagnostic and primary casts.
• This survey line runs from occlusal third in the near b. For tripoding the cast (recording the cast position).
zone to the cervical third in the far zone. c. To transfer the tripod marks to another cast.
• In this case, a reverse circlet clasp is used. d. To survey the master cast.
• It is more common on the buccal surfaces of canines e. To contour crowns and cast restorations.
and premolars. f. To place internal attachments and rests.
 Quick Review Series for BOS 4th Year: Prosthodontics

g. To perform mouth preparation directly on the cast to Undercut Gauges

determine the outcome of treatment.
They are used to measure the linear dimension of any struc-
h. To survey the master cast.
ture. Undercut gauges are used to measure the depth and
i. To survey ceramic veneers before final glazing.
location of the undercuts on the analyzed tooth in three
Q. 3. Undercut gauge. dimensions.
Stewart states the availability of undercut gauges in
Ans.
three standard sizes namely, 0.010 inch, 0.015 inch, and
• Undercut gauges are used for measuring the depth and 0.020 inch. McCracken states the availability of undercut
location of the undercuts on the analyzed tooth in three gauges at 0.010 inch, 0.020 inch, and 0.030 inch. All these
dimensions. gauges have the same shank and only the size of the tip or
• Undercut gauges are available in three sizes, namely, bead varies.
0.010 inch, 0.020 inch, and 0.030 inch.
• All these gauges have the same shank and only the size Wax Knife
of the tip varies.
• The gauges are usually of standard sizes and the area It can be attached to the mandrel of the surveying arm. It is
of the tooth that matches the gauge is chosen as the used to directly trim the excess wax while surveying the wax.
undercut.
Q. 5. Discuss briefly the various steps in surveying for
• Ney surveyors have a circular beaded undercut gauge;
removable partial denture fabrication.
whereas, Jelenko surveyors have a fan-shaped bead
with each wing of the fan measuring different dimen- Ans.
sions.
Q. 4. Surveying tools.
Steps in Surveying
i. Mounting the caste.
Ans.
ii. Positioning the surveying arm.
iii. Analysing the caste.
Surveying Tool
Surveying tools are tools attached to the mandrel of the i. Mounting the Caste
surveying arm and are used for surveying.
They are as follows: • The primary cast should be mounted on the surveying
a. Analyzing rod, table. The cast can be fixed tightly to the clamps on the
b. Carbon marker, surveying table.
c. Undercut gauges, and • The cast should be mounted such that the occlusal sur-
d. Wax knife. faces of the remaining teeth are parallel to the base.

Analyzing Rod Positioning the Surveying Arm

It is a diagnostic surveying tool. It acts like a tangent to the • The horizontal arm is positioned in the surveyor in such
convex surface of the object being surveyed. It is more of a a way that it is vertically adjusted, such that the survey-
diagnostic survey tool. It helps to analyze the location of ing arm can contact at least three different spaced out
the height of contours and the presence and absence of fa- points on the cast.
vourable and unfavourable undercuts for a particular path • After the proper position of the horizontal arm is deter-
of insertion. mined, it is locked to the vertical arm with the help of a
It is a solid cylindrical metal rod and was the first to be thumbscrew.
used during surveying.
iii. Analyzing the Cast
Carbon Markers • The cast is rotated against the analyzing rod to analyze
They are similar to the lead points commercially available the presence of undercuts (favourable and unfavour-
for the microtip pencils. able).
In Ney surveyor, it is circular in cross-section and in • Favourable undercuts should be present on the abutment
Jelenko surveyor, it is triangular in cross-section. teeth to place the retentive components of a clasp.
After analyzing the teeth with an analyzing rod, it is • Unfavourable undercuts (soft tissue and bony under-
replaced with a carbon marker. cuts) should be eliminated.
Section I I Topic Wise Solved Questions of Previous Years
• If favourable undercuts are absent during analyzing,
then undercuts favourable to that path of insertion
should be created. Enamel is contoured using a bur-
dimpling or by slightly tilting the cast (not preferred -
tilting the cast is done only to improve the placement of
the non-retentive claps).
Q. 6. Block out procedure in cast partial denture.
Ans.
Block out
Block out is defined as, 'Elimination of undesirable under-
cut areas on the cast to be used in the fabrication of the re-
movable partial denture'.
Types of Block out
Based on the purpose, block out can be classified into three
types:
i. Parallel block out
• In this procedure, undercuts below the height of contour
of the existing teeth are eliminated in relation to that
path of insertion.
• Surveying of the master cast is done and the undercuts in
relation to the determined path of insertion are marked.
• Block out wax is filled into the infra-bulge (undercut)
area of the tooth and trimmed such that its surface is
parallel to the path of insertion.
• Excess block out wax is trimmed using a parallel or ta-
pered wax carving blade attached to the surveying arm.
ii. Arbitrary black out
• In this procedure, the soft tissues and other unwanted
undercuts in the cast are filled with block out wax.
• This is done to eliminate the unwanted undercuts (ridge
and soft tissue), which may interfere with the path of
insertion.
• It is called arbitrary block out, because the surface of
the block out wax need not be parallel to the path of
insertion.
iii. Formed or shaped black out
• This procedure is done in the undercut of the primary
abutment along the lower border of the proposed reten-
tive arm.
• The block out wax is not trimmed to flush with the tooth
surface, but it is filled in excess, i.e., the surface of the
block out wax will be projecting from the surface of the
teeth.
• On the occlusal surface, the excess wax will form a
ledge. This ledge will follow the lower border of the
proposed retentive arm drawn on the master cast.
• This block out will be reproduced as a ledge in the
refractory cast duplicated from the master cast.
• The ledge will act as a guide for the fabrication of the
wax pattern for the retentive arm.
Q. 7. Path of insertion of removable partial dentures.
Ans.
Path of Insertion of Removable Partial
Dentures
• Path of insertion is defined as the direction in which the
prosthesis is placed upon and removed from the abut-
ment teeth (GPT).
• The path of insertion or path of withdrawal is the angle
made by the direction of removable partial denture with
the remaining teeth during insertion.
• Altering the tilt/angulation of the cast on the sur-
veyor is a simple method to establish an ideal path of
insertion.
Factors Influencing Path of Insertion
i. Retentive undercut.
ii. Interference.
iii. Aesthetics.
iv. Guiding planes.
v. Denture base.
vi. Location of vertical minor connector.
i. Retentive undercut
• Favourable undercuts on the abutment tooth should be
identified to obtain good retention when the cast is
placed horizontally.
• The cast can be tilted until the height of contour be-
tween the gingival and middle third of the crown.
The advantages are:
• Aesthetic placement of clasp.
• Rotational force on the abutment tooth is reduced.
• Force transferred on the abutment tooth is decreased.
ii. Interference
• If surgery cannot be done to remove the interferences
due to some areas in the mouth, then the path of inser-
tion should be altered.
• Some structures that can produce interferences are:
• In the mandible, lingual tori and lingual inclination
of remaining teeth.
• In the maxilla, torus palatines and buccally tip
teeth.
iii. Aesthetics
• Aesthetics is a pleasure-feeling obtained due to visual
perception of an object.

• The following procedures can be done for obtaining
optimum aesthetics:
• Clasp's arms should be concealed.
• A balance must be achieved between aesthetic and
function.
• Placing the artificial teeth in the same position as the
natural teeth.
• In few cases where the length of the edentulous span
is reduced, e.g., Kennedy's class IV due to mesial
migration of the remaining teeth guides planes are
prepared on the proximal surface of the abutment
tooth, for increasing the length of the edentulous span.
• In cases where mesially tilted abutments on either side
of the edentulous space and large unaesthetic under-
cuts with accumulation of plaque and debris are pres-
ent, tilting the cast posteriorly or altering the path of
insertion or selectively grinding the teeth to establish
a proper guiding plane can eliminate the undercuts.
iv. Guiding planes
• The guiding planes determine the path of insertion.
• The proximal plates on the partial denture should and
will contact the guide planes during insertion.
• Therefore, when many guide planes are used, multiple
paths of insertion are avoided.
v. Denture base
• The path of insertion is determined by the shape and
extent of the denture base.
SHORT NOTES
Q. 1. Mention three uses of surveyors.
Ans.
The uses of surveyor are as follows:
• To survey the diagnostic and primary casts.
• For tripoding the cast.
• To survey the master cast.
Q. 2. Define surveyor.
Ans.
A surveyor is defined as an instrument used in the construc-
tion of a removable partial denture to locate and delineate
the contours and relative positions of abutment teeth and
associated structures.
Q. 3. Undercut gauges and their application in surveying.
Ans.
• Undercut gauges are used for measuring the depth and
location of the undercuts on the analyzed tooth in three
dimensions.
• Undercut gauges are available in three sizes namely,
0.010 inch, 0.020 inch, and 0.030 inch.
Quick Review Series for BOS 4th Year: Prosthodontics
• If a distal extension denture base is made to extent
anteriorly on both sides, then it tends to embrace the
abutment by limiting multiple paths of insertion.
vi. Location of the vertical minor connector
• The vertical minor connector connects the auxiliary rest
to the major connector.
• It is parallel to the guide plane on the abutment.
Point of origin of the approach arm of a bar clasp:
• A bar clasp arises from the denture base minor con-
nector.
• The approach arm of the clasp then descends down
and loops up to end in a T-shaped tip (retentive
terminal).
• It is capable of producing interference during
insertion.
• The bar clasp is designed to produce least resistance
according to the path of insertion.
• In some cases where the approach arm cannot be
modified, the path of insertion can be altered.
• When the path of insertion is altered, the resulting bar
clasp will not provide retention in the vertical direction,
but it will provide resistance to removal only against the
path of insertion.
• The other factors which control the path of insertion
(e.g., guide planes) will provide resistance to vertical
displacement of the denture.
• All these gauges have the same shank and only the size
of the tip varies.
Q. 4. Height of contour.
Ans.
• Height of contour is the widest circumference of the
tooth.
• During surveying, teeth are surveyed to determine their
height of contour and based on this height of contour,
RPD clasp is designed.
• The rigid component of the clasp should lie above the
height of contour.
Q. 5. Tripoding.
Or
Tripoding the cast.
Ans.
Tripoding is a procedure where three different widely
spaced-out points of a single plane are marked on the cast.
These tripod points are used as a reference point and it
should not be altered, until the treatment is completed.
Section I I Topic Wise Solved Questions of Previous Years

Q. 6. Survey lines. Classification of Survey Lines

Ans. According to Blatterfein system, survey lines are classi-
fied as:
Survey Line i. High survey lines.
Survey line is a line drawn on a tooth or teeth of a cast by ii. Medium survey lines.
means of a surveyor, for the purpose of determining the iii. Diagonal survey lines.
positions of the various parts of a clasp or clasps. iv. Low survey lines.

-------------------<( Topic 9)
Impression Materials and Procedures for RPD

LONG ESSAYS
Q. 1. What is functional impression in removable partial • Border moulding is carried out on the edentulous
denture? How will you obtain such an impression? portion of the tray borders and a functional impression
of the distal extension ridge is made using zinc oxide
Or
eugenol impression paste or polyvinylsiloxane (PVS)
Enumerate the methods of making a functional impres- by recording the impression with patient biting on the
sion for removable partial dentures. What is the signifi- occlusal rims.
cance of such functional impressions? • A second impression is made using alginate with a
stock tray placed over the first impression, which
Ans.
is positioned in its functional position with finger
pressure.
Functional Impression in Removable Partial
Denture Disadvantage
The functional impression or physiologic impression is the • Finger pressure cannot produce the same functional
impression which records the residual ridge under general- displacement of the tissue that biting force produces.
ized compression.
B. Hindel's method
The technique is same as McLean's method, except that
Types of Functional Impression Methods
the stock tray was modified by Hindel for the second
The following are the types offunctional impression: impression, in which holes are provided on both sides in
A. McLean's method. the molar region so that finger pressure could be applied
B. Hindel's method. through the tray as the hydrocolloid impression was
C. Functional relining method. made.
D. Fluid wax method.
Differences from McLean's technique
A. McLean's method
• Hindel's technique is an anatomic impression of the
• This technique is used in distal extension partial ridge at rest made with a free-flowing zinc oxide euge-
dentures (as in Kennedy's Class I and II situations) nol paste.
to record the tissues of the residual ridge that support • After making the hydrocolloid second impression, fin-
a distal extension denture base in its functional ger pressure is applied through the holes in the tray to
form. the anatomic impression. The pressure is maintained,
• A dual impression technique is used in this technique. until the alginate sets.
• Finger pressure is applied on the preliminary im-
Procedure pression through the holes in the stock tray while
• A custom impression tray is constructed over a prelimi- making the second impression to achieve functional
nary cast of the arch with wax occlusal rims. loading.

Disadvantages
• The displaced or functional form technique may lead to
interruption of blood circulation with adverse soft tissue
reaction and bone resorption.
• When the patient's teeth come together, the artificial
teeth contact first and the remaining natural teeth con-
tact only after the mucosa has been displaced. This will
lead to premature contacts, which will cause discomfort
to the patients.
C. Functional relining method
• In this technique, the secondary impression is made af-
ter the construction of metal framework and denture
base. So, it is referred as functional reline.
• By using this technique, a new surface is added to the
tissue side of the denture base.
• This can be done before insertion or later, if excessive
resorption is present.
Procedure
• A soft metal spacer (Ash No.7 metal) is adapted over
the ridge on the cast, before the metal denture base is
being processed.
• After processing, the metal is removed, which leaves
an even space between the base and the edentulous
ridge.
• Border moulding is done and impression is made using
a low-fusing modelling plastic placed over the tissue
surface of the denture base.
• The modelling plastic is tempered in a water bath and
seated in the patient's mouth, until an accurate impres-
sion of the ridge is made.
• The patient should partially open his mouth during the
entire procedure
• After modelling plastic application is complete, about
1 mm of modelling plastic is scraped away uniformly
from all over the crest of ridge.
• Final impression is made with a free-flowing zinc oxide
eugenol impression paste. In cases where excessive un-
dercuts are present, an elastomeric impression material
is used.
Disadvantages
• Occlusion may be altered after the new denture base is
processed.
• Previous occlusal contacts cannot be established.
• May be difficult to maintain the correct relationship
between the framework and the abutment teeth during
the impression procedure.
D. Fluid wax functional impression
• The term fluid wax denotes waxes that have the ability
to flow at mouth temperature.
Quick Review Series for BOS 4th Year: Prosthodontics
Types of waxes that can be used are
• Iowa wax, developed by Dr. Smith.
• Korecta wax No. 4, developed by Dr O C Applegate and
Dr S G Applegate.
• Korecta wax No. 4 has better flow properties than
Iowa wax.
Objectives of fluid wax technique
• To obtain maximum extension of the peripheral borders
of the denture base.
• To record the stress-bearing areas of the ridge in their func-
tional form and remaining tooth in their anatomic form.
Uses of fluid wax technique
• For making a reline impression for existing partial den-
ture.
• For correcting the distal extension of edentulous ridge
portion as in altered cast technique.
Procedure
• Impression tray is made, which is attached to the frame-
work after verifying fit of framework.
• After the tray is seated in the mouth, correction of pe-
ripheral extensions of tray is done. The tray should be
I or 2 mm short of the movable tissue.
• The posterior extension of the tray should end at two
third the coverage of retromolar pad.
Border moulding the impression tray
The mandibular distal extension tray is border moulded in
two steps:
i. From the anterior extent of the buccal flange to the most
posterior extent of the tray.
ii. The remainder of the lingual and distal lingual flange.
At all times, correct positioning of framework on teeth is
ensured by finger pressure on the abutments.
Relieving tray
About 1-2 mm of the tray is relieved for impression pro-
cedure.
Impression procedure
• The fluid wax impression is made with the open mouth
technique.
• The impression wax is melted in a water bath main-
tained at 51-54°C within a container.
• A brush is used to paint the wax on to the tissue side
of the impression tray.
• Each time the tray is placed into the patient's mouth,
it should be kept in place for 5 min to allow the wax
to flow and to prevent build-up of pressure, in order
to avoid distortion.
Section I I Topic Wise Solved Questions of Previous Years
• The tray is removed after 5 min and the wax is exam-
ined for glossy surface which indicates adequate
contact.
• Making the impression borders.
The peripheral extension of the impression tray
should be short by 2 mm to develop a proper bor-
der seal with tissue movements done by the patient.
• Buccal and distobuccal borders in mandibular impres-
sions
These are obtained by asking the patient to open the
mouth wide, as this will activate the buccinator muscle
and pterygomandibular raphe and produce the desired
border.
• Lingual extension for a mandibular impression
Tongue is thrust into the cheek opposite the side of
the arch being border moulded by the patient.
SHORT ESSAYS
Q. 1. Impression techniques in removable partial den-
tures.
Or
Impression procedures in removable partial denture.
Ans.
Impression Techniques
The various impression techniques are:
A. Single pressure-free impression technique.
B. Selective pressure impression technique.
C. Physiologic or functional impression technique.
Single Pressure-free Impressions
These impressions are usually made in association with
tooth-supported and some tooth tissue-supported situa-
tions.
Impression materials used are
• Irreversible hydrocolloid (alginate).
• Reversible hydrocolloid (agar).
• Polysulfide.
• Silicone rubber.
Selective Pressure Impression Technique
• These types of impressions are those which selectively
compress the stress-bearing tissues.
• Selective pressure impression technique equalizes
the support between the abutment teeth and the soft
tissue.
• Distolingual extension
i. The patient is asked to press the tongue forward
against the lingual surfaces of the anterior teeth.
ii. When the entire border is satisfactorily copied, the
impression is replaced in the mouth for a final time
for 12 min to ensure complete flow of wax and to
release any pressure present.
• The new cast is then poured immediately to avoid wax
distortion.
Advantage
Accurate impression can be produced, if properly done.
Disadvantages
• Time-consuming.
• Can cause excessive tissue displacement, if not done
accurately.
• It helps direct forces to the portions of the ridge capable
of withstanding the force.
• The least displacement is seen in the relief areas (e.g.,
the crest of the ridge in mandibular, incisive papillae,
and median palatine raphe in maxillary); while, at
the areas the tray contacts, the tissues will have
maximum displacement (such as buccal shelf area in
mandibular, slopes of the ridge, and posterior palatal
space).
Impression materials used for selective pressure technique
Zinc oxide eugenol paste
• Zinc oxide eugenol paste is of intermediate viscosity. Its
main advantage is that it requires less time to make im-
pression.
• It is considered to be the impression material of choice,
if gross undercuts are not present.
Rubber base materials
• Polysulfide and silicone rubber base impression materi-
als are commonly used.
• They are slightly more viscous than zinc oxide eugenol
paste; this viscosity can be altered by using higher per-
centage of light-bodied material in the mix.
• More time is needed to make the impression.
• Cannot be corrected by addition.
• To ensure that the rubber adheres to the tray, an adhesive
must be used.
• Multiple holes are needed to prevent excessive displace-
ment of soft tissue. These holes will also prevent air
traps.
 Quick Review Series for BOS 4th Year: Prosthodontics

Indication The following are the types offunctional impression:

• Indicated for patients with bony undercuts in the eden- i. McLean's method.
tulous ridge. ii. Hindel's method.
iii. Functional relining method.
iv. Fluid wax functional impression.
Physiologic Impressions (Dual Impression
Techniques)
The functional impression or physiologic impression is the
impression which records the residual ridge under general-
ized compression.

SHORT NOTES
Q. 1. Altered cast technique. Q. 3. Impression in distal extension partial denture.
Or Or
Altered impression technique. Impression procedure for distal extension RPD.

Ans. Ans.

Altered Cast Technique Impression in Distal Extension Partial

This technique involves altering only the distal extension Denture
part of the master cast made of anatomical impression into Fluid wax functional impression is the impression procedure
functional impression by a second impression method by used in distal extension partial denture.
utilizing the metal framework as a tray. Types of waxes that can be used are:
• Iowa wax and Korecta wax No. 4.
Objectives
• To reduce the support differential for a free-end saddle Advantage
by obtaining a compressive impression of the edentu-
lous area that approximates functional loading. Accurate impression can be produced, if properly done.
• To achieve uniform distribution of load from the denture to
the residual ridge, in order to increase the denture stability. Disadvantages
• Time-consuming.
Methods that can Utilize Altered Cast Technique • Can cause excessive tissue displacement, if not done
• Fluid wax functional impression. accurately.
• Functional reline technique.
Q. 4. Methods of special impression procedures in remov-
• Functional selective pressure dual technique.
able partial denture.
Q. 2. Physiological impression in RPD.
Ans.
Ans.
The different methods of impression procedures in removable
The functional impression or physiologic impression is the partial denture are:
impression which records the residual ridge under general- • Single pressure-free impression technique.
ized compression. • Selective pressure impression technique.
The following are the types of physiologic impression: • Physiologic or functional impression technique
a. McLean's method. • McLean's impression technique.
b. Hindel's method. • Hindel's impression technique.
c. Functional relining method. • Fluid wax impression technique.
d. Fluid wax method. • Functional relining technique.
Section I I Topic Wise Solved Questions of Previous Years
--------------------<(Topic 1 o)
Support for the Distal Extension Denture Base,
Occlusal Relationship for RPO, and Laboratory
Procedures and Work Authorization for RPO
LONG ESSAYS
Q. 1. Explain altered cast impression technique.
Ans.
Altered Cast Impression Technique
In altered cast technique, the master cast is altered into
functional impression by using a second impression method
utilizing the metal framework as a tray.
Objective
• To receive uniform distribution of load from the denture to
the residual ridge that in tum increases denture stability.
• To reduce the support differential for a free-end saddle
by obtaining compressive impression of the edentulous
area that approximates functional loading.
Methods that Utilize Altered Cast Technique
• Fluid wax functional impression.
• Functional reline technique.
• Functional selective pressure dual technique.
A. Fluid wax functional impression
The term fluid wax denotes waxes that have the ability to
flow at mouth temperature.
Types of waxes that can be used are:
• Iowa wax, developed by Dr Smith.
• Korecta wax No.4, developed by Dr O C Applegate and
Dr S C Applegate.
• Korecta wax No. 4 has better flow properties than
Iowa wax.
Objectives of fluid wax technique
• To obtain maximum extension of the peripheral borders
of the denture base.
• To record the stress-bearing areas of the ridge in their func-
tional form and remaining tooth in their anatomic form.
Uses of fluid wax technique
• For making a reline impression for existing partial
denture.
• For correcting the distal extension edentulous ridge por-
tion as in altered cast technique.
Procedure
i. Impression tray is made and attached to the framework
after verifying fit of framework.
ii. Peripheral extensions of tray are corrected after seating
the tray in the mouth. The tray should be 1 or 2 mm
short of the movable tissue.
The posterior extension of the tray should end at two
third the coverage of retromolar pad.
iii. Border moulding the impression tray
The mandibular distal extension tray is border moulded
in two steps:
a. From the anterior extent of the buccal flange to the
most posterior extent of the tray and
b. The remainder of the lingual and distal lingual
flange.
At all times, correct positioning of framework on
teeth is ensured by finger pressure on the abutments.
iv. Relieving tray
As no relief was provided between the ridge and the
tray during the fabrication of denture base, 1-2 mm of
the tray is relieved for impression procedure.
v. Impression procedure
• The fluid wax impression is made with the open
mouth technique.
• The impression wax is melted in a water bath main-
tained at 51-54°C within a container.
• A brush is used to paint the wax on to the tissue side
of the impression tray.
• Each time the tray is placed into the patient's mouth;
it should be kept in place for 5 min to allow the wax
to flow and to prevent build-up of pressure, which
can result in distortion.
• After 5 min, the tray is removed and the wax is
examined for glossy surface indicating adequate
contact.
vi. Making the impression borders
The peripheral extension of the impression tray should
be short by 2 mm to develop a proper border seal with
tissue movements done by the patient.

vii. Buccal and distobuccal borders in mandibular impres-
sions
These are obtained by asking the patient to open the
mouth wide, which will activate the buccinator muscle
and pterygomandibular raphe and produce the desired
border.
viii. Lingual extension for a mandibular impression
Tongue is thrust into the cheek opposite the side of the
arch being border moulded by the patient.
ix. Distolingual extension
• The patient is asked to press the tongue forward
against the lingual surfaces of the anterior teeth.
• After the entire borders are copied satisfactorily,
the impression is replaced in the mouth for a final
time for 12 min to ensure complete flow of wax and
to release any pressure present.
x. The new cast is then poured immediately to avoid wax
distortion.
Advantage
Accurate impression can be produced, if properly done.
Disadvantages
• Time-consuming.
• Can cause excessive tissue displacement, if not done
accurately.
B. Physiologic impressions (Dual impression
techniques)
The functional impression or physiologic impression is the
impression which records the residual ridge under general-
ized compression.
The following are the types offunctional impression:
McLean's physiologic impression
This technique is used in distal extension partial dentures
(as in Kennedy's class I and II situations) to record the tis-
sues of the residual ridge that support a distal extension
denture base in its functional form. This needs a dual im-
pression technique.
Procedure
i. A custom impression tray is constructed over a pre-
liminary cast of the arch with wax occlusal rims.
ii. Border moulding is carried out on the edentulous por-
tion of the tray borders and a functional impression of
the distal extension ridge is made using zinc oxide eu-
genol impression paste or polyvinylsiloxane (PVS) by
recording the impression with patient biting on the oc-
clusal rims.
iii. A second impression is made using alginate with a
stock tray placed over the first impression, which
is positioned in its functional position with finger
pressure.
Quick Review Series for BOS 4th Year: Prosthodontics
Disadvantage
Finger pressure cannot produce the same functional dis-
placement of the tissue that biting force produces.
Hindel's method
The technique is same as McLean's method, except that
Hinde) modified the stock tray for the second impression, in
which holes are provided on both sides in the molar region,
so that finger pressure could be applied through the tray as
the hydrocolloid impression was made.
Disadvantages
• The displaced or functional form technique may lead to
interruption of blood circulation with adverse soft tissue
reaction and bone resorption.
• When the patient's teeth come together, the artificial
teeth contact first and the remaining natural teeth con-
tact only after the mucosa has been displaced. This will
lead to premature contacts which will cause discomfort
to the patients.
C. Functional relining method
In this technique, the secondary impression is made after
the construction of metal framework and denture base. So,
it is referred as functional reline. This technique adds a new
surface to the tissue side of the denture base.
This can be done before insertion or later, if excessive
resorption is present.
Procedure
• A soft metal spacer (Ash No.7 metal) is adapted over
the ridge on the cast before processing the metal denture
base. After processing, the metal is removed leaving an
even space between the base and the edentulous ridge.
• Border moulding is done and impression is made using
a low-fusing modelling plastic placed over the tissue
surface of the denture base. The modelling plastic is
tempered in a water bath and seated in the patient's
mouth, until an accurate impression of the ridge is made.
• The patient should partially open his mouth during the
entire procedure.
Final impression
After the application of modelling plastic is complete,
1 mm of modelling plastic is scraped away uniformly from
all over the crest of ridge.
Final impression is made with a free-flowing zinc oxide
eugenol impression paste. In case of excessive undercuts,
an elastomeric impression material is used.
Disadvantages
• Occlusion may be altered after the new denture base is
processed.
Section I I Topic Wise Solved Questions of Previous Years
• Cannot establish previous occlusal contacts.
• May be difficult to maintain the correct relationship
between the framework and the abutment teeth during
the impression procedure.
Q. 2. Denture base material in RPD.
Ans.
Denture Base Materials in RPO
The denture base materials used in RPD are:
a. Acrylic.
b. Metal.
c. Combination.
a. Acrylic Resin Denture Base
• Acrylic resin denture base is used along with acrylic
tooth replacements.
• Acrylic resin denture base is mainly used for distal ex-
tension partial denture.
• The denture base resin should be at least 1.5 mm thick,
so that it can provide adequate strength.
Advantages
• Anterior teeth can be replaced in their original position
even if there is residual ridge resorption.
• It can be relined.
• It restores the contour of the edentulous ridge.
SHORT ESSAYS
Q. 1. Factors influencing the support of the distal exten-
sion base.
Ans.
Factors Influencing the Support of Distal
Extension Base
• Quality of soft tissue covering ridge.
• Quality of bone supporting denture base.
• Design of partial denture.
• Amount of tissue coverage by denture base.
• Occlusal forces.
• Stress-bearing areas need to be utilized in maxillary and
mandibular dentures.
a. Quality of soft tissue covering ridge
More support to denture is obtained by a firmly
attached mucosa than a flabby tissue.
b. Quality of bone supporting denture base
Vertical forces can be resisted more by cortical bone
than the cancellous bone.
Disadvantages
• It has the tendency to break on usage.
• It tends to distort by the release of internal strains.
• It tends to accumulate mucous deposits and thus leads
to calculus formation.
b. Metal Resin Denture Base
Metal resin denture base is mainly used for tooth supported
partial denture.
Advantages
• It adapts accurately to the soft tissues and thus has a
better retention
• It is easy to clean and there are no mucous deposits.
• In case of severe ridge resorption, thinner metal bases
can be given.
• It has a better soft tissue response.
• There is no interference with the tongue.
Disadvantages
• It is difficult to trim and adjust.
• Overextension of the denture base can injure the soft
tissues.
• Underextension can lead to ridge resorption.
• It has poor aesthetics.
• It is difficult to reline and rebase.
c. Design of partial denture
Better stability, support, and retention are pro-
vided, if the accurately designed partial denture
with direct and indirect retainers is placed in the
right areas.
d. Amount of tissue coverage by denture base
Denture base which covers maximum surface area
will have uniform distribution of load.
e. Occlusal forces
A partial denture opposing natural teeth is sub-
jected to more occlusal forces than opposing a com-
plete denture or RPD.
f. Stress-bearing areas
They need to be utilized in maxillary and mandibular
dentures.
In case of maxillary: Buccal slopes of the ridge and
palatine shelves resist lateral and vertical displacement of
the prosthesis.
In case of mandibular: Buccal shelf area and slopes of
residual ridge resist vertical and horizontal forces.

SHORT NOTES
Q. 1. Lingualized occlusion.
Ans.
• Lingualized occlusion was first proposed by Alfred
Gysi in 1927.
• This occlusion involves occlusion of large upper palatal
cusp against a wide lower central fossa.
Q. 2. Distal extension denture base in removable partial
denture construction.
Ans.
--------------------<(Topic 11)
Correction of RPOs, Repairs and Additions to RPO,
Relining and Rebasing the RPO and Miscellaneous
SHORT ESSAYS
Q. 1. Discuss the necessity of dentures for semi-edentulous
and completely edentulous patients.
Ans.
Dentures for Semi-Edentulous and
Completely Edentulous Patients
Dentures are necessary for semi-edentulous and completely
edentulous patients for any of the following reasons:
• To restore or improve the ability to masticate.
• To restore or improve the appearance.
• To restore the speech of the patient.
• To maintain the oral tissues in as healthy a condition as
possible.
Restoring Mastication
• A complete denture should have proper balanced
occlusion in order to increase the stability of the
denture.
• When the loss of natural teeth is more, then the majority
of chewing will be carried out on the artificial molars
and premolars. The partial denture contributes directly
to chewing in such cases.
Quick Review Series for BOS 4 th Year: Prosthodontics
• Distal extension denture base is defined as a denture
base that extends posteriorly without posterior support
from the natural teeth.
• They are tooth tissue supported partial dentures.
Q. 3. Support for the removable partial denture.
Ans.
• It is defined as 'to hold up or serve as a foundation or
prop for'.
• It is the resistance to the movement of the denture in the
gingival direction.
• It is provided by incisal, occlusal, and lingual rests.
Restoring Appearance
• Anterior teeth may be lost as a result of caries, peri-
odontal disease, or trauma.
• In children, the loss of upper anterior teeth is common,
and is liable to be followed by rapid mesial tilting and
migration of the teeth distal to the space.
• Central incisor is the most common tooth to be lost, and
immediate provision of a space maintainer in the form
of a simple partial spoon denture is necessary to pre-
serve the space for the later provision of a more perma-
nent restoration, such as a fixed bridge.
• In completely edentulous patients, the complete denture
should restore the lost facial contours, vertical dimen-
sion, etc.
• Artefacts like stains can be incorporated to improve
aesthetics.
Maintaining or Restoring the Speech of the
Patient
• This is one of the most important functions of a denture.
• It is very important to restore the speech, as the pa-
tient needs to communicate with the other people
properly.
Section I I Topic Wise Solved Questions of Previous Years
Maintaining the Oral Tissues
• All the oral diseases should be eliminated to a greatest
extent.
• The teeth and their supporting structures, the oral mucosa,
the temporomandibular joints, and the muscles of masti-
cation comprise the integrated masticatory apparatus.
• Loss of teeth and consequent occlusal derangement may
have effects on some or all of these components.
• Partial dentures play a great role to prevent, or at least
minimize and retrograde the pathological changes in the
oral structures.
Q. 2. Kelly's combination syndrome.
Ans.
Kelly's Combination Syndrome
• This syndrome was identified by Kelly in 1972 in pa-
tients wearing a maxillary complete denture opposing a
mandibular distal extension prosthesis.
• The syndrome should be identified at an early stage and
prevented.
• Some methods to prevent combination syndrome are
planning overdentures and designing implant-supported
dentures.
Pathogenesis
• It progresses in a sequential manner.
• The group of complications which represent as a syn-
drome are interlinked to one another.
• The disease can progress in any one of the following
sequences:
Sequence 1
• The patient tends to concentrate the occlusal load on the
remaining natural teeth (mandibular anteriors) for pro-
prioception. For this reason, there is more force acting
on the anterior portion of the maxillary denture.
• Increased resorption of the anterior part of the maxilla
gets replaced by flabby tissue.
• Tilting of the occlusal plane gets anteriorly upwards and
posteriorly downwards due to lack of anterior support.
• The labial flange will displace and irritate the labial ves-
tibule, which leads to the formation of epulis fissuratum.
• There will be fibrous overgrowth of the tissues in the
maxillary tuberosity, posteriorly.
• The shift of the occlusal plane posteriorly downwards
causes resorption in the mandibular distal extension
denture-bearing area.
• Tilting of the occlusal plane leads to the shift of the
mandible anteriorly during occlusion.
• There is reduction in the vertical dimension at occlu-
sion. The retention and stability of the denture is also
reduced.
• The tilt in the occlusal plane disoccludes the lower
anteriors causing them to supraerupt and leads to de-
crease in the periodontal support of the anterior teeth.
• There is increased amount of force acting on the anterior
part of the complete denture, due to the supraerupted
anteriors and the vicious cycle continues.
Sequence 2
• The distal extension residual ridge in the mandible un-
dergoes gradual resorption.
• This causes tilting of the occlusal plane posteriorly
downwards and anteriorly upwards.
• The rest of the vicious cycle continues as in sequence I.
Q. 3. Splints.
Or
Surgical splints.
Ans.
Splint
• A splint is defined as a prosthesis which maintains a
hard and/or soft tissue in a predetermined position.
• Splinting can be removable or fixed.
• It is made of rigid material, e.g., wood, metal, and plas-
ter; or, flexible material, e.g., fabric or adhesive tape.
• Its uses are to protect, immobilize, support, brace, or
restrict motion in a part.
Removable Splinting
i. They will either decrease the mobility or at least prevent
the increase in mobility of the teeth.
ii. Splinting helps retain the teeth and maintain the conti-
nuity of the arch, as extraction can lead to the incorpo-
ration of additional modification spaces into the design
of the RPD.
Fixed Splinting
This type of splinting has better prognosis than a removable
splint, as the patient's cooperation is not needed for the
success of treatment.
Indication
• For teeth that do not provide adequate amount of sup-
port for the RPD.

Contraindications
• Teeth with more than 50% loss of bone support.
• Teeth with less than 1: 1 crown-root ratio.
SHORT NOTES
Q. 1. Combination syndrome.
Ans.
Kelly's Combination Syndrome
• This syndrome was identified by Kelly in 1972 in pa-
tients wearing a maxillary complete denture opposing a
mandibular distal extension prosthesis.
• The syndrome should be identified at an early stage and
prevented.
• Some methods to prevent combination syndrome are
planning overdentures and designing implant-supported
dentures.
Q. 2. Pressure indicating paste.
Ans.
• Pressure indicating paste is a paste used to coat the tis-
sue surface of the framework before insertion.
• It contains calcium carbonate and chloroform.
• It helps in indicating premature contacts in the framework.
Q. 3. Reciprocation in RPD.
Ans.
Quick Review Series for BOS 4 th Year: Prosthodontics
• Avoided in cases, where immobilization of teeth is not
possible.
• Reciprocation is defined as the means by which one part
of a prosthesis is made to counter the effect created by
another part.
• It is provided by a rigid reciprocal arm.
• It resists the stresses generated by the retentive arm.
• It helps in stabilizing the denture against horizontal
movement.
• It holds the tooth when retentive arm is active.
• Other parts which offer reciprocation are:
i. Lingual plate major connector.
ii. An additional occlusal rest placed on the oppo-
site side of the tooth along with the minor con-
nector.
Q. 4. Enameloplasty in RPD.
Ans.
• Enameloplasty is defined as a procedure of recon-
touring a portion of the enamel to obtain a desired
morphology.
• A tapered diamond cylinder stone in a high speed hand-
piece with air water spray is used for the procedure.
• After the procedure, fluoride application is done using
plastic mouth guards.
--------------------- - <( Section 11 )

Multiple Choice Questions

Part I Complete Dentures 301

Part II Fixed Partial Dentures 304
Part 111 Removable Partial Dentures 307
This page intentionally left blank
--------------------- -<( Section 11 )

Multiple Choice Questions

Part I
Complete Dentures
1. The normal biting force in natural dentition and com- 6. Vomiting during impression making procedures may
plete denture is be prevented by
a. 200 N and 600 N a. Sedating the patient
b. 9000 N and 7000 N b. Injecting local anaesthetic
c. 100 N and 30 N c. Asking patient to come empty stomach
d. 600 N and 1 10 N d. Change the impression material

2. All are consequences of edentulism except 7. Which of the following property of saliva affects
a. Prognathic appearance denture retention?
b. Thinning of lips a. Quality and quantity of serous and mucus saliva
c. Decreased length of lip b. Quantity of mixed saliva
d. Increase in columella-philtrum angle c. Quantity of only serous saliva
d. None of the above
3. The replacement of missing part by artificial substitute
is called as 8. The relationship of the denture base that resists
a. Obturator dislodgement of denture in horizontal direction is
b. Tongue blade a. Stability
c. Prosthesis b. Pressure
d. Myofunctional appliances c. Support
d. Retention
4. An artificial replacement of an absent body part of human
body is called 9. Denture-bearing area of the ridge is
a. Prosthesis a. Non-keratinized
b. Appliance b. Keratinized
c. Obturator c. Para-keratinized
d. Artificial velum d. None of the above

5. The replacement of missing part by artificial substitute 10. The thickness of the spacer used in special tray is
is called as a. 5 mm
a. Obturator b. 2.0 mm
b. Tongue blade c. 1.5 mm
c. Prosthesis d. 1.0 mm
d. Myofunctional appliances

1. d 2. C 3. C 4. a 5. C 6. b 7. a 8. a 9. b 10. b

301
 Quick Review Series for BOS 4th Year: Prosthodontics

11. Distal palatal termination of the maxillary complete 19. Clicking of denture during speaking is due to
denture base is dictated by a. Increased vertical dimension of occlusion
a. Vibrating line b. Increased interocclusal space
b. Fovea palatine c. Decreased vertical dimension of occlusion
c. Tuberosity d. Both 'b' and 'c'
d. Maxillary torus
20. Which of the following is an example of static method
12. Incorporation of peripheral seal in an impression is of recording centric relation?
necessary to obtain a. Intraoral records
a. Stability b. Needles
b. Functionally moulded periphery c. House
c. Harmonious occlusion d. Paterson
d. Posterior palatal seal
21. The common defects in fabrication of complete den-
13. In determining the posterior limit of a maxillary denture tures is (are)
base, which of the following is on the posterior border? a. Lifting of the posterior occlusal rim during jaw
a. Hamular notch relations may lead to posterior open bite
b. Hamular process b. Lifting of the anterior occlusal rims during jaw
c. Fovea palatine relations may result in anterior open bite
d. Vibrating line c. Interference heels of the opposing casts on articulator
can cause anterior open bite
14. Vibrating line is on the
d. All of the above
a. Hard palate
b. Junction of hard and soft palate 22. Greatest warpage of the acrylic denture base occurs
c. On soft palate a. During packing
d. At the junction of muscularis uvulae and palatine b. During curing
muscle c. During removal from the cast
d. During polishing
15. Post-dam area serves mainly to
a. Prevent ingress of food and saliva beneath denture 23. An edentulous patient has a complaint that his denture
base becomes loose several hours after wearing. This indi-
b. Prevent lifting away of denture during incising cates
c. Stabilize the denture a. An improper extension of denture base
d. All of the above b. A deflective occlusal contact
c. A high vertical dimension
16. Faulty registration of occlusion cannot be directly
d. An overextended denture flanges
attributed to
a. Viscosity 24. Epulis fissuratum is associated with
b. Pain in the muscles of mastication a. Ill-fitting denture
c. Pain in the TMJ b. Riboflavin deficiency
d. Skeletal class III relation c. Excessive vertical dimension
d. Decreased vertical height
17. Interocclusal space is
a. Space between upper and lower teeth 25. Salts of Gantrez is
b. Space between maxilla and mandible at rest a. Denture adhesive
c. Space between the jaws, when muscles that elevate b. Natural gum
and depress the mandible are in minimum tonic c. Acrylic adhesive
contraction d. Cellulose-based salt
d. None of the above
26. In a denture-wearing patient, there is
18. Orientation records are transferred by a. No bone resorption
a. Gothic arch tracing b. Bone formation
b. Face-bow record c. Independent of denture, there is bone resorption
c. Dual impression technique d. Initial bone resorption, followed by bone formation
d. Any of the above

11. a 12. b 13. a 14. c 15. b 16. d 17. a 18. b 19. a 20. a 21. d 22. c 23. b 24. a 25. a 26. c
Section I II Multiple Choice Questions

27. Punched out lesions on the alveolar ridge is due to 31. The immediate effect of a deflective occlusal contact is
a. Acrylic nodules on tissue-facing surface of denture a. Pain due to trauma
b. Disturbed occlusion b. Mobility of the tooth
c. Overextended borders of denture c. Migration of the tooth
d. Narrow occlusal table d. Periapical abscess formation
28. Uncontrolled diabetes poses a problem to prosthodon- 32. Main aim of the corrected impression method
tist as a. It records the tissues under some loading
a. More bone resorption b. It relates the tissues under some loading
b. Increased salivary flow c. It distributes the load over large area
c. Less bone resorption d. May be all of the above
d. Less tissue laxity
33. Advantage(s) of fluid-wax technique of impression
29. Number of swallowings per day is making is/are
a. 300 a. Greater flow
b. 400 b. Less displacement of tissues
c. 1500 c. Less flow
d. 600 d. 'a' and 'b'
30. Burning sensation in anterior palate region of a patient 34. Objectives of fluid-wax impression are the following,
wearing new complete dentures is due to except
a. Overextension in the buccal sulcus area a. Using the fluid wax for impression making
b. Occlusal discrepancies b. Functional form of stress-bearing area
c. Inadequate relief of the incisive papilla c. Non-bearing areas in anatomic form
d. Rough palatal surface d. Maximum border extension

27. a 28. a 29. d 30. c 31. a 32. d 33. d 34. a

 Quick Review Series for BOS 4 th Year: Prosthodontics

Part 11
Fixed Partial Dentures

1. A patient comes for post and core restoration on upper
central incisor in which RCT has been done, the tooth is
painful on percussion. The treatment is
a. Proceed with post and core
b. Do not make full crown restoration on post and core
c. Do not make post and core
d. There is no relation between pain on percussion and
post and core
2. Loss of several teeth may result
a. Change in facial appearance
b. TMJ disturbances
c. Periodontal disturbances
d. All of the above
3. Biologically and mechanically acceptable connector
ofFPD
a. It is thin occlusogingivally and wide faciolingually
b. It extends the entire inter-proximal space occluso-
gingivally
c. It is circular in form and occupies the region of the
contact area
d. It extends into the facial margins of the retainer.
4. In which of the following cases may a non-rigid connec-
tor be used in fixed partial dentures?
a. Long-span FPD replacing two or more teeth
b. Short-span FPD replacing one missing tooth in which
the prepared abutment teeth are not in parallel alignment
c. Long- or short-span FPD in which one abutment
tooth has limited periodontal support
d. None of the above
5. Ideal requirement of metal-ceramic casting
a. Low-fusing ceramics and high-fusing alloys
b. Matching of coefficients of thermal expansion of
ceramics and alloys
c. Bonding between ceramic and alloy
d. All of the above
6. To replace a missing canine, the best pantie design is
a. Modified ridge lap
b. Ridge lap
c. Ovoid
d. Sanitary
7. A fixed partial denture is indicated to replace maxillary
first and second premolars. The abutment teeth, which
are in normal alignment, are the canine and the first
molar. The connectors of choice are
a. Precision attachments on both the canine and the
molar
b. A soldered joint on the canine and a non-precision
dovetail key way on the molar
c. A soldered joint on the molar with a submucosal
rest of the canine
d. Soldered joints on both the canine and the molar
8. The type of gold alloy used in fixed partial den-
tures is
a. Soft gold
b. Medium gold
c. Hard gold
d. Extra hard gold
9. A patient has undergone root canal treatment in upper
anterior teeth and a post crown was placed. He com-
plains of pain on biting. There is no mobility of the
teeth. The likely reason may be
a. Improper occlusal contacts
b. Vertical root fractures
c. Edges of the crown irritating the gingiva
d. Psychological reasons
10. The formation of a pocket on the mesial side of an
anteriorly tipped second molar is due to
a. Extrusion of upper molars into the edentulous
space
b. Food impaction
c. Lack of stimulation from the anterior edentulous
portion
d. Vertical forces not directed along the long axis of
the crown
11. Which of the following combinations produces the
least occlusal wear
a. Gold versus gold
b. Glazed porcelain versus acrylic tooth
c. Acrylic teeth versus gold
d. Unglazed porcelain against gold

1. C 2. d 3. C 4. b 5. d 6. a 7. d 8. C 9. b 10. d 11. a
Section I II Multiple Choice Questions

12. Dentulous maxillary cast and mandibular cast are 19. A problem with a porcelain jacket is, it
related on articulator by a. Is not colour stable
a. Wax index, where the patient has to bite into b. Is very brittle
maximum contact of the teeth c. Has a very high compression strength
b. Wax index, where the patient has closed from rest d. Is irritating to the gingiva
position just penetrating to tooth contact 20. Porcelain jacket crown can best tolerate which of the
c. Occlusal wax rims placed on the teeth and record- following forces?
ing centric occlusion a. Compressive forces
d. None of the above
b. Shearing stress
13. Egg-shaped pontic is indicated for the replace- c. Tensile forces
ment of d. None of the above
a. Mandibular posteriors 21. Porcelain jacket crowns are contraindicated in
b. Mandibular anteriors a. Hypoplastic teeth
c. Maxillary posteriors b. Excessive horizontal overlap
d. Maxillary anteriors c. Decay is extensive, but pulp is vital
14. A pontic as compared to a missing posterior tooth d. Excessive vertical overlap with little horizontal overlap
should be 22. Which of the following gingival retraction cord is used
a. Same dimensions as that of natural teeth in hypertensive patients?
b. Same dimensions mesiodistally, but less faciolin- a. Plain retraction cord
gually b. Retraction cord with 2% racemic epinephrine
c. Same dimensions faciolingually, but less mesiodis- c. Retraction cord with 8% aluminium chloride
tally d. None of the above
d. Lasser than natural tooth, to exert same forces of
23. In post-space preparation, which of the following acts
mastication
as the best anti-rotational feature?
15. In constructing a fixed partial denture for a patient, a. Anti-rotational notch.
the dentist will use a hygienic pontic. Which of the b. A linear groove in the thickest wall of the root
following will primarily determine the faciolingual c. An oval cross-section of the dowel
dimension of the occlusal portion of this pontic? d. A conical cross-section of the dowel
a. The length of the pontic 24. Gingival retraction is done by all of the following except
b. The masticatory force of the patient a. Aluminium chloride
c. The position of the opposing contact areas b. Aluminium sulphate
d. The width and crestal position of the edentulous c. Ferric sulphate
ridge d. Aluminium nitrate
16. Most appropriate pontic design is 25. Carbon dowel compared to metal dowel is
a. It should fill the missing teeth area a. Aesthetic
b. Greater lingual embrasure b. Translucent
c. Should contact mucosa, but should not irritate it c. Resilient
d. None of the above d. All of the above
17. A fixed bridge with pontics rigidly fixed to the retain- 26. Dicoris
ers provides a. Castable ceramic
a. Strength to the abutments b. Metavite
b. Reduction of stress associated with restoration c. Vitallium
c. Aesthetics to the fixed bridge d. Vita ceramic
d. Reciprocation of forces acting on the pontic
27. The effectiveness of condensing porcelain powder to
18. The use of porcelain laminates is indicated for reduce shrinkage is determined by
a. Teeth in parafunction a. Shape and size of the particle
b. Heavily-restored teeth b. Thickness of the platinum matrix
c. Closure of 1 mm diastema c. Speed of increase of furnace heat
d. Lower anterior teeth d. Using powder of same particle size
12. b 13. a 14. b 15. c 16. c 17. b 18. c 19. b 20. a 21. a 22. d 23. c 24. d 25. c 26. a 27. a
 Quick Review Series for BOS 4th Year: Prosthodontics

28. The main advantage of a natural glaze rather than ap- 32. The most common cause of failure of fixed partial
plied glaze is that the natural glaze dentures is
a. Is more permanent a. Caries on abutments
b. Is easier to achieve b. Periapical lesions
c. Offers better aesthetics c. Retained roots
d. Requires a lower firing temperature d. Wearing of the panties
29. The porcelain constituent that fuses at firing tempera- 33. All of the following are considered detrimental during
ture and forms a matrix is cementation of the cast restoration except
a. Kaolin a. Debridement of the tooth with 3% hydrogen per-
b. Quartz oxide
c. Feldspar b. Rapid mix of the cement
d. Aluminium oxide c. Presence of moisture in the crevice
d. Drying of the tooth with hot air
30. To be biologically and mechanically acceptable, a
soldered joint of a fixed bridge should be so formed 34. In a patient, sensitivity immediately after cementation
that it of a three unit FPD is due to
a. Extends to the buccal margin of the retainer a. Cervical caries in abutment
b. Extends the entire interproximal space occluso- b. Cementum exposure
gingivally c. Thin margins of restoration
c. Thins occlusogingivally and thickens buccolin- d. Cervical abrasion
gually
35. The setting time of zinc phosphate cement can be
d. Depends upon clasping and indirect retention
retarded by
31. Painless erythematous lesion is seen after 3 weeks of a. Increasing the ratio of powder to liquid
crown placement on maxillary lateral incisor. The lesion is b. Diluting the liquid with a small amount of water
a. Pyogenic granuloma c. Accelerating the rate of addition of powder to
b. Granular cell tumour liquid
c. Metastatic tumour d. Decreasing the rate of addition of powder to
d. Periodontal abscess liquid

28. a 29. c 30. c 31. a 32. a 33. a 34. c 35. d

Section I II Multiple Choice Questions

Part Ill
Removable Partial Dentures

1. The purpose of replacing a lost member is 7. The support for a removable partial denture is usually
a. Functional a. Tooth support
b. Aesthetic and functional b. Mucosa support
c. Aesthetic c. Occlusal rest support
d. To remove caries d. Tooth and mucosa support

2. A removable partial denture replacing one tooth
a. Is an acceptable permanent method
b. Is not an acceptable method, unless it is tempo-
rary treatment until a fixed partial denture is
placed
c. Does not result in caries under the clasps
d. Has no danger of aspiration of prosthesis
3. Which of the following will produce the most rigid
restoration for framework of same dimension?
a. Wrought alloys
b. Palladium alloys
c. Cobalt-chrome alloys
d. Partial denture casting gold
4. Before pouring an elastic impression, it is washed with
slurry of water and stone to
a. Increase gel strength
b. Prevent syneresis
c. Prevent distortion
d. Wash off saliva on impression
5. Class IV Kennedy classification is
a. Bilateral edentulous area located posterior to the
remaining natural teeth
b. Unilateral edentulous area located posterior to the
remaining natural teeth
c. Unilateral edentulous area with natural teeth re-
maining both anterior to the remaining natural teeth
and posterior to it
d. A single, but bilateral (crossing the midline) edentu-
lous area located anterior to the remaining natural
teeth
6. A distal extension partial denture receives its support
a. From terminal abutments.
b. Equally from abutments and residual ridges.
c. Mostly from residual ridge.
d. Exclusively from residual ridge.
8. The mandibular distal extension RPD extends up to
a. Full length of retromolar pad
b. Anterior one-third length of retromolar pad
c. Anterior two-third of retromolar pad
d. None of the above
9. Distal extension RPD is
a. Both tissue- and tooth-borne
b. Tooth-borne
c. Class III condition
d. Class IV condition
10. Main advantage of RPD over fixed bridge in replacing
bilateral lost teeth
a. Cross-arch stabilization
b. Aesthetics
c. Less expensive
d. Comfort of the patient
11. The major concern of RPD associated with a diabetic
patient is
a. Selection of artificial teeth
b. Unfavourable response of supporting tissue
c. Problems in impression procedures
d. Nothing of special concern in diabetic patients
12. For planning to construct RPD, centric relation and cen-
tric occlusion of the remaining natural teeth is established
a. Before designing of the RPD
b. After secondary impressions are taken
c. After processing and before insertion of the RPD
d. If only patients complain of any problem
13. A patient has his upper incisors replaced by a RPD.
Whistling sound when patient is trying to speak is due
to all of the following except
a. Excessive deepbite
b. Palatally placed incisors
c. Excessive overjet
d. Insufficient overbite

1. b 2. b 3. d 4. C 5. d 6. C 7. d 8. C 9. a 10. a 11. b 12. a 13. a


14. An excellent objective in partial denture prosthesis is
a. To produce a highly complex design
b. To devise an intriguing new design
c. To utilize a new material
d. To keep appliance design as simple as possible
15. When planning a maxillary class IV RPD, the planning
for aesthetics begins with
a. Survey of the radiograph
b. Selection of proper shade of artificial teeth
c. Survey of the diagnostic cast
d. Survey of the refractory cast
16. The aim of the mouth preparation prior to RPD planning
is to
a. Enhance the aesthetics
b. Assure a definite path of insertion for the RPD
c. Protect the periodontal structures by minimizing
the torque forces
d. All of the above
17. Mounted diagnostic casts help in
a. Selection of type of denture base
b. Determination of areas of support
c. Selection of pantie teeth
d. All of the above
18. Tripod markings are placed on the cast during surveying to
a. Record the undercut areas of the cast
b. Record undercut areas of the teeth
c. Record the orientation of the cast to the surveyor
d. Record the orientation of the cast to the articulator
19. The first step in surveying the casts for RPD is
a. Establishment of guiding planes
b. Establishment of undercuts for retention
c. Establishment of tooth contour for aesthetics
d. Establishment of interferences for major connectors
20. Slurry water is prepared by
a. Mixing gypsum products in water
b. Adding fine set gypsum to water
c. Allowing set gypsum to be in water for > 48 h
d. By adding synthetic gypsum to the water
21. Immersion of reliever master cast in slurry water
a. Is kept upside down
b. Allows air entrapped beneath sheets of wax to escape
c. Prevents etching of surface of mater cast
d. Accomplishes all of the above
14. d 15. c 16. d 17. d 18. c 19. a 20. c
Quick Review Series for BOS 4th Year: Prosthodontics
22. First step before relining a partial denture
a. Verify fit of the framework of partial denture
b. Occlusal adjustments should be carried out
c. Dual impression should be taken
d. Eliminate undercuts in denture base
23. Fractured metal parts in an RPD are best joined by
a. Spot welding
b. Brazing
c. Laser welding
d. Electric soldering
24. Occasionally, the need for repamng or replacing a
direct retainer assembly or one of its components
arises. Such a need may arise because of
a. Repeated flexure into and out of an excessive
undercut
b. Structural failure of the clasp itself due to improper
form or casting procedures
c. Careless handling by the patient
d. All of the above are correct
25. Breakage of occlusal rests usually occurs because of
a. Improper reduction of marginal ridges on abutment
teeth during rest seat preparation
b. An overreduction of rests to accommodate opposing
cusps
c. All of the above
d. None of the above
26. A dentist making an impression to reline a distal exten-
sion base notes that indirect retainers are not in their
intended position on the respective abutment teeth. He
should
a. Finish the reline procedure realizing that the denture
base will settle again
b. Use additional impression material in the denture
base
c. Not be concerned with the relationship of the
indirect retainers to the abutment teeth
d. Start over and do it correctly
27. Most common complaint of the patient with a thick
palatal bar in a RPD is
a. Distortion under occlusal stress
b. Poor dissipation of force due to rigidity
c. Difficulty in pressing the food backward and
swallowing
d. Loss of taste sensation
21. d 22. a 23. d 24. d 25. c 26. d 27. c
Section I II Multiple Choice Questions

28. During multiple splinting, the use of the inlay is 30. Which of the following points are important in multiple
avoided for anchorage of a splint because spruing for partial denture construction?
a. It may fracture a. Use a few sprues of larger diameter rather than
b. It may cause fracture of the tooth several smaller sprues
c. Of the danger of its becoming partially loosened b. Keep all sprues as short and direct as possible
d. It weakens the splint c. Avoid abrupt changes in direction and T-shaped
junctions
29. Which of the following are types of anterior teeth used
d. All of the above
on partial dentures?
a. Porcelain or resin denture teeth 31. Failure of partial dentures due to poor clasp design can
b. Ready-made resin denture teeth best be avoided by
c. Resin teeth processed to a metal framework a. Using stress breakers
d. All of the above b. Using bar-type clasps
c. Altering tooth contours
d. Clasping only those teeth with fairly long crowns
and normal bone support

28. C 29. d 30. d 31. C

This page intentionally left blank
--------------------- - <( Section 111)

Previous Years' Question Bank

PART I: COMPLETE DENTURES

Topic 1 Introduction to Complete Dentures 313
Topic 2 Diagnosis and Treatment Planning 314
Topic 3 Diagnostic Impressions in CD and Mouth Preparation for CD 314
Topic 4 Primary Impression in Complete Dentures and
Lab Procedures Prior to Master Impression Making 315
Topic 5 Secondary Impression in Complete Dentures and Lab
Procedures Prior to Jaw Relation 318
Topic 6 Maxillomandibular Relations 319
Topic 7 Lab Procedures Prior to Try-in 323
Topic 8 Lab Procedures Prior to Insertion and Complete
Denture Insertion 325
Topic 9 Relining and Rebasing in Complete Dentures 326
Topic 10 Special Complete Dentures and Miscellaneous 326

PART II: FIXED PARTIAL DENTURES

Topic 1 Introduction to Fixed Partial Dentures 329
Topic 2 Parts and Design of Fixed Partial Dentures 329
Topic 3 Occlusion in Fixed Partial Dentures 331
Topic 4 Types of Abutments 332
Topic 5 Tooth Preparation 332
Topic 6 Types of Fixed Partial Dentures 335
Topic 7 Impression Making in Fixed Partial Dentures 336
Topic 8 Temporisation or Provisional Restorations and Lab
Procedures Involved in Fabrication of FPO 337
Topic 9 Cementation of Fixed Partial Dentures and Miscellaneous 338
Topic 10 Maxillofacial Prosthetics and Implant Dentistry 339

PART 111: REMOVABLE PARTIAL DENTURES

Topic 1 Introduction and Terminology 341
Topic 2 Introduction, Treatment Planning, and Mouth Preparation 342
Topic 3 Major and Minor Connectors 342
Topic 4 Rests and Rest Seats 344
Topic 5 Direct and Indirect Retainers 345
Topic 6 Denture Base Considerations 347
Topic 7 Principles of RPO Design 347
Topic 8 Surveying and Preparation of Mouth for RPO 347
Topic 9 Impression Materials and Procedures for RPO 349
Topic 10 Support for the Distal Extension Denture Base,
Occlusal Relationship for RPO, Laboratory
Procedures and Work Authorization for RPO 349
Topic 11 Correction of RPDs, Repairs and Additions to RPO,
Relining and Rebasing the RPO and Miscellaneous 350
--------------------- - <( Section 111)
Previous Years' Question Bank
Part I
Complete Dentures
------------------ - <( Topic
Introduction to Complete Dentures
Long Essays
1. Define physiologic rest position of mandible. Give the
importance of Silverman's closest speaking space and
discuss the effects of increased vertical dimension in
complete dentures. [MUHS Nov 2003]
2. Discuss in detail how you will manage mandibular poor
foundation case for complete denture fabrication.
[MUHS 2002]
3. Classify denture stomatitis and write its causative
factors. [MUHS Aug 1999]
4. Primary stress-bearing areas in mandibular arch with
reasoning. [MUHS Aug 1997]
5. What do you mean by physiological rest position? What
is the importance of it in constructing the successful
complete denture? [MUHS Jun 1994]
6. What is the importance of patient education? What
instructions you will give to a patient receiving com-
plete denture prosthesis? [RGUHS Jun 1991]
7. Define denture aesthetics and discuss the various factors
influencing denture aesthetics. [RGUHS Jun 1989]
8. A teacher aged 50 years wearing complete denture for
last ten years visits your office for consultation. Give
your method of examining treatment procedure.
[RGUHS Apr 1987]
9. Enumerate the reasons for loss of teeth. What are the
consequences of loss of teeth? What are the methods of
prosthodontic replacements? [BUHS Apr 1987]
1)
Short Essays
1. Mental attitude of patients. [NTR-NR Oct 2004, Apr
2002]
2. Compare residual ridge resorption of maxillary and
mandibular edentulous ridge. [RGUHS Sep 2002]
3. Metallic denture base. [NTR-OR Apr 2001]
4. Ridge resorption. [NTR-OR May 1994]
5. Edentulous state. [NTR-OR Feb 1990]
Short Notes
1. Fabrication of custom tray for completely edentulous
arches. [TN Feb 20 I I]
2. Rougae area and its clinical application in complete
denture prosthodontics. [MUHS Aug 2007]
3. What are the objectives of complete denture prosth-
odontics? Explain them. [MUHS Nov 2006]
4. Advantages of metal bases. [RGUHS Aug 2006]
5. RRR. [RGUHS Aug 2006]
6. Xerostomia. [RGUHS Aug 2006]
7. Metallic denture base. [RGUHS Aug 2005]
8. What are the soft tissues covering the hard palate and
their relevance to complete dentures? [MUHS Aug 2005]
9. Polished surface. [NTR-NR Oct 2004, 2002]
10. Draw maxillary and mandibular edentulous cast and
label the anatomical landmarks of clinical importance.
[MUHS Nov 2004]
313

11. Define the term geriodontology. What are the age changes
occurring in geriatric patient? [MUHS Jun 2002]
12. What are the stress-bearing and relief areas of maxillary
foundation? [MUHS Sep 2002]
-------------------<( Topic 2)
Diagnosis and Treatment Planning
Long Essays
1. Discuss in detail the clinical significance of the follow-
ing for ensuring success of complete denture treatment.
a. Pre-extraction records.
b. Examination, diagnosis, and treatment planning.
[MUHS Sep 2007]
2. Discuss the significance of case history recording, diagno-
sis, and treatment planning in the fabrication of complete
dentures prosthesis. [GOA Dec 2005]
3. What do you understand by the term 'Examination of
the patient?' Name the objectives of examination of a
patient. Discuss in detail the clinical significance of
anatomical landmarks of edentulous maxilla and man-
dible. [TN Nov 2001]
4. Diabetic patient aged 65 years with few teeth remaining
comes to your dental college hospital for dental prosthe-
sis. Discuss the treatment planning and special steps to
be taken by you for the management of the patient.
[NTR-OR Mar 1991]
5. A teacher aged 50 years wearing complete denture for
last ten years visits your office for consultation. Give
your method of examining treatment procedure. [BUHS
Apr 1987]
-------------------<( Topic 3)
Diagnostic Impressions in CD and Mouth
Preparation for CD
Long Essays
1. Define complete denture retention. Enumerate the vari-
ous factors of retention. [RGUHS Jun/Jul 2010 (RS2)]
2. Define impression. Discuss the biological consider-
ations for a maxillary impression. [RGUHS Jun/Jul
2010 (RS)]
Quick Review Series for BOS 4 th Year: Prosthodontics
13. Polishing surfaces of the complete denture. [GOA Nov
1998]
14. Soft palate. [RGUHS Aug 1993]
Short Essays
1. Pre-prosthetic surgery. [NTRUGHS Aug 2013]
2. Influence of saliva on retention and stability. [RGUHS
Jun/Jul 201 I (OS)]
3. Importance of preprosthetic evaluation of the edentu-
lous area before making impression. [MUHS Aug
2007]
4. Why should complete radiograph examination be made
of an edentulous mouth? [MUHS Nov 2002]
5. Discuss the diagnosis and treatment planning in com-
plete denture patients. [GOA Dec I 998]
Short Notes
1. Mental attitudes of patients. [TN Feb 2012]
2. Undercuts in complete denture. [RGUHS Jul 2008 (RS)]
3. Importance of full mouth intraoral radiographs in eden-
tulous patients. [RGUHS Jul 2008 (RS2)]
4. Significance of retromolar pad. [NTRUHS Oct 2007]
5. Preprosthetic surgery. [GOA Dec 2004]
6. House classification of mental attitudes. [GOA Aug
2003, 1999]
3. Discuss the mouth preparation of compete dentures.
[TN Aug 2005]
4. Define impressions in prosthodontics. Why is it called
as biological? Discuss the principles and objectives of
impression making in complete denture prosthesis.
[GOA Dec 1999]
Section I 111 Previous Years' Question Bank
Short Essays
1. Diagnostic cast and its uses [RGUHS Jun/Jul 2010
(OS)]
2. Importance of preprosthetic evaluation of the edentu-
lous area before making impression. [MUHS 2007]
3. Preprosthetic surgery. [RGUHS Aug 2006; NTR-NR
Oct 2002 2001]
4. Vestibuloplasty. [NTR-NR Apr 2003]
5. Preprosthetic surgical managements in complete den-
ture. [NTR-OR Apr 1998]
Short Notes
1. Retromolar pad. [NTRUGHS Aug 2013]
2. Anterior reference points. [NTRUGHS Aug 2013]
--------------------,( Topic 4)
Primary Impression in Complete Dentures and Lab
Procedures Prior to Master Impression Making
Long Essays
1. Define stability and support in complete dentures.
Describe the methods to obtain stability and support.
[RGUHS Dec/Jan 2012 (RS)]
2. Write in detail about the anatomical landmarks
of maxillary and mandibular edentulous arches in re-
lation to complete denture construction. [TN Feb
2011]
3. Write in detail the supporting and limiting structures of
maxillary and mandibular edentulous arch. [RGUHS
Dec 2011/Jan 2012 (RS2)]
4. Define the term 'impression' in complete denture
prosthodontics. Classify impression techniques and ex-
plain the objectives and theories of impression making.
[TN Feb 2010; NTR-OR Oct 1995]
5. Define stability and discuss the various factors affect-
ing stability in complete denture. [NTRUHS Aug
2009]
6. Define and discuss retention in complete denture.
[RGUHS Jul 2008 (OS)]
7. Mention the objects of impression making and discuss
the procedure of merits and demerits of different
impression techniques for a complete denture. [TN Feb
2007]
8. Give the importance of impression techniques used for
different patient treatment planning and post-insertion
instruction to the patient. [MUHS Jul 2007]
3. Preprosthetic surgery. [RGUHS Dec 2010 (RS)]
4. Mandibular stress-bearing areas. [RGUHS Dec 2010
(RS)]
5. Buccal shelf area. [RGUHS Jun/Jul 2010 (RS2); TN
Apr 2004]
6. Incisive papilla. [RGUHS Jun/Jul 2010 (OS)]
7. Muscles of the soft palate. [TN Apr 2004]
8. Alveolingual sulcus. [TN Oct 2003]
9. Muscles of mastication and facial expression. [TN Oct
2003]
10. Balanced occlusion. [TN Sep 2002]
9. Define retention. Write briefly about the various
factors involved in the retention of complete denture.
[RGUHS Aug 2006]
10. Mention the importance of posterior palate seal in com-
plete denture. Describe in detail the anatomic location
and the methods of recording the same. [TN Feb 2006]
11. Define complete denture impression. Discuss in detail
the aims and objectives of impression making.
[RGUHS Aug 2005]
12. Describe any one method of making the primary im-
pression for a maxillary complete denture, stating step
by step precautions and causes of errors in the impres-
sion. [MUHS Jun 2005]
13. Describe in brief the principles and objectives of mak-
ing maxillary final impression for complete edentulous
patient and write the concepts incorporated in your
impression procedure. [MUHS Aug 2005]
14. Define 'retention' in complete dentures. Enumerate
and discuss the various factors responsible for the
retention of complete dentures. [TN Apr 2004]
15. Neutral zone. [NTR-NR Apr 2004 2003]
16. Define impression. Discuss the various theories
of impression making and describe your method of
making a definitive impression. [GOA Nov 2003]
17. Define impression making in complete denture. Name
the objectives of impression making. Discuss the
factors affecting the retention. [TN Sep 2002]

18. Discuss the aims and objectives of impression making
in complete denture treatment. [GOA 2001]
19. Define retention, stability, and support. Explain how
you will achieve these factors in complete denture
prosthesis. [GOA Oct/Nov 2000]
20. Discuss the anatomical landmarks in case of a com-
pletely edentulous patient. [NTR-OR Oct 2001]
21. What do you understand by term 'stability' of complete
denture? Write the factors which influence stability in
CD. [RGUHS Mar 2001]
22. Define retention, stability, and support in complete
denture. Write in detail about the factors influencing
retention. [NTR-OR Apr 1998]
23. Discuss the factors affecting retention and stability in
complete dentures. [MUHS Nov 1997]
24. Discuss posterior palatal seal in detail. [MUHS Nov
1997]
25. Define retention, stability, and support. Discuss the im-
portance of stress and non-stress-bearing areas in com-
plete denture patient. [RGUHS Jan 1991, Mar 1995]
26. Define the term 'retention'. Describe the factors of
retention in complete denture. [NTR-OR Nov 1995]
27. What is 'Posterior palatal seal? Describe how it is ob-
tained? [MUHS 1994, 1995]
28. What are the various causes for inadequate retention in
complete denture? What precautions would you take to
achieve good retention in complete denture? [MUHS
1995]
29. Define impression. Discuss the aims and objectives of
impression for a complete denture patient. [BUHS Feb
1993]
30. What are the objectives of impression making and how
will you achieve them during impression making?
[NTR-OR May 1992]
31. What do you understand by the terms retention,
stability, and support? What factors affect stability of
the complete denture? [MUHS 1991]
32. What is mucostatic impression? Give in detail the mu-
costatic impression procedure with special reference to
its underlying principle. Describe its merits. [RGUHS
Feb 1990]
33. With the help of a diagram, discuss the denture-
bearing area of edentulous mouth. Give the clinical
importance of anterior palatal seal and retromolar
pad. [RGUHS Jul 1990]
34. With the help of a diagram, discuss the denture-
bearing area of edentulous mouth. Give the clinical
importance of anterior palatal seal and retromolar
pad. [BUHS Jul 1990]
35. What is posterior palatal seal and give its significance?
Describe one of the methods of projecting posterior
palatal seal in complete denture patient. [BUHS 1989]
36. Discuss the various factors related to retention and
stability in complete dentures. [MUHS 1989]
Quick Review Series for BOS 4th Year: Prosthodontics
37. What do you understand by the terms, retention and
stability in complete denture prosthesis? Discuss the
various doctrines incorporated in prosthesis for guess-
ing good retention in conversional complete denture
prosthesis. [RGUHS Mar 1988]
38. What do you understand by the terms, retention and
stability in complete denture prosthesis? Discuss the
various doctrines incorporated in prosthesis for guess-
ing good retention in conversional complete denture
prosthesis. [BUHS Mar 1988]
39. Explain how different groups of muscles cause dislodge-
ment of maxillary and mandibular complete denture and
how muscular power can be harnessed for further reten-
tion of complete denture? [BUHS Aug 1988]
40. Describe in detail the various anatomical landmarks in
an edentulous mouth to be considered for construction
of complete denture. [RGUHS May 1986]
41. What do you understand by the term 'stability' of
complete denture? Write the factors which influence
stability in CD.
Short Essays
1. Factors affecting stability of complete dentures.
[NTRUHS Mar 2012 (NR)]
2. Alginate impression material. [NTRUHS Mar 2012
(NR)]
3. Physical factors of retention of dentures. [RGUHS Dec
201 I/Jan 2012 (RS2)]
4. Impression compound. [NTRUHS Jul 201 I (OR)]
5. Pressure theory of impression making. [RGUHS Dec
2010 (OS)]
6. Objectives of impression making. [MUHS Jun I 999;
NTRUHS Feb 20 IO]
7. Relief areas. [NTRUHS Aug 2009]
8. Factors affecting stability of complete dentures.
[NTRUHS Mar 2008]
9. Alveolingual sulcus. [RGUHS Jul 2008 (RS)]
10. Retromolar pad. [RGUHS Jul 2008 (OS)]
11. Write about the significance of posterior palatal seal in
maxillary prosthesis. [RGUHS Mar 2006]
12. Discuss the materials and methods for recording
complete denture impressions. [GOA Dec 2005]
13. Posterior palatal seal. [NTR-NR Mar 2005, NTR-OR
Apr 1995, May 1994]
14. Maxillary anatomic landmarks. [NTR-NR Mar 2005]
15. Microscopic anatomy of supporting and limiting struc-
tures of maxilla. [TN Apr 2004]
16. Factors for retention and stability of complete denture.
[TN Oct 2003]
17. Impression technique for a flabby ridge. [TN Apr
2003]
18. Retention in complete dentures. [NTR-NR Apr 2003;
NTR-OR Apr 2000, I 997]
Section I 111 Previous Years' Question Bank

19. Define retention, stability, and support. Discuss the 14. Retention in complete denture. [RGUHS Mar 2005,
various causes for inadequate retention in complete Sep 2000; TN Aug 2010]
dentures. [GOA 2002] 15. Classify impression materials. [NTRUHS Aug 2009]
20. Incisive papilla. [NTR-NR Oct 2002; NTR-OR Apr 16. Tissue conditioners. [NTRUHS Aug 2009]
2001, Feb 1990] 17. Vibrating line of palate. [RGUHS Jul 2008 (RS)]
21. Buccal sheet area. [NTR-OR Apr 2002] 18. What is the significance of a posterior palatal seal?
22. Define and explain the significance of posterior palatal Enumerate the techniques used to develop the same.
seal with diagram. [RGUHS Sep 2002] [MUHS Nov 2008]
23. Factors affecting retention in complete dentures. 19. Posterior palatal seal area. [MUHS Dec 2007]
[NTR-OR Oct 2001] 20. Enumerate the functions of posterior palatal seal.
24. Role of saliva in edentulous patients. [MUHS Jun [MUHS Dec 2007]
1999] 21. Syneresis and imbibition. [RGUHS Feb 2007 (RS)]
25. Enumerate the various objectives of impression mak- 22. Labial frenum. [RGUHS Feb 2007 (RS)]
ing in complete denture. Discuss the various philoso- 23. Significance of centric relation. [RGUHS Feb 2007 (RS)]
phies of impression making in complete denture. 24. Disadvantages of condensation silicones. [RGUHS
[MUHS Jun 1999] Feb 2007 (RS)]
26. Role of saliva in edentulous patients. [MUHS Jul 25. Significance of incisive papilla? [NTR-NR Apr 2006]
1999] 26. How you will record buccal frenum in maxillary
27. Enumerate the various objectives of impression making impression? Name the muscles associated with it.
in complete denture. Discuss the various philosophies [MUHS 2006]
of impression making in complete denture. [MUSH 27. Objectives of final impression making in complete
Aug 1999] denture prosthodontics. [MUHS 2006]
28. Significance of retromolar pad. [NTR-OR Apr 28. Saliva's influence on denture retention and stability.
1998] [RGUHS Aug 2006]
29. Primary stress-bearing areas. [NTR-OR Oct 1998] 29. Ruguae support. [RGUHS Aug 2006]
30. Classify the various methods of impression making in 30. Torus palatines. [RGUHS Aug 2006]
complete denture. [MUHS Aug 1998] 31. Factors affecting complete denture retention. [NTR-
31. Write a note on surverying. [GOA 1998] NR Mar 2005]
32. Saliva and its role in complete dentures. [NTR-OR 32. House's palate classification. [NTR-NR Oct 2005]
Oct 1997] 33. How would you locate the posterior palatal seal area?
33. Retromolar pad. [NTR-OR Feb 1990, Nov 1994] Describe any one method of incorporating the effect
34. Mylohyoid ridge. [NTR-OR Feb 1990] in the maxillary complete denture. [MUHS Aug
2005]
34. What are the advantages of zinc oxide eugenol
Short Notes
impression paste? State its composition. [MUHS
1. Disinfection of impression. [NTRUGHS Jul 2014] Aug 2005]
2. Dual arch impression. [NTRUGHS Jul 2014] 35. Define retention as applicable to complete dentures
3. Neutral zone. [RGUHS Aug 2005, Jun I 990, Feb and list five possible causes for failure in achieving it.
I 989; TN Feb 20 I 3] [MUHS Nov 2005]
4. Retromolar pad. [RGUHS Apr 2003; TN Feb 2013, 36. Retention and stability. [TN Aug 2005]
2009] 37. Selective pressure impression. [RGUHS Mar 2004]
5. Buccal shelf. [NTRUHS Mar 2012 (NR)] 38. Anterior and posterior vibrating lines. [RGUHS Mar
6. Ring form. [RGUHS Dec 201 I/Jan 2012 (OS)] 2004]
7. Stress-bearing areas. [NTRUHS Mar 2012 (NR); 39. Mechanism of complete denture support. [TN Apr
RGUHS Feb 2007 (RS); TN Feb 2012] 2003]
8. Primary stress-bearing area. [RGUHS Jun/Jul 201 I 40. Objectives of impression making in complete dentures.
(RS2)] [MUHS Dec 2004, 2003]
9. Anterior and posterior vibrating lines. [RGUHS Jun/ 41. Define posterior palatal seal and give conventional
Jul 201 I (RS2)] method to record it. [MUHS Nov 2004]
10. Rugae. [RGUHS Jun/Jul 201 I (RS2)] 42. Materials which can be used for wash impressions in
11. Retention. [NTRUHS Feb 2011] final impression for complete dentures. [MUHS Dec
12. Stability. [NTRUHS Feb 2011] 2004]
13. Selective pressure impression technique in complete 43. What is a functional impression and write the technique
denture patients. [TN Aug 20 IO] for making the same? [MUHS Dec 2004]

44. Masseteric notch. [RGUHS Sep 2004, Mar 2001]
45. Posterior palatal seal area/ [NTR-NR Apr 2003]
46. Mention the physical factors which aid in retention of
complete dentures. [MUHS Nov 2003]
47. Marking of vibrating line. [RGUHS Sep 2002]
48. What is the purpose of border moulding? [MUHS
Aug 2002]
49. Factors of retention in complete denture. [MUHS
Aug 2002]
------------------- <( Topic
Secondary Impression in Complete Dentures and Lab
Procedures Prior to Jaw Relation
Long Essays
1. Define articulators. Give classification, uses of articu-
lators, and discuss in detail about a semi-adjustable
articulator. [NTRUHS Mar 2008]
2. Define impression for complete denture and discuss
in detail the anatomic structures influencing the im-
pression of edentulous mandible. [NTR-NR Apr
2004]
3. Define articulators. Give classification, and discuss the
uses of articulators. [GOA Aug 2004]
4. What is posterior palatal seal? Describe how it is ob-
tained. [GOA Aug 2004]
5. Write in detail about the need for balanced articulation
and explain in detail the factors governing balanced
articulation. [TN Apr 2003]
6. Define impression. Discuss in detail about the most
widely accepted technique of making impression in
complete denture treatment. [NTR-NR Oct 2002]
7. Define complete denture impression. Discuss the
various theories of impression making. [NTR-OR
Apr 2001]
8. Define articulators. Give any two classifications of
articulators. Write the advantages and disadvantages of
mean value articulators. [GOA Sep 2001]
9. Describe the theories of impression making in com-
plete dentures prosthodontics. Describe the impres-
sion procedure you will follow for a patient with up-
per anterior movable flabby tissue. [NTR-OR Apr
1996]
10. Define the term 'impression' in complete denture
prosthodontics. Classify impression techniques and
explain the objectives of impression making. [NTR-
OR Oct 1995]
Quick Review Series for BOS 4th Year: Prosthodontics
50. Atmospheric pressure. [NTR-NR Oct 2002]
51. Marking of vibrating line. [RGUHS Sep 2002, Mar 1995]
52. Stability in complete dentures. [NTR-OR May 1994,
GOA 2002]
53. Mucocompressive impression theory. [RGUHS Sep
2000]
54. Stress-bearing areas of the edentulous arches. [GOA
Sep 1998]
55. Soft palate. [BUHS Aug 1993]
5)
11. What are the objectives of impression making and how
you will achieve them during impression making?
[NTR-OR May 1992]
12. What is mucostatic impression? Give in detail the mu-
costatic impression procedure with special reference to
its underlying principle and describe its merits. [BUHS
Feb 1990]
13. What is posterior palatal seal and give its significance?
Describe one of the methods of projecting posterior pala-
tal seal in complete denture patient. [RGUHS Feb 1989]
Short Essays
1. Posterior palatal seal. [NTRUHS Jan 2012 (OR), Oct
2007; RGUHS Dec/Jan 2012 (RS); TN Nov 2001]
2. Semi-adjustable articulator. [RGUHS Jun/Jul 2011
(RS2)]
3. Draw a neat labelled diagram of mean value articula-
tor. [RGUHS Dec 2010 (RS)]
4. Selective pressure impression theory [RGUHS Jun/Jul
2010 (RS)]
5. Articulators. [NTRUHS Aug 2009; TN Oct 2003, Sep
2002]
6. Selective pressure impression technique. [NTR-NR
Oct 2005, Apr 2000; NTRUHS Oct 2007]
7. Various theories of impression making of edentulous
arches. [NTR-NR Apr 2006]
8. Discuss the materials and methods for recording com-
plete denture impressions. [GOA Dec 2005]
9. Rubber base impression materials. [TN Apr 2003]
10. Trial denture. [NTR-NR Apr 2003]
11. Define and explain the significance of posterior palatal
seal with diagram. [RGUHS Sep 2002]
Section I 111 Previous Years' Question Bank
12. Selective compression theory. [NTR-OR Apr 1998]
13. Pascal's law. [NTR-OR Apr 1997]
14. Controlled pressure theory of impression making.
[NTR-OR Oct 1997]
15. Define articulator. Classify and discuss the importance
of articulators in prosthodontics. [GOA 1997]
16. Selective pressure theory of impression. [NTR-OR
Apr 1995]
17. Border moulding in mandible. [NTR-OR Nov 1994]
Short Notes
1. Primary stress-bearing area. [NTRUGHS Aug 2013]
2. Disinfection of impressions. [NTRUHS Mar 2012 (NR)]
3. Mean value articulator. [RGUHS Dec/Jan 2012 (RS)]
4. Articulators - classification. [NTRUHS Jul 201 I (OR)]
5. Define articulator. Classify them. [NTRUHS Feb
2010]
6. Hinge axis. [NTRUHS Feb 2010]
7. Vibrating line. [RGUHS Dec 2010 (OS)]
8. Significance of posterior palatal seal. [RGUHS Dec
2010 (RS)]
9. Border moulding. [RGUHS Dec 2010 (RS)]
------------------ -<( Topic
Maxillomandibular Relations
Long Essays
1. Define face-bow. Give classification and utility of face-
bow in complete denture prosthodontics. [NTRUGHS
Jul 2014]
2. What are jaw relations? Discuss the biological signifi-
cance of following during complete denture prepara-
tion? [TN Feb 2013]
3. Write the importance of centric relation in complete
denture treatment. Write in brief the methods to record
centric relation in complete dentures. [TN Feb 2012]
4. Define centric relation. Explain its significance. Discuss
the various methods of recording centric relation in
edentulous patients. [NTRUHS Feb 2012]
5. Define centric jaw relation. Mention in brief the various
methods of recording it. [NTRUHS Feb 2011]
6. Define centric jaw relation. Classify different methods
and explain any one method for recording jaw elation.
[RGUHS Jun/Jul 2011 (RS2)]
7. Describe and classify face-bow. Mention the parts of
face-bow. Discuss the uses of face-bow. [RGUHS Jun/
Jul 2011 (OS)]
10. Hinge axis. [RGUHS Jun/Jul 2010 (OS)]
11. Disinfecting the impression. [NTRUHS Aug 2009]
12. Significance of peripheral seal in complete denture.
[TN Feb 2009]
13. Posterior palatal seal area. [RGUHS Apr 2001; TN Apr
2004, Feb 2007]
14. Bennett angle. [BUHS Mar 1988; NTRUHS Oct 2007]
15. Materials used for master impression. [RGUHS Aug
2006]
16. Final impression materials for complete denture.
[NTR-NR Oct 2004]
17. Functions of posterior palatal seal. [TN Aug 2004]
18. Articulators and their uses. [TN Aug 2004]
19. Occlusion rims for construction of complete denture.
[TN Apr 2004]
20. Posterior palatal seal area. [GOA 2004, 2002, 1997;
TN Sep 2002]
21. Maxillary tuberosity. [TN Sep 2002]
22. Average movement articulators. [TN Apr 2001]
23. Mucocompressive impression theory. [RGUHS Sep
2000]
24. Selective pressure impression. [BUHS Mar 1995]
25. Bennett movement. [BUHS Apr 1987]
6)
8. Define centric relation and write its significance. List
the methods of recording centric relation in complete
dentures. Write in detail any one of them. [RGUHS
Dec 2010 (OS)]
9. Define centric relation. Explain its significance and
methods of recording the centric relation. [TN Oct
2003, Feb 2007, Aug 2010]
10. Define centric relation. Name the different methods of
recording centric relation of an edentulous patient.
Describe in detail one of the methods you choose for
recording centric relation in your clinic. [RGUHS Jul
1990, Feb 1989; TN Feb 2009]
11. What is balanced articulation and mention its impor-
tance? Describe the factors responsible for balanced
articulation in complete dentures. [NTRUHS Oct
2007]
12. Mention recordable jaw relation for complete den-
tures. Describe in detail the vertical jaw relation.
[RGUHS Feb 2007 (OS)]
13. What is orientation relation? Write in detail about re-
cording of orientation relation in complete denture
patient. [MUHS Dec 2006]

14. Define balanced occlusion. Write in detail about the
various factors that contribute to balanced occlusion?
[RGUHS Mar 2006]
15. Define and classify jaw relation. Discuss the methods
of establishing vertical relations. [GOA Jul 2006]
16. Shade selection. [NTR-NR Mar 2005]
17. Define balanced occlusion. Explain its significance.
What are the factors affecting it? Explain each in de-
tail. [NTR-NR Mar 2005]
18. Signification of centric relation. [RGUHS Aug 2005]
19. What is articulator? Classify articulator. Write the uses
and requirements of an articulator? [RGUHS Mar
2005, Sep 2004]
20. Define jaw relations. Enumerate the various jaw rela-
tions. Mention the significance of physiologic rest
position. Discuss the effects of increased and
decreased vertical jaw relation. [NTR-OR Apr 1995;
TN Feb 2005]
21. What is an articulator? Write the uses and require-
ments of an articulator. Classify articulator. [RGUHS
Mar 2005, Sep 2004]
22. Classify jaw relation. Define centric relation. Explain
its clinical significance. What are the methods for
recording centric relation? Explain one in detail.
[NTR-NR Oct 2004]
23. Write in detail the procedures involved in selection of
anterior teeth in complete denture patients. [RGUHS
Mar 2004]
24. Define centric relation. Discuss the methods of record-
ing centric relation. [GOA Aug 2004]
25. What is face-bow? Discuss the importance of same in
complete dentures in removable partial prosthesis.
[GOA Aug 2004]
26. Define physiologic rest position of mandible. Give the
importance of Silverman's closest speaking space and
discuss the effects of increased vertical dimension in
complete dentures. [M 2003]
27. Dentogenic concept. [NTR-NR Apr 2003]
28. Define balanced occlusion. Describe in brief the factors
to be considered to obtain balanced occlusion in a com-
plete denture. [BUHS May 1986, RGUHS Apr 2003]
29. Define centric relation. Classify the different methods
of recording the same and discuss the significance of
centric relation in complete denture prosthodontics.
[MUHS Sep 2003, 1998]
30. Define centric relation. Explain the different methods
of recording the same. [RGUHS Sep 2002]
31. Describe the principles of selection of teeth for com-
plete denture patient. [NTR-NR Apr 2002]
32. Define balanced occlusion. Explain the rationale of
balanced occlusion. Discuss the factors controlling the
balanced occlusion. [NTR-OR Apr 2002]
33. Describe the principles of selection of teeth for com-
plete denture patient. [NTR-NR Apr 2002]
Quick Review Series for BOS 4th Year: Prosthodontics
34. What is jaw relation? Classify jaw relation. Enumerate
the various methods of recording different jaw rela-
tions. Discuss in detail any one method of recording
vertical jaw relation. [TN Sep 2002]
35. Define centric relation. List the various methods to
record it and explain one of them in detail. Add a note
on the difficulties encountered while recording centric
relation. [TN Nov 2001]
36. Define jaw relations. Classify and write briefly about
the methods of recording vertical jaw relation. [TN
Apr 2001]
37. Define articulator. Mention the different types of
articulators and discuss a semi-adjustable articulator.
[NTR-NR Apr 2000]
38. Define centric relation. Write in detail one method
of recording centric relation in a complete denture
patient. [NTR-OR Apr 1999]
39. What are the types of jaw relation? Write in detail
about the definition and different methods or recording
vertical jaw relation. [NTR-OR Oct 1998]
40. What are the vertical jaw relations? Why is it impor-
tant to record the correct vertical jaw relation? What is
the method followed in your clinic to record vertical
jaw relation? [GOA Jun 1998]
41. What is an articulator? Give the classifications, func-
tions, and requirements of an articulator. [NTR-OR
Apr 1997]
42. What are the different maxillomandibular relation-
ships? Discuss their importance and different methods
of recording horizontal jaw relation in complete
denture patient. [MUHS Aug 1997]
43. Define the term 'centric relation'. Mention the signifi-
cance of centric jaw relation. Enumerate the methods
of recording centric relation. Describe in detail your
method of recording centric jaw relation. [NTR-OR
Oct 1997]
44. Describe the technique of establishing and verifying
vertical jaw relationship in completely edentulous
patient, who has no pre-extraction records. [MUHS
Dec 1995]
45. Define vertical dimension of occlusion. Give briefly
any one method that you know of registering the same.
[RGUHS Sep 1994, BUHS Feb 1990]
46. Define centric relation. Describe a method for record
centric relation for complete denture construction.
[NTR-OR May 1994]
47. Discuss aesthetics in complete denture and discuss the
factors which favour the selection of anterior teeth.
Write the uses and requirements of an articulator selec-
tion of anterior teeth. [BUHS Mar 1994]
48. Anterior teeth for an edentulous patient. [NTR-OR
May 1993]
49. Describe the methods of selecting anterior teeth for an
edentulous patient. [NTR-OR May 1993]
Section I 111 Previous Years' Question Bank

50. Squint test. [BUHS Aug 1993] 12. Face-bow. [NRT-NR 2005, Apr 2002, Oct 2002, NTR-
51. Describe the methods of selecting anterior teeth in OR May 1999, 1996, 1992, Nov 1992; NTRUHS Oct
edentulous patients. [NTR-OR Nov 1992] 2007; RGUHS July 2008 (OS)]
52. Discuss the physical and biological factors for the 13. Classification of jaw relations. [RGUHS Feb 2007
selection of teeth for complete denture construction (RS)]
in edentulous patient. [BUHS Mar 1992, Feb 1990, 14. Articulators. [NTR-OR Nov 1992, May 1993, Oct
Apr 1987] 1995; NTR-NR Apr 2006, Oct 2005]
53. What are centric and eccentric jaw relations? Enumer- 15. Physiologic rest position and its significance. [NTR-
ate the methods of recording centric jaw relation and NR Apr 2006]
describe your method for recording the same. [RGUHS 16. Colour selection of teeth. [RGUHS Aug 2006]
Jul 1991] 17. Write about orientation relation in complete denture.
54. What are centric and eccentric jaw relations? Enumer- [RGUHS Mar 2006]
ate the methods of recording centric jaw relation and 18. Write about Arcon articulators. [RGUHS Mar 2006]
describe your method for recording the same. [BUHS 19. Enumerate the factors affecting balanced occlusion.
Jul 1991] [NTR-NR Apr 2006]
55. What is a face-bow? Discuss the importance of face- 20. Increased vertical dimension. [RGUHS Aug 2005, Sep
bow transfer for an edentulous patient. [MUHS 1991, 2002]
1990] 21. Shade selection. [NTR-NR Mar 2005, NTR-OR Oct
56. What are the consequences of incorrect vertical dimen- 2001]
sion record in complete denture construction? De- 22. Dentogenic concept. [NTR-NR Mar 2005]
scribe your methods of obtaining vertical dimension 23. Pre-extraction guides for complete denture. [NTR-NR
records. [MUHS Dec 1989] Apr 2004]
57. Define denture aesthetics and discuss the various 24. Laws of balanced occlusion? [RGUHS Mar 2004]
factors influencing denture aesthetics. [BUHS Jun 25. Requirements of an articulator. [NTR-NR Apr 2004,
1989] NTR-OR Apr 1998]
58. Define physiological rest position of mandible. De- 26. Neutral zone. [NTR-NR Apr 2004, 2003]
scribe the method of establishing and verifying vertical 27. Needles chew-in technique. [TN Apr 2003]
jaw relation for edentulous patient. [BUHS Aug 1988, 28. Increased vertical relation. [NTR-OR Apr 2002]
Jan 1987] 29. Discuss the various jaw relation recording procedures
59. What is balanced occlusion and articulation? What are in complete denture patients. [GOA 2002]
the laws of articulation of developing balanced occlu- 30. Principles of arrangement of teeth in complete denture.
sion in complete denture prosthesis? [BUHS May [NTR-NR Oct 2002]
1988] 31. Rationale of balanced occlusion. [NTR-OR
Apr 2001]
32. Condylar guidance. [NTR-OR Apr 2000]
Short Essays
33. Vertical dimension. [NTR-OR Apr 1999]
1. Gothic arch tracing. [RGUHS Dec 201 I/Jan 2012 34. Anatomical articulators. [NTR-OR Apr 1999]
(RS2)] 35. Non-anatomic tooth. [NTR-OR Apr 1999]
2. Alveolingual sulcus. [NTRUHS Jul 201 I (OR)] 36. Non-anatomic teeth. [NTR-OR Apr 1999]
3. Physiologic rest position. [NTR-NR Apr 2002, 37. Anatomical articulators? [NTR-OR Apr 1999]
NTRUHS Feb 20 I 1] 38. Classify jaw relation. Discuss in detail the significance
4. Method of training the patient to retrude the mandible. of horizontal jaw relations in complete denture con-
[NTRUHS Feb 2010] struction. [GOA 1998]
5. Plane of orientation. [RGUHS Dec 2010 (OS)] 39. Define orientation relation and give its importance in
6. Vertical jaw relationship. [RGUHS Dec 2010 (RS)] complete dentures. [MUHS 1997]
7. Methods of recording vertical jaw relation. [RGUHS 40. Define centric relation and give its significance.
Jun/Jul 2010 (RS2) [MUHS 1997]
8. Centric relation. [RGUHS Jun/Jul 2010 (RS)] 41. Orientation jaw relation. [NTR-OR Apr 1997]
9. Significance of recording centric relation. [NTR-0R 42. Significance of centric relation. [NTR-OR Apr 1996]
Apr 2000, RGUHS Jun/Jul 2010 (RS2)] 43. Decreased vertical dimension. [NTR-OR Nov 1995]
10. Method of recording centric jaw relation. [NTRUHS 44. Physiologic rest position of mandible. [NTR-OR Oct
Mar 2008] 1995]
11. Effect of incorrect vertical dimensions [NTRUHS Mar 45. Balanced occlusion. [NTR-OR Nov 1995, Nov 1994,
2008] Nov 1992, May 1993, Feb 1990]
 Quick Review Series for BOS 4th Year: Prosthodontics

46. Freeway space (interocclusal distance). [NTR-OR 25. Define centric relation. Write in brief about the differ-
May 1994] ent methods to record it. [MUHS 2006]
47. Gothic arch tracing. [NTR-OR Apr 2001, NTR-OR 26. Altered VD. [RGUHS Aug 2006]
May 1994] 27. Group function. [RGUHS Aug 2006]
48. Bennet movement and Bennet angle. [NTR-OR May 28. Interocclusal clearance. [RGUHS Mar 2006]
1993, Nov 1992] 29. Centric jaw relation record. [RGUHS Mar 2006]
49. Compensating curves. [NTR-OR May 1992] 30. Lingualized occlusion. [NTR-NR Apr 2006]
50. Physiologic rest position of mandible. [BUHS Jul 31. Significance of centric relation. [TN Feb 2006]
1990] 32. Compensating curves. [TN Feb 2006]
51. Importance of pre-extraction records. [BUHS Feb 33. Silverman speaking space. [TN Aug 2004, Feb 2006]
1989] 34. Increased vertical relation. [RGUHS Aug 2005, Sep
52. Condylar and incisal guidance. [BUHS Mar 1988] 2002]
35. Posterior tooth forms. [NTR-NR Apr 2005]
36. Give any one definition of centric relation of mandible.
Short Notes
Describe any two important consequences of failure to
1. Selective grinding in complete denture. [NTRUGHS record it correctly for complete dentures. [MUHS
Jul 2014] 2005]
2. Gothic arch tracing. [RGUHS Sep 2002, May 1985; 37. Write the various methods for assisting the patient to
TN Apr 2003; NTRUHS Mar 2008, Jul 2014] retrude the mandible during centric relation registra-
3. Merits of face-bow. [NTRUHS Jan 2012 (OR)] tion. [MUHS 2005]
4. Vertical dimension at rest. [NTRUHS Jan 2012 (OR)] 38. Hinge axis. [NTR-NR Apr 2005]
5. Chamfer finish line. [RGUHS Dec/Jan 2012 (RS)] 39. Effect of increased vertical dimension. [TN Aug
6. Overjet and overbite. [RGUHS Dec/Jan 2012 (RS)] 2005]
7. Parts of face-bow. [RGUHS Dec/Jan 2012 (RS)] 40. Perleche. [RGUHS Mar 2005, Sep 2004, Jul 1991]
8. Origination jaw relation. [RGUHS Dec 201 I/Jan 2012 41. Beyron's point. [RGUHS Mar 2005, Sep 2004]
(OS)] 42. Canine-guided occlusion. [RGUHS Mar 2005, Sep
9. Hazards of increased vertical dimension. [RGUHS 2004]
Dec 201 I/Jan 2012 (RS2)] 43. Difference between natural and artificial dentition.
10. Bennett movement. [RGUHS Dec 201 I/Jan 2012 [RGUHS Mar 2004]
(RS2)] 44. Closest speaking space. [RGUHS Mar 2004]
11. Altered vertical dimension. [RGUHS Jun/Jul 2011 45. Problems with reduced vertical dimension in complete
(OS)] dentures. [MUHS 2004]
12. Freeway space. [BUHS Feb 1993, RGUHS Jun/Jul 46. Niswonger's method of establishing vertical examples.
2011 (OS); NTRUHS Oct 2007] [MUHS 2003]
13. Face-bow. [TN Apr 2004, Feb 2005, 2007, 2010, 2011] 47. Vibrating line of palate and its importance in complete
14. Vertical jaw relations. [TN Feb 2010] denture. [TN Oct 2003]
15. Rest position of mandible. [RGUHS Jun/Jul 2010 48. Retruding the mandibular to centric relation. [TN Oct
(OS)] 2003]
16. Needle-House chewing technique. [TN Aug 2009] 49. Define centric relation and give its significance.
17. Define face-bow. Enumerate its types. [NTRUHS Aug [MUHS 2002]
2009] 50. Cuspless teeth. [NTR-NR Oct 2002]
18. Freeway space. [NTR-NR Apr 2002; TN Apr 2004, 51. Significance of rest position of the mandible. [TN Apr
Aug 2009] 2001]
19. Overjet and overbite. [NTRUHS Mar 2008] 52. Freeway space and its importance. [MUHS 2000]
20. Closest speaking space. [RGUHS Jul 2008 (RS,OS)] 53. Relief factor. [GOA Oct/Nov 2000]
21. Describe the importance of marking the midline, the 54. Write the differences between arbitrary and kinematic
canine line, and the high lip line during jaw relation. face-bow. [MUHS 1999]
[MUHS Nov 2007] 55. Enumerate the characteristics of increase of
22. Physiologic rest position. [NTRUHS Oct 2007] vertical relation in complete denture patient.
23. State the consequence of increased vertical relation re- [MUHS1999]
cording in complete denture case. [MUHS Dec 2006] 56. Define centric relation. [MUHS 1999]
24. Enumerate the various methods of determining vertical 57. Methods of recording centric relations. [RGUHS Aug
relation of occlusion. [MUHS Dec 2006] 1995]
Section I 111 Previous Years' Question Bank
58. Methods of recording centric relations. [BUHS Aug
1995]
59. Face-bow transfer. [RGUHS Mar 1994]
60. Neutrocentric occlusion. [BUHS Aug 1993]
61. Anatomical articulator? [BUHS Sep 1992]
62. Face-bow. [RGUHS Jul 1991]
---------------------,( Topic 7)
Lab Procedures Prior to Try-in
Long Essays
1. Define articulators. Give the classifications and uses of
articulators and discuss in detail about semi-adjustable
articulator. [NTRUGHS Aug 2013]
2. Discuss occlusion in complete denture. [RGUHS Dec
201 I/Jan 2012 (OS)]
3. Define balanced occlusion. Enumerate the advantages
of a balanced occulsion. Describe any two factors that
affect a protrusive balance. [MUHS 2008]
4. What is balanced occlusion? Write in brief the factors
governing balanced occlusion. [RGUHS July 2008
(RS)]
5. Selection of anterior and posterior teeth in complete
denture. [RGUHS July 2008 (RS2)]
6. Discuss the various factors to be considered in selec-
tion of teeth for complete denture patient. [MUHS
1998; TN Feb 2007]
7. Define articulator? Discuss the advantages, disadvan-
tages, and classifications of articulators. [TN Aug
2006]
8. What is articulator? Classify articulator. Write the uses
and requirements of an articulator [RGUHS Sep 2004,
Mar 2005]
9. What is an articulator? Write the uses and require-
ments of an articulator. Classify articulator [RGUHS
Mar 2005, Sep 2004]
10. Write in detail the procedures involved in selection of
anterior teeth in complete denture patients. [RGUHS
Mar 2004]
11. Discuss the importance of try-in stage in complete
denture prosthodontics. [MUHS 2004]
12. Mention the importance of occlusion in complete den-
tures. Write in brief about the factors governing bal-
anced articulation. [TN Aug 2004]
13. Describe in brief the various posterior tooth forms for
dentures. [TN Aug 2004]
14. Describe in detail about tooth selection for treating a
fully edentulous patient. [TN Oct 2003]
63. Physiologic rest position of mandible. [RGUHS Jul
1990, GOA Aug 1998]
64. Importance of pre-extraction records. [RGUHS Feb
1989]
65. Articulator. [BUHS Mar 1988]
66. Christianson phenomenon. [RGUHS Aug 1988]
15. Define balanced occlusion. Describe in brief the
factors to be considered to obtain balanced occlusion
in a complete denture. [RGUHS Apr 2003]
16. What are the factors for selection of anterior teeth for
a complete denture patient? [MUHS 2003]
17. Discuss the various factors to be considered in the
selection of teeth for complete denture patient. [GOA
2003; MUHS 1998]
18. Define denture aesthetics. Discuss selection of artifi-
cial teeth for a complete denture. [GOA 2002]
19. Discuss the factors which help in the selection of arti-
ficial teeth in complete denture prosthodontics. [GOA
2002]
20. What is balanced occlusion? How do you establish it
while fabricating a complete denture? [TN Apr 2001]
21. Define balanced occlusion and articulation? Discuss in
brief determination of balanced occlusion. [GOA Oct/
Nov 2000]
22. Discuss the principles in arrangement of artificial teeth
in complete denture prosthesis. [GOA 1999]
23. Write the aims, objectives, and scope of prosthodon-
tics. Discuss the role of arrangement of artificial
teeth in the success of complete denture. [GOA
1998]
24. Requirements of articulator. [MUHS 1998]
25. Define denture aesthetics. Write in detail about the
aesthetic requirements of complete denture prosthesis.
[GOA 1997]
26. Discuss aesthetics in complete denture and discuss the
factors which favour the selection of anterior teeth.
[RGUHS Mar 1994]
27. Discuss physical and biological factors for the selec-
tion of teeth for complete denture construction in
edentulous patient. [RGUHS, Mar 1992, Feb 1990,
Apr 1987]
28. What is balanced occlusion and articulation? What are
the laws of articulation of developing balanced occlu-
sion in complete denture prosthesis? [RGUHS May
1988]
 Quick Review Series for BOS 4th Year: Prosthodontics

Short Essays 20. Describe the various dimensions of colour. [MUHS

2006]
1. Hinge axis. [NTRUGHS Aug 2013]
21. Define guiding planes. [MUHS 2006]
2. Dentogenic concept. [NTRUHS Oct 2007, NTRUHS
22. Canine-guided occlusion. [RGUHS Mar 2005, Sep
Mar 2012 (NR)]
2004]
3. Types of posterior teeth. [RGUHS Dec 2011/Jan 2012
23. Selection of anterior teeth. [GOA Dec 2005]
(RS2)]
24. Write the methods of selecting the colour/shade of
4. Anterior teeth selection. [NTRUHS Feb 2011]
artificial teeth. [MUHS 2005]
5. Anterior tooth selection for complete denture.
25. Differences between natural and artificial dentition.
[NTRUHS Feb 2010]
[RGUHS Mar 2004, GOA 1999]
6. Factors affecting balanced occlusion. [RGUHS Jun/Jul
26. ASP factor in complete denture. [TN Aug 2004]
2010 (RS2)]
27. Laws of articulation in complete denture. [MUHS
7. Posterior selection of teeth. [RGUHS Jun/Jul 2010
2004]
(OS)]
28. Define articulator and name the different types of
8. Principles in teeth arrangement for completely edentu-
articulators. [MUHS 2004]
lous patients. [RGUHS Jul 2008 (RS2)]
29. Posterior teeth selection for complete denture. [TN
9. Rationale of balanced occlusion. [RGUHS Aug
Apr 2004]
2005]
30. Post-insertion problems of complete denture. [TN Apr
10. Laws of balanced occlusion. [RGUHS Mar 2004]
2004]
11. Try-in procedure. [NTR-OR Apr 1999]
31. Selection of posterior teeth. [GOA 1998; TN Apr
12. Discuss the selection of posterior teeth in complete
2004, 2001]
denture. [MUHS 1999]
32. Differences between natural and artificial occlusion.
[GOA 2003]
Short Notes 33. Importance of try-in complete dentures. [MUHS
2003]
1. Balanced occlusion. [GOA 2004; TN Aug 2006, Feb
34. Define terminal hinge axis and give its importance.
2010; NTRUGHS Jul 2014]
[MUHS 2003]
2. Hanau's quint. [TN Feb 2013]
35. Selection of teeth for geriatric patients. [TN Apr
3. Arcon articulators. [TN Feb 2013]
2003]
4. Non-anatomic teeth. [RGUHS Dec 2010 (RS), Jun/Jul
36. Factors on which dentogenic concept of selection of
2010 (RS), Dec 201 I/Jan 2012 (OS), July 2008
teeth is based. [MUHS 2003]
(OS]
37. Selection of anterior teeth. [RGUHS April 2003, Sep
5. Neutral zone. [NTRUHS Oct 2007, RGUHS Dec/Jan
I 992, Jan I 989]
2012 (RS)]
38. What are the criteria for selection of anterior teeth for
6. SPA factor. [RGUHS Jun/Jul 2010 (RS2)]
a complete denture patient? [MUHS 2002]
7. Semi-adjustable articulators. [TN Feb 2011]
39. Indications of non-anatomic teeth in complete denture.
8. Bilabial sounds. [RGUHS Jun/Jul 2010 (RS)]
[MUHS 2002]
9. Porcelain denture teeth. [NTRUHS Feb 2010]
40. Try-in complete dentures. [GOA 2001]
10. Dentogenic concept. [GOA Oct/Nov 2000, I 999; TN
41. Importance of age factor in selection of teeth. [MUHS
Apr 2004, Nov 2001, Aug 2006, 2009]
2000]
11. SPA factor. [GOA I 997, RGUHS Jul 2008 (OS)]
42. Importance of compensatory curve. [MUHS 2000]
12. Compensating curve. [NTRUHS Mar 2008]
43. Concept of mutually protected occlusion. [MUHS
13. Classify articulators. Give two examples for each type.
1999]
[MUHS 2008]
44. Factors determining neutrocentric occlusion. [MUHS
14. Define centric relation and give its significance.
1998]
[MUHS 2008]
45. Neutrocentric occlusion. [RGUHS Aug I 993]
15. Discuss in short, neutral zone. [MUHS 2007]
46. Squint test. [RGUHS Aug I 993]
16. Define retention and stability. [NTRUHS Oct 2007]
47. Anatomical articulator. [RGUHS Sep 1992]
17. Occlusal refining. [RGUHS Mar 2006]
48. Condylar and incisal guidance. [RGUHS Mar I 988]
18. Finishing and polishing agents for acrylic dentures.
49. Articulator. [RGUHS Mar I 988]
[RGUHS Mar 2006]
50. Bennett angle. [RGUHS Mar I 988]
19. Classify articulators. [MUHS 2006]
51. Bennett movement. [RGUHS Apr I 987]
Section I 111 Previous Years' Question Bank
------------------ - <( Topic
Lab Procedures Prior to Insertion and Complete
Denture Insertion
Long Essays
1. Write an essay on sequelae of complete denture wear-
ing. [NTRUHS Jul 2011 (OR)]
2. Discuss in detail the various post-insertion problems in
edentulous patients using complete dentures. [NTR-
NR Apr 2006]
3. What are the various post-insertion problems and their
management? [NTR-NR Oct 2005]
4. Discuss in detail about the insertional instructions and
aftercare of the complete denture. [NTR-NR Apr 2003]
5. Give your method of fitting complete denture prosthe-
sis and instructions and aftercare to patients. [GOA
Aug 1999]
6. What are the post-insertion problems in complete den-
tures? Discuss the methods of rectifying the same.
[MUHS Aug 1998]
7. Give your method of fitting/insertion of complete den-
ture and aftercare for complete denture prosthesis.
[BUHS Sep 1994]
8. What is the importance of patient education? What
instructions you will give to a patient receiving com-
plete denture prosthesis? [BUHS Jun 1991]
9. Discuss in brief the post-insertion management in
complete denture prosthodontics. [NTR-OR Feb
1990]
Short Essays
1. Denture stomatitis. [RGUHS Mar 2004; NTRUHS Feb
2010, NTRUGHS Jul 2014]
2. Denture resins. [NTRUHS Jan 2012 (OR)]
3. Denture stomatitis. [NTRUHS Feb 2011]
4. Instructions to complete denture patients. [RGUHS
Jun/Jul 201 I (RS2)]
5. Neutral zone. [NTRUHS Feb 2011; TN Apr 2001]
6. Burning mouth syndrome. [RGUHS Jul 2008 (RS)]
7. Importance of finishing and polishing of complete
dentine. [MUHS 2007]
8. Write about the instructions to complete denture patient
at the time of denture delivery. [MUHS 2006]
9. Describe the steps in delivering complete denture.
[GOA Jul 2006]
10. Write the instructions given to the patient during
insertion of new complete dentures. [MUHS 2005]
11. Compare residual ridge resorption of maxilary and
mandibular edentulous ridge. [RGUHS Sep 2002]
8)
12. Problems associated with complete denture use. [TN
Sep 2002]
13. Denture cleansing agents. [NTR-OR Oct 2001]
14. What are the post-insertion problems in complete den-
tures? Discuss the methods of rectifying the same.
[MUHS 1998]
15. Mechanism of action of denture cleansers. [MUHS
I 998]
16. Instructions to be given to patient receiving complete
denture. [NTR-OR Oct I 995]
17. Give your method of fitting/insertion and aftercare for
complete denture prosthesis. [RGUHS Sep 1994]
18. Importance of patient education. [NTR-OR
May 1993]
Short Notes
1. Tissue conditioners. [RGUHS Mar 2005, Apr 2003;
GOA 1998; TN Feb 2013]
2. Role of tissue conditioners. [TN Feb 20 I 2]
3. Denture adhesives. [NTRUHS Jan 2012 (OR),
NTRUHS Mar 2008, NTRUHS Aug 2009]
4. Tissue conditioner. [RGUHS Dec/Jan 2012 (RS),
RGUHS Dec 201 I/Jan 2012 (OS)]
5. Injection-moulded glass ceramic. [RGUHS Dec 201 I/
Jan 2012 (OS)]
6. Need for periodic recall of complete denture patients.
[NTRUHS Feb 2010]
7. Denture stomatitis. [RGUHS Jun/Jul 2010 (RS2),
GOA 2002, 1998; TN Apr 2003, Aug 2009]
8. Denture cleaning agents. [RGUHS Jun/Jul 2010 (RS);
TN Feb 2007]
9. Diet in complete denture. [RGUHS Jun/Jul 2010
(OS)]
10. Residual ridge resorption. [TN Feb, Aug 2010]
11. Denture hyperplasia. [TN Feb 2009]
12. Denture irritation hyperplasia. [RGUHS Jul 2008
(RS)]
13. Articulating paper. [RGUHS Feb 2007 (OS)]
14. Denture irritation hyperplasia. [RGUHS Feb 2007
(RS)]
15. Perleche. [RGUHS Mar 2005, Sep 2004]
16. Treatment of abused tissues. [TN Aug 2004]
17. Epulis fissuratum. [RGUHS Apr 2003; NTR-NR Apr
2002]
18. Gag reflex. [GOA I 998]
19. Denture allergy. [RGUHS Jan 1987]
 Quick Review Series for BOS 4th Year: Prosthodontics

------------------ - <( Topic 9)

Relining and Rebasing in Complete Dentures
Long Essays 6. Indications, diagnosis, and contraindications for relining
and rebasing of complete denture. [NTR-NR Mar 2005]
1. Tissue conditioner. [NTR-NR Apr 2006, Oct 1998,
7. Importance of counselling for a complete denture
NTR-OR Apr 1995]
wearer. [TN Aug 2004]
2. Conditioning of abused and irritated tissues. [RGUHS
8. Dentures relining. [RGUHS Apr 2003]
Aug 2006]
9. Midline fracture of complete denture. [RGUHS Apr
3. Patient aged 55 years, who is wearing complete pros-
2003]
thesis for last 15 years complains of skidding of
10. Complete denture repair. [RGUHS Sep 2002]
prosthesis on examination, both maxillary and man-
11. Relining and rebasing of complete denture. [NTR-OR
dibular ridges being hyperplastics. Give your method
Oct 1998]
of treatment for the patient. [GOA Dec 1999]
12. Closed-mouth technique for relining of denture.
4. What are the post-insertion problems in complete den-
[MUHS 1998]
tures? Discuss the methods of rectifying the same.
13. Relining and rebasing. [NTR-OR Apr 1996, Oct 1995]
[MUHS Nov 1998]
14. Causes for midline fractures of maxillary complete
5. What is relining and rebasing of complete dentures?
denture. [BUHS Jan 1991]
How would you proceed to reline the maxillary com-
plete denture? [MUHS Sep 1990]
6. State the clinical indications for relining and rebasing of Short Notes
complete denture and discuss the hazards of relining 1. Tissue conditioners. [NTRUGHS Aug 2013]
procedures. [RGUHS Jun 1989] 2. Rebasing. [GOA 2001, RGUHS Jun/Jul 2011 (OS)]
3. Relining and rebasing. [GOA Dec 2005, NTRUHS Jul
Short Essays 2011 (OR); TN Nov 2001, Aug 2010, Feb 2011]
4. Dentures relining. [RGUHS Apr 2003, RGUHS Jun/
1. Age change in edentulous patients. [RGUHS Dec 2011/
Jul 2010 (RS2)]
Jan 2012 (OS)]
5. Tissue preparation for relining. [RGUHS Dec 2010 (OS)]
2. Post-insertion problems in complete denture patients.
6. Relining. [RGUHS July 2008 (OS)]
[RGUHS Dec 2011/Jan 2012 (OS)]
7. Resilient liners. [TN Feb 2005]
3. Repair and relining of complete denture. [RGUHS Dec
8. Soft reliners. [TN Aug 2004]
2011/Jan 2012 (RS2)]
9. Steps in rebasing of complete dentures. [NTR-NR Apr
4. Repair of complete denture. [NTRUHS Feb 2011]
2004]
5. Open mouth relining technique. [RGUHS Jul 2008
10. Rebasing and relining of denture. [TN Oct 2003]
(RS2)]
11. Complete denture repair. [RGUHS Sep 2002]

______________ _____,(Topic 1
Special Complete Dentures and Miscellaneous
Long Essays
1. Enumerate the advantages and disadvantages of over-
dentures. [MUHS Jul 2008]
2. Define overdenture. Discuss in detail the following in
treatment planning of an overdenture.
a. Selection and preparation of abutment teeth.
b. Objectives or goals of overdenture treatment.
[MUHS May 2007]
o)
3. What are overdentures? Describe their indications,
contraindications, and advantages. [MUHS 2005,
2002]
4. What are overdentures? State the indications, advan-
tages, and disadvantages of overdentures. [MUHS Nov
2006]
5. What are the indications and contraindications for an
immediate complete denture? [RGUHS Mar 2003, Sep
1992]
Section I 111 Previous Years' Question Bank

6. Define interim removable dentures and give indica- 23. Problems encountered in single denture construction.
tions for use. [MUHS 1999] [NTR-OR Apr 2000]
7. What are the advantages and disadvantages of immedi- 24. Indications for immediate denture. [MUHS 1998]
ate denture service? [MUHS 1994] 25. Pascal's law. [NTR-OR Apr 1997]
8. What is 'Preventive prosthodontics'? Give the princi- 26. Altered cast technique. [NTR-OR Oct 1997, 1992]
ple, advantages, and disadvantages of overdentures. 27. Clinical remount procedure? [NTR-OR Apr 1997]
[MUHS 1994] 28. Immediate dentures, their advantages and disadvan-
9. Discuss why are dentures necessary for semi-edentulous tages. [NTR-OR Apr 1996]
and completely edentulous patients. [RGUHS Jan 1991] 29. Implant dentures. [NTR-OR Nov 1994, 1992, May
10. Enumerate the reasons for loss of teeth. What are the 1992]
consequences of loss of teeth? What are the methods 30. Single dentures. [NTR-OR, May 1993, Nov 1992]
of prosthodontic replacements? [RGUHS Apr 1987] 31. Importance of study cast. [BUHS Sep 1992]
32. Split cast technique. [NTR-OR Feb 1990]
33. Granular porosity in dentures. [BUHS May 1986]
Short Essays
1. Single complete denture. [RGUHS Dec 2010 (RS),
RGUHS Jun/Jul 201 I (RS2); NTRUGHS Jul 2014]
Short Notes
2. Immediate dentures. [NTR-OR May I 992, Nov I 992; 1. Pindex system. [NTRUGHS Jul 2014]
NTRUGHS Aug 2013] 2. Obturators. [NTR-OR Nov I 992, I 994, Apr 2000,
3. Advantages of overdenture. [NTR-OR Apr 2001, 1996, Apr 1992; NTR-NR Oct 2002, Apr 2002;
RGUHS Jun/Jul 2010 (RS)] NTRUGHS Jul 2014]
4. Advantages of immediate denture. [MUHS 2007, 3. Disinfecting dentures. [NTRUGHS Aug 2013]
RGUHS Jun/Jul 2010 (RS2)] 4. Endosseous implant. [NTRUGHS Aug 2013]
5. Immediate complete denture. [NTR-OR, Apr 1995, 5. Advantages of partial denture. [NTRUHS Jan 2012
May I 994, NTRUHS Aug 2009] (OR)]
6. Requirements of an overdenture. [RGUHS Jul 2008 6. Screw-retained prosthesis. [NTRUHS Jan 2012 (OR)]
(RS2)] 7. Combination syndrome. [TN Feb 2012]
7. What is immediate denture? Write about indications 8. Tooth-supported overdentures. [TN Feb 2011]
and contraindications. [MUHS 2006] 9. Immediate denture. [GOA 2004, 2002; NTRUHS Feb
8. Infection control in prosthodontics. [RGUHS Aug 20 I 1 ; TN Sep 2002]
2006] 10. Immediate overdenture. [NTRUHS Jul 201 I (OR)]
9. What are overdentures? Write the advantages and 11. Disadvantages of immediate denture. [RGUHS Jun/Jul
disadvantages. [RGUHS Mar 2005, Sep 2004] 2011 (RS2)]
10. Write the disadvantages of immediate complete denture. 12. Abutment considerations of overdentures. [NTRUHS
[MUHS 2005] Feb 2010]
11. What is a refractory cast? Write its fabrication. [MUHS 13. Advantages of metal denture implants. [RGUHS Dec
2005] 2010 (RS)]
12. Overdenture. [NTR-NR Oct 2005, NTR-OR Apr 1996, 14. Muscles producing protrusive and retrusive mandibu-
Oct 1995, May I 992, Nov I 992] lar movements. [RGUHS Jul 2008 (RS2)]
13. Types of implant denture. [NTR-NR Apr 2004] 15. Enumerate the different types of obturators, their func-
14. Pre-extraction guides for complete denture fabrication. tions, and the materials used for making them. [MUHS
[NTR-NR Apr 2004] Dec 2007]
15. Methods of training the patient to retrude the mandi- 16. Overdenture advantages. [MUHS Dec 2007]
ble. [NTR-NR Apr 2004] 17. Types of bar-retained overdentures. [NTR-NR Apr
16. Rationale and advantages of immediate complete den- 2006]
ture. [NTR-NR Apr 2004] 18. What are the causes of gagging? [RGUHS Aug 2006]
17. Die spacers. [NTR-NR Apr 2003] 19. Temporary prosthesis. [RGUHS Mar 2006]
18. Laboratory remounting. [NTR-NR Apr 2003] 20. Write in brief, the treatment planning for maxillary
19. lnterocclusal recording media. [NTR-NR Apr 2003] obturator prosthesis. [RGUHS Mar 2006]
20. Drawbacks of single complete denture. [NTR-NR Oct 21. Group function. [RGUHS Aug 2006]
2002] 22. Advantages of immediate complete dentures. [RGUHS
21. Altered cast. [NTR-NR Apr 2002] Apr 2006]
22. Indication of immediate denture. [NTR-NR Apr 2002] 23. Occlusal refining. [RGUHS Mar 2006]
 Quick Review Series for BOS 4th Year: Prosthodontics

24. Kelly's combination syndrome. [TN Feb 2006] 40. Appliance versus prosthesis. [RGUHS Sep 2002]
25. Remounting procedures in complete dentures. 41. How will you make a treatment plan for a cleft palate
[RGUHS Mar 2006] patient? [MUHS 2002]
26. Write the concept and the advantages of overdenture. 42. Define implants. Enumerate the various materials used
[MUHS 2005] for implants. [MUHS 2002]
27. Edentulous state. [RGUHS Aug 1988, Sep 2004, Mar 43. Clinical remounting. [NTR-NR Oct 2002]
2005] 44. Transitional denture. [NTR-NR Apr 2002]
28. Name the different maxillary prostheses and facial 45. Appliance versus prosthesis. [RGUHS Sep 2002]
prostheses and the materials used. [MUHS 2005] 46. Advantages of overdentures. [MUHS 2002]
29. Describe the components of a sub-periosteal dental- 47. Immediate complete denture. [TN Apr 2001]
implant-supported complete denture. [MUHS 2005] 48. Temporary prosthesis. [RGUHS Mar 2000]
30. Advantages of immediate dentures. [RGUHS Aug 49. Processing errors in complete denture prosthesis.
2005] [GOA 1999]
31. Write in brief the concept of osseointegration. [MUHS 50. Immediate obturator. [NTR-OR Oct 1998]
2005] 51. Transitional denture. [NTR-OR Nov 1995, 1994]
32. Overdenture. [NTR-NR Oct 2004, GOA Jul 2006, 52. Advantages and disadvantages of immediate denture.
GOA 2002, 1998, Oct/Nov 2000, 1999; TN Aug, Apr [RGUHS Mar 1995]
2004, Feb 2005] 53. Split cast techniques. [RGUHS Feb 1993]
33. Define and mention the factors of dentogenics. [NTR- 54. Hybrid dentures. [NTR-OR, May 1993, Nov 1992]
NR Apr 2004] 55. Interim denture. [BUHS Feb 1993]
34. Realeff effect. [NTR-NR Oct 2004] 56. Obturator. [RGUHS Aug 1993, Sep 1992, Jul 1990]
35. Define tooth-supported CD and give its advantages. 57. Interim denture. [RGUHS Feb 1993]
[MUHS 2004] 58. Implant denture. [NTR-OR May 1992]
36. Rationale of overdentures. [TN Aug 2004] 59. Importance of study cast. [RGUHS Sep 1992]
37. Immediate denture. [RGUHS Mar 1992, Aug 1988; 60. Causes for midline fractures of maxillary complete
TN Aug 2004] denture. [RGUHS Jan 1991]
38. Midline fracture of complete denture. [RGUHS Apr 61. Granular porosity in dentures. [RGUHS May 1986]
2003; TN Aug 2004] 62. Gunning splint. [BUHS Jan 1987; RGUHS Jan 1987]
39. Occlusal pivots. [NTR-NR Apr 2002]
Section I 111 Previous Years' Question Bank
Part 11
Fixed Partial Dentures
------------------1( Topic
Introduction to Fixed Partial Dentures
Long Essays
1. Importance of radiograph in fixed partial denture
treatment. [MUHS May 2007, 2002]
2. Abutment. [MUHS 2005]
3. Discuss in detail about the advantages, disadvantages,
indications, and contraindications of FPD. [TN Oct
2003]
4. Discuss the indications and contraindications for a
fixed partial denture. Describe components of a fixed
partial denture in detail. [GOA 2002]
5. Abutments for fixed partial prosthesis. [MUHS May
1999, 1989]
6. Indications and contraindications for fixed partial
dentures. [MUHS Jun 1997]
7. Discuss the importance of diagnosis and treatment
planning in fixed partial prosthodontics. [GOA 1997]
8. What are questionable abutments? Give the manage-
ment of such abutment successfully in a fixed partial
denture. [MUHS Dec 1995]
9. Define an abutment and a pier. How will you manage
abutment with compromised periodontal conditions?
[MUHS Dec 1995]
10. Describe the advantages and disadvantages of fixed
partial prosthodontics. [NTR-OR Nov 1994]
------------------ -<( Topic 2)
Parts and Design of Fixed Partial Dentures
Long Essays
1. Classify pontic. Discuss in detail the various pontics
used in FPD. [RGUHS Dec 2011/Jan 2012 (RS2)]
2. Name the component parts of a bridge. Define and
classify pontics and add a note on selection of pontic
design and requirements of pontic. [NTRUHS July
2011 (OR)]
3. Define pontic. Discuss in detail about pontic designs.
[NTRUHS Feb 2010]
1)
Short Essays
1. Fibre-reinforced bridges. [NTRUGHS Aug 2013]
2. Resin-bonding bridges. [NTRUGHS Aug 2013]
3. Importance of radiographs in fixed partial dentures.
[MUHS Jun 2006, 2004]
4. Criteria for ideal abutment. [MUHS 2004]
5. Indications for fixed partial denture. [MUHS Dec
1999]
6. Write four uses of radiographs in FPD. [MUHS Dec
1999]
Short Notes
1. Cantilever restoration. [NTRUGHS Jul 2014]
2. Splints and stents. [NTRUGHS Aug 2013]
3. Indications for FPD. [RGUHS Aug 2006]
4. Contraindications of fixed partial denture. [TN Aug
2004, Feb 2006]
5. Indications and contraindications for fixed partial
denture. [TN Apr 2004]
6. Significance of radiographs in fixed partial denture.
[NTR-OR Oct 1997]
7. Importance of radiographs in crown and bridge. [NTR-
OR May 1994]
4. Define and classify pontics. Write in detail indications,
design, and advantages of different types of pontics.
[NTRUHS Mar 2008]
5. Discuss the various components of partial denture and
the functional role played by them individually.
[RGUHS Jul 2008 (RS2)]
6. Describe the component parts of fixed partial denture.
[RGUHS July 2008(RS); TN Oct 2003]
7. Define and classify pontic. Discuss the indications and con-
traindications of various types of pontics. [GOA Jul 2006]
 Quick Review Series for BOS 4th Year: Prosthodontics

8. Classify bridge panties. Discuss in detail regarding the Short Essays

principles of designing pantie. [TN Aug 2004]
1. Rigid and non-rigid connectors in FPD. [RGUHS Jun/
9. What is fixed partial denture prosthesis? How do you
Jul 2011 (OS)]
classify them? Discuss with reasons in your choice of
2. Sanitary pantie. [RGUHS Jun/Jul 2010 (RS)]
materials for construction of 3-unit bridge for missing
3. Ridge lap and modified ridge lap pantie. [RGUHS Jun/
26. [RGUHS Sep 2003]
Jul 2011 (RS2)]
10. Define panties. Classify them and discuss the princi-
4. Selection of retainers for a fixed partial denture.
ples for designing panties. [MUHS May 2003, 1991]
[RGUHS Jul 2008(RS); TN Nov 2001]
11. Define and classify panties of fixed partial denture.
5. Types of connectors used in FPDs. [RGUHS Aug
Explain the indications, design, and advantages of any
2006]
three types. [RGUHS Sep2002]
6. Connectors in fixed partial dentures. [NTR-NR Apr 2006]
12. Discuss the indications and contraindications for a
7. Pantie. [MUHS Oct 2005]
fixed partial denture. Describe the components of a
8. Define pantie. Describe the various types with indication.
fixed partial denture in detail. [GOA Jun 2002]
[RGUHS Mar 2004]
13. Define panties in fixed partial denture. Classify and
9. Define and classify pantie. Describe the various types
discuss the selection and fabrication of panties. [TN
of pantie with indication. [GOA Nov 2004]
Sep 2002]
10. Define and classify connectors in FPD. [RGUHS Apr
14. Define fixed partial denture. Mention the different
2003]
types of retainers and the criteria for the selection of
11. Types of bridges. [MUHS May 2003]
the retainers. Add a note on care for the prosthesis.
12. Adhesive bridge. [NTR-OR Apr 2001; MUHS 1990]
[NTR-0R Apr 2000]
13. Classify connectors in FPD. [MUHS Nov 2000]
15. Define bridge retainer. Requirements in selection of
14. Define and classify retainers in fixed partial prosthesis.
retainer. Mention cast restoration which can be used as
Describe in detail the principles of tooth preparation
retainer. [RGUHS Sep 1992]
for the mandibular first molar to receive a fill cast
16. Discuss in detail the factors affecting retention in fixed
metal crown. [GOA Oct/Nov 2000]
partial prosthesis. [MUHS Jul 1991]
15. Define components of fixed partial prosthesis and clas-
17. Discuss the connectors used in fixed partial prosthesis.
sify the same. Give your design of panties with neces-
[MUHS Oct 1990]
sary indications. [GOA Dec 1999]
18. Discuss the management of endodontically treated
16. Achieving retention in FPD. [MUHS Dec 1998]
abutment tooth in fixed dental prosthesis. [NTRUGHS
17. Maryland bridges. [NTR-OR Apr 1997, Feb 1990]
Jul 2014]
18. Connectors in FPD. [NTR-OR Oct 1997; MUHS Dec
19. Define an abutment and enumerate the criteria in-
1994]
volved in abutment selection. [RGUHS Mar 2005, Sep
19. Non-rigid connectors in crown and bridge. [NTR-OR
2004]
May 1994]
20. Describe the concept, design, and placement of mar-
20. Bridge retainer. [NTR-OR May 1993, Nov 1992]
gins of crown and retainers in fixed partial dentures.
21. Soft tissue management in FPD. [RGUHS Dec/Jan
[RGUHS Apr 2004]
2012 (RS)]
21. Define and classify panties of fixed partial denture.
22. Ante's law. [NTRUHS Jul 2011 (OR)]
Explain the indications, design, and advantages of any
23. Define pantie. Write about the different types of pantie
three types. [RGUHS Sep 2002]
designs and their indications in case of posterior fixed
22. Define pantie and classify the panties. [NTR-OR May
prosthesis. [RGUHS Mar 2006]
1994]
24. Hygienic pantie. [NTR-NR Oct 2005]
23. Classify bridge panties. Discuss in detail regarding the
25. Sanitary pantie. [RGUHS Aug 2005]
principles of designing panties. [BUHS Sep 1993]
26. Define pantie. Describe its types with indications.
24. Define abutment. Describe the factors to be considered
[RGUHS Mar 2004]
in selection of a bridge abutment. [RGUHS Jul 1991]
27. Modified ridge lap pantie. [NTR-NR Apr 2004]
25. Describe the concept, design, and placement of mar-
28. Pantie. [NTR-NR Oct 2004, Apr 2002, NTR-OR Oct
gins of crown and retainers in fixed partial dentures.
1995, May 1993, Nov 1992]
[NTR-OR Oct 1995]
29. Requirements of panties. [RGUHS Apr 2003]
26. What is fixed partial denture prosthesis? How do
30. Hygienic pantie. [NTR-OR Apr 2002]
you classify them? Discuss with reasons in your choice
31. Root extension pantie. [NTR-OR Oct 2001]
of materials for construction of 3-unit bridge for
32. Disadvantages of ridge lap type pantie. [NTR-OR Apr
missing 26. [NTR-OR Oct 1995]
2001]
Section I 111 Previous Years' Question Bank
33. Discuss biomechanical principles used in the prepara-
tion of vital teeth to receive a fixed partial denture.
[GOA 1998]
Short Notes
1. Hygienic pantie. [TN Feb 2012]
2. Ovate pantie. [RGUHS Dec 201 I/Jan 2012 (OS); TN
Feb 2009]
3. Sanitary (Hygienic) pantie. [NTRUHS Feb 2011, Jul
2008 (OS); TN Nov 2001]
4. Altered vertical dimension. [RGUHS Jun/Jul 201 I
(OS)]
5. Modified ridge lap panties. [RGUHS Dec 2010 (OS)]
6. Mesia! half crown. [RGUHS Dec 2010 (RS)]
7. Spheroidal pantie. [RGUHS Jun/Jul 2010 (RS2)]
8. Connectors in FPD. [NTR-NR Oct 2005; MUHS Nov
1994; RGUHS May 1986; TN Feb 2006, 2010]
9. Define pantie. Enumerate the types of pantie.
[NTRUHS Aug 2009]
10. Bullet-shaped pantie. [RGUHS Jul 2008 (RS2)]
11. Enumerate the factors affecting retention form for a
fixed partial denture. [MUHS May-Jun 2008]
12. Panties. [GOA Dec 2005, 2001, 1998; TN Nov 2001,
Aug 2006, Feb 2007]
13. Ridge lap panties. [TN Feb 2006]
14. Sanitary pantie. [RGUHS Aug 2005]
15. Choice of pantie as related to tissue contacts. [MUHS
Jun 2004]
------------------ -<( Topic
Occlusion in Fixed Partial Dentures
Long Essays
1. What is balanced occlusion? Write in brief about the
factors governing balanced occlusion. Write in detail
about the principles of tooth preparation for fixed partial
denture. [RGUHS Dec 2010 (RS)]
Short Essays
1. Recording of jaw relation records for crown and bridge.
[RGUHS Feb 2007 (OS)]
16. What is pontic? Give its classification. [MUHS Oct
2004, 1998]
17. Components of FPD. [RGUHS Apr 2003; TN Apr
2004]
18. Requirements of pontics. [RGUHS Apr 2003]
19. Pontic design. [TN Oct 2003]
20. Radiographic evaluation of prospective abutment teeth
for fixed partial denture. [TN Oct 2003]
21. What are the ideal requirements of pontic design?
[MUHS May 2002]
22. Classify bridges and give their types. [MUHS May 2002]
23. Extracoronal retainers in fixed partial prosthodontics.
[TN Apr 2001]
24. Write the ideal requirements for retainers in FPD.
[MUHS May 2000]
25. Classify retainers in FPD. [MUHS 1999]
26. Non-rigid connectors in FPD. [MUHS 1998]
27. Radicular bridge retainers. [BUHS Sep 1992]
28. Non-precision fixed bridges. [BUHS Feb 1990]
29. Sanitary pontic. [NTRUGHS Aug 2013]
30. Pier abutments. [NTRUGHS Aug 2013]
31. Crown-root ratio. [RGUHS Jun/Jul 2011 (RS2)]
32. Treatment protection to prepared abutment. [RGUHS
Aug 2005]
33. Abutment evaluation in fixed partial denture. [TN Aug
2004]
34. Ante's law. [RGUHS Mar 2004, Jul 1991, GOA 2004]
35. Factors in selection of abutment in FPD. [RGUHS Apr
2003]
3)
2. Achieving retention in fixed partial denture. [GOA 2003]
3. Clinical remounting. [GOA 2002]
4. Selective grinding procedure. [BUHS Jul 1991]
Short Notes
1. Selective grinding. [RGUHS Dec 2011/Jan 2012 (RS2),
Jul 2008 (OS); TN Apr 2003, Nov 2001]
2. Types of occlusion in FPD. [NTR-NR Oct 2005]
3. Selective grinding procedure. [RGUHS Jul 1991]

Types of Abutments
Long Essays
1. Define abutment. Explain the criteria for selection of
teeth for a fixed partial denture abutment. [RGUHS Jun/
Jul 2010 (RS); TN Feb 2007]
2. Selection of abutment for FPD. [RGUHS Feb 2007 (RS)]
3. Define an abutment and discuss the biomechanical princi-
ples involved in abutment preparations. [GOA Dec 2005]
4. Define an abutment and enumerate the criteria involved
in abutment selection. [RGUHS Mar 2005, Sep 2004]
5. Define the term 'Abutment' in fixed partial dentures.
Describe the factors responsible for selection of an abut-
ment. [NTR-OR Apr I 996]
6. Define an abutment and a pier. How will you manage
abutment with compromised periodontal conditions?
[MUHS Dec I 995]
7. Define abutment. Describe the factors to be considered
in selection of a bridge abutment. [BUHS Jul I 99 I]
Short Essays
1. Pier abutment. [RGUHS Dec/Jan 2012 (RS)]
2. Ideal abutments. [RGUHS Dec 2011/Jan 2012 (RS2)]
3. Abutment selection for FPD. [RGUHS Jun/Jul 2010 (RS2)]
Tooth Preparation
Long Essays
1. Define retention and resistance in fixed partial dentures.
What are the factors affecting retention and resistance in
posterior tooth preparation? [NTRUHS Jan 2012 (OR)]
2. Discuss the principles of tooth preparation in detail.
[NTRUHS Feb 2011]
3. Give in detail the step by step procedure for preparing
metal-ceramic crowns for a maxillary central incisor.
[RGUHS Dec 2010 (OS)]
4. What is balanced occlusion? Write in brief about the
factors governing balanced occlusion. Write in detail
about the principles of tooth preparation for fixed partial
denture. [RGUHS Dec 2010 (RS)]
5. What is crown? How do you prepare a maxillary centre
incisor to receive a complete ceramic crown? [RGUHS
Jul 2008 (OS)]
Quick Review Series for BOS 4 th Year: Prosthodontics
( Topic 4)
4. Post and core. [RGUHS Jun/Jul 2010 (RS2)]
5. Factors affecting selection of abutment tooth. [NTR-
NR Apr 2004]
6. Abutment selection. [NTR-NR Oct 2004]
7. Factors in selection of abutment in FPD. [RGUHS Apr
2003]
8. What is an ideal abutment? Discuss selection of abut-
ment teeth for a fixed partial prosthesis. [GOA 2003]
9. Ante's law. [NTR-NR Oct 2001]
10. Bridge abutment. [NTR-OR Oct I 995]
11. Selection of bridge abutment. [NTR-OR May I 992]
Short Notes
1. Ideal abutments. [NTRUHS Jan 2012 (OR)]
2. Pier abutment. [NTR-NR Oct 2000; NTRUHS Mar
2012 (NR); NTRUHS Mar 2008, Feb 2010, NTRUHS
Feb 2011; TN Feb 2012]
3. Cantilever fixed partial denture. [RGUHS Jun/Jul
201 I (OS)]
4. Parapost. [RGUHS Jun/Jul 2010 (OS)]
5. Osseointegration. [RGUHS Jul 2008 (RS)]
6. Ante's law. [NTR-NR Oct 2004, Oct 2002]
( Topic s)
6. Enumerate the principles of tooth preparation in fixed
prosthesis. Write the factors affecting retention and
resistance. [BUHS Apr 1998; TN Feb 2007]
7. Discuss in detail the principles of tooth preparation to
receive artificial crown. [NTRUHS Oct 2007]
8. What are the biomechanical principles of tooth prepa-
ration? Discuss the biologic principles in detail.
[MUHS Oct 2006]
9. Describe in detail about the steps in preparation of
tooth for receiving full metal crown. [NTR-OR Apr
2006]
10. Write in detail about the biomechanical considerations
for preparation of a tooth for fixed prosthesis? [RGUHS
Mar 2006]
11. Give a step by step description of preparation of a
mandibular first molar for receiving a ceramic-metal
Section I 111 Previous Years' Question Bank
crown with reasons for amount of reduction and from
to the tooth. [MUHS July 2005]
12. Define an abutment and discuss the biomechanical
principles involved in abutment preparations. [GOA
Dec 2005]
13. Enumerate and discuss the principles of preparation
of tooth to receive artificial crown. [RGUHS Aug
2005]
14. List the principles of tooth preparation. Describe each
with examples and instructions. [NTR-OR Apr 1997;
TN Feb 2005]
15. Describe tooth preparation of a maxillary central in-
cisor to receive porcelain jacket with justification.
Illustrate with diagram. [MUHS Oct 2004]
16. Describe the principles of tooth preparation and write
about mechanical considerations in detail. [RGUHS
Mar 2004]
17. Write about biomechanical principles of tooth prepara-
tion. [TN Apr 2004]
18. What are the biomechanical principles in tooth prepa-
ration? Discuss. [TN Apr 2004]
19. Describe the principles of abutment preparation for
fixed partial denture. [NTR-OR Apr 2003]
20. What is FPD prosthesis? Give its classification with
reasons in your choice of materials for 3-unit bridge
for missing 26? [RGUHS Sep 2003]
21. Steps in the preparation of upper central incisor to
receive a jacket crown. [RGUHS Mar 2003]
22. Discuss the recent advances in materials used for fixed
partial dentures. [MUHS Oct 2002]
23. Enumerate the principles of tooth preparation aside in
detail the mode of preparation of 36 to receive a ¾
crown. [RGUHS Aug2002]
24. Discuss the mechanical, biological, and aesthetics in-
volved in tooth preparation in fixed bridge prosthesis.
[MUHS Oct 2002]
25. Discuss the recent advances in materials used for fixed
partial dentures. [MUHS Oct 2002]
26. Discuss the biological and mechanical considerations
in tooth preparation to receive a fixed partial denture.
[GOA May 2002, 2001]
27. Discuss the mouth preparation of a patient for fixed
partial denture. [NTR-0R Oct 2001]
28. What are the principles in tooth preparation? Explain
each in detail. [NTR-OR Oct 2001]
29. Discuss the principles of tooth preparation to receive
artificial crown. [NTR-NR Apr 2001]
30. Discuss the principles of preparation of abutment teeth
for partial veneer crown. [NTR-OR Apr1999]
31. Define retainer in FPD. Classify the retainers in FPD
and describe the step by step preparation of posterior
tooth to receive a complete veneer crown. [NTR-OR
Oct 1998]
32. Discuss the principles and design of a tooth prepara-
tion for receiving a cast complete veneer restoration.
[GOA Dec 1998]
33. What are the principles of tooth preparation? Describe
the various steps in the preparation of maxillary central
incisor to receive a ceramic-metal restoration. [MUHS
Jun 1997]
34. Define and classify retainers in FPD. Describe in detail
the principles of tooth preparation for first maxillary
molar. [RGUHS, BUHS Aug 1993]
35. Enumerate the principles of tooth preparation in fixed
prosthesis. Write the factors affecting retention and
resistance. [RGUHS Aug 1993]
36. Describe the biomechanical principles of tooth prepa-
ration in fixed partial denture. [BUHS May 1991]
37. Discuss the biomechanical principles of tooth reduc-
tion in fixed partial denture prosthodontics. [NTR-OR
Feb 1990]
38. Describe the clinical and laboratory steps in the
preparation of a porcelain jacket crown. [BUHS Sep
1985]
Short Essays
1. Finish lines in FPD. [NTR-NR Oct 2004; MUHS Dec
1994; NTR-OR Feb 1990; NTRUHS Jul 2011 (OR)]
2. Principles of tooth preparation. [RGUHS Jun/Jul 2011
(OS); TN Oct 2003]
3. Supragingival finish line. [RGUHS Jun/Jul 2010 (RS2)]
4. Step-wise tooth preparation of a molar tooth for crown
and prosthesis. [RGUHS Feb 2007 (OS)]
5. Describe the indications, contraindications, advan-
tages, and disadvantages of partial veneer crowns.
[RGUHS Mar 2005, Sep 2004]
6. Indications, advantages, and disadvantages of ¾th
partial veneer crown. [NTR-NR Apr 2004]
7. Briefly write on the principles of tooth preparation.
[TN Apr 2004]
8. Proximal groves in partial veneer crown. [NTR-OR
Nov 1994; TN Apr 2004]
9. Describe the indications, advantages, and disadvan-
tages of subgingival finish line. [RGUHS Apr 2003]
10. Give the advantages and disadvantages of porcelain
jacket crown. [RGUHS Apr 2003]
11. Gingival finishing lines. [MUHS May 2003; NTR-OR
Apr 1998]
12. Axioproximal grooves. [NTR-NR Oct 2001, NTR-OR
Apr 1998; TN Apr 2003]
13. Marginal finish lines. [NTR-NR Apr 2002]
14. What are the advantages of porcelain jacket crown?
[MUHS Oct 2002]
15. Indications and contraindications of porcelain jacket
crown. [RGUHS Sep 2002]
 Quick Review Series for BOS 4th Year: Prosthodontics

16. PFM (porcelain fused to metal restoration). [NTR-NR 14. What are the requirements of an ideal abutment?
Apr 2000] [MUHS May 2007]
17. Define and classify retainers in fixed partial prosthesis. 15. Discuss in short, the validity of Ante's law as applica-
Describe in detail the principles of tooth preparation ble to fixed prosthodontics. [MUHS Nov/Dec 2007]
for the mandibular first molar to receive a fill cast 16. Maryland bridges and their limitations. [MUHS Nov/
metal crown. [GOA Oct/Nov 2000] Dec 2007]
18. Partial veneer crown. [NTR-OR Apr 1999] 17. Importance of functional cusp bevel. [MUHS Jun
19. Advantages of porcelain jacket crown. [NTR-OR Apr 2006]
1999] 18. What are the different types of finish lines? Write
20. Dowel crown. [NTR-OR Apr 1999] about heavy chamfer type of finish line. [MUHS Nov
21. Metal crown. [NTR-OR Apr 1999, Apr 1996] 2006]
22. Discuss the biomechanical principles used in the prep- 19. Types of cervical finish lines in fixed prosthesis.
aration of vital teeth to receive a fixed partial denture. [RGUHS Mar 2006]
[GOA Jun 1998] 20. Disadvantages of subgingival finishing lines. [NTR-
23. Etch cast restorations. [MUHS 1998] NR Apr 2006]
24. Principles of tooth preparation. [NTR-OR Apr 1998] 21. All ceramic systems. [RGUHS Aug 2006]
25. Full veneer crown. [NTR-OR Oct 1997] 22. Disadvantages of partial veneer crown. [NTR-NR Apr
26. Retention grooves in anterior and posterior partial ve- 2005]
neer crowns. [MUHS Nov 1997] 23. What are the purposes for establishing a clear gingival
27. Post and crown. [NTR-OR Oct 1997] finishing line in tooth preparations for crowns? What
28. Finish line - location and types. [NTR-OR Oct 1995] are the possible location of the finishing line and their
29. Porcelain jacket crown. [NTR-OR Apr 1995] reason? [MUHS Jul 2005]
30. Post core crown. [BUHS Aug 1995] 24. Name and draw different finish lines with one indica-
31. Shoulder. [NTR-OR May 1994] tion of each. [MUHS Oct 2004]
32. Types of gingival finish lines in crown preparation. 25. Finishing lines in fixed partial dentures. [GOA 2004]
[NTR-OR Nov1992] 26. Depth orientation groove. [TN Oct 2003]
33. Comparison of acrylic and porcelain crown. [MUHS 27. Biological considerations in tooth preparation for
Oct 1989] crown and bridge. [TN Apr 2003]
28. Enumerate the various margins design in fixed partial
denture giving examples. [MUHS May 2003]
Short Notes
29. Indications and contraindications of partial veneer
1. Advantage of partial denture. [NTRUHS Jan 2012 (OR)] crown. [RGUHS Apr 2003]
2. Functional cusp bevel. [NTRUHS Mar 2012 (NR)] 30. Jacket crown. [NTR-NR Apr 2003]
3. Chamfer finish line. [NTRUHS Mar 2012 (NR), 31. Give the benefits of supragingival margins in fixed
RGUHS Dec/Jan 2012 (RS); Jun/Jul 2011 (RS2)] prosthodontics. [MUHS Oct 2003]
4. Shoulder finish line. [RGUHS Jun/Jul 2011 (OS)] 32. What are the different types of finish lines? What finish
5. Gingival finish lines. [GOA Dec 2005; TN Apr 2004, line is used for metal-ceramic restoration and why?
2001, Feb 2011] [MUHS Oct 2002]
6. Ante's law. [RGUHS Dec 2010 (RS)] 33. Advantages of porcelain jacket crown. [NTR-NR Apr
7. Chamfer. [RGUHS Jun/Jul 2010 (RS)] 2002]
8. Resistance and retention form in tooth preparation. 34. Chamfer. [NTR-NR Oct 2002, 2001]
[TN Aug 2009] 35. Different margin designs with indications. [MUHS Oct
9. Cervical finish lines in tooth preparation. [TN Feb 2009] 1997]
10. Shoulder with bevel. [RGUHS Jul 2008 (OS)] 36. Supragingival finish line. [BUHS Apr 1996]
11. Tensofrictional resistance. [RGUHS Jul 2008 (OS); 37. Proximal grooves in anterior PVC. [BUHS Mar
TN Apr 2004, 2001] 1995]
12. Dowel post. [NTRUHS Oct 2007] 38. Indications and contraindications for acrylic jacket
13. Maintenance of air rotor hand pieces. [RGUHS Feb crown. [BUHS Feb 1990]
2007 (OS)] 39. Chamfers. [RGUHS May 1986]
Section I 111 Previous Years' Question Bank

------------------1( Topic 6)
Types of Fixed Partial Dentures
Long Essays 7. Resin-bonded fixed partial dentures. [NTRUHS Feb
2010]
1. Name the component parts of a bridge. Define and
8. Indications for jacket crown. [RGUHS Jun/Jul 2010
classify panties and add a note on selection of pantie
(RS)]
design and requirements of pantie. [NTRUHS Jul 2011
9. Enumerate the various failures in fixed partial denture.
(OR)]
[RGUHS Jul 2008 (RS2)]
2. What is partial veneer crown? Mention about its indi-
10. Comparative merits of complete veneer and partial
cations and contraindications. Describe about the steps
veneer crowns. [RGUHS Jul 2008 (RS2)]
of preparation for a three-quarter crown preparation on
11. Describe the indications, contraindications, advan-
maxillary cuspid with diagram. [MUHS Nov 2006]
tages, and disadvantages of partial veneer crowns.
3. Describe tooth preparation of a maxillary central incisor
[RGUHS Mar 2005, Sep 2004]
to receive porcelain jacket with justification. Illustrate
12. Give the advantages and disadvantages of porcelain
with diagram. [MUHS Oct 2004]
jacket crown. [RGUHS Apr 2003]
4. Discuss the tooth preparation for a metal-ceramic res-
13. Indications and contr indications of porcelain jacket
toration in maxillary central incisors. [TN Aug 2004]
crown. [RGUHS Sep 2002]
5. Mention the indications and contraindications for a
14. What are the different types of finish lines? What finish
metal-ceramic crown. Describe the step by step proce-
line is used for metal-ceramic restoration and why?
dure in the preparation of molar tooth for a metal-
[MUHS Oct 2002]
ceramic crown. [TN Apr 2003]
15. Failure effect in post and core restorations. [MUHS
6. Name the various types of bridges. Diagrammatically
Mar 2000]
name the parts of a bridge. Classify the retainers. Dis-
16. Define and classify retainers in fixed partial prosthesis.
cuss in detail about radicular retainers. [TN Sep 2002]
Describe in detail principles of tooth preparation for
7. Discuss the recent advances in materials used for fixed
the mandibular first molar to receive a fill cast metal
partial dentures. [MUHS March 2002]
crown. [GOA Oct/Nov 2000]
8. Briefly enumerate the step by step preparation of a
17. Alloys used in FPD. [MUHS Jun 1998]
maxillary premolar to receive a complete ceramic-
18. Comparison of acrylic and porcelain crown. [MUHS
metal restoration. [MUHS Jun 1995]
Nov 1989]
9. Describe the clinical and laboratory steps in the prepa-
19. Retention grooves in anterior and posterior partial
ration of a porcelain jacket crown. [RGUHS Sep 1985]
veneer crowns. [MUHS Oct 1989]
10. Enumerate the principles of tooth preparation aside in
detail the mode of preparation of 36 to receive a ¾
crown. [NTRUHS Mar 2012 (OR)] Short Notes
11. What is FPD prosthesis and give its classification with
1. Pier abutment. [NTRUHS Mar 2012 (NR)]
reasons in your choice of materials for C 3-unit bridge 2. Tooth preparation for anterior all-ceramic crown. [TN
for missing 26. [NTRUHS Mar 2012 (OR)] Feb 2012]
12. Steps in the preparation of upper central incisor to re-
3. Porcelain jacket crown. [RGUHS Dec 2011/Jan 2012
ceive a jacket crown. [NTRUHS Mar 2012 (OR)] (OS)]
4. Resin-retained bridges. [RGUHS Dec 2011/Jan 2012
(RS2)]
Short Essays 5. Anterior partial veneer crown [NTRUHS Feb 2011]
1. All-ceramic crown. [NTRUGHS Jul 2014] 6. Resin-bonded fixed partial denture. [TN Feb 2005,
2. Dental ceramics. [NTRUGHS Aug 2013] 2010]
3. Cantilever fixed partial denture. [NTRUHS Jan 2012 7. Indications and contraindications of partial veneer
(OR)] crown. [RGUHS Apr 2003, Dec 2010 (OS)]
4. Rochette bridge. [NTRUHS Jan 2012 (OR)] 8. Advantages of porcelain veneer. [RGUHS Jun/Jul
5. Types of fixed partial denture. [RGUHS Dec 2011/Jan 2010 (RS)]
2012 (RS2)] 9. Advantages of partial veneer crown. [RGUHS Jun/Jul
6. Full veneer crown. [RGUHS Jun/Jul 2011 (RS2)] 2010 (RS), (OS)]
 Quick Review Series for BOS 4th Year: Prosthodontics

10. Maryland bridge. [RGUHS Jun/Jul 2010 (OS); TN Sep 21. Metal-free ceramics. [TN Aug 2004]
2002, Aug 2005] 22. Acid-etched bridges. [TN Apr 2004]
11. Partial veneer crown. [GOA Dec 2002; TN Feb 2010] 23. Polycarbonate crowns. [RGUHS Mar 2004]
12. Indications of anterior jacket crown. [TN Aug 2009] 24. Cantilever fixed partial dentures [RGUHS Mar 2004]
13. Compound bridge. [RGUHS Jul 2008 (RS2)] 25. Metal-ceramic crown. [TN Oct 2003]
14. Resin-bonded bridges. [NTRUHS Mar 2008] 26. What are the advantages of porcelain jacket crown?
15. Indications and contraindications for porcelain jacket [MUHS Oct 2002]
crown. [NTRUHS Mar 2008] 27. Richmond crown. [TN Sep 2002]
16. Adhesive bridges. [TN Aug 2006, Feb 2007] 28. Complete veneer crown. [GOA Dec 2001]
17. What is ceramic laminate? Write about its indications. 29. Cast porcelain crowns. [RGUHS Aug 1995, Apr 1987]
[MUHS Nov 2006] 30. Radicular bridge retainers. [RGUHS Sep 1992]
18. Advantages of partial veneer crowns over full veneer 31. Non-precision fixed bridges. [RGUHS Feb 1990]
crowns. [MUHS Nov 2006] 32. Indications and contraindications for acrylic jacket
19. Post core crown. [RGUHS Aug 1995, TN Aug 2005] crown. [RGUHS Feb 1990]
20. Telescopic crowns. [TN Aug 2004] 33. Cast core.

------------------ -<( Topic 7)

Impression Making in Fixed Partial Dentures
Long Essays 4. Gingival retraction techniques. [RGUHS Feb 2007 (RS)]
5. Write in detail the impression procedures in crown and
1. What is impression? Enumerate the impression theories.
bridge prosthesis. [RGUHS Feb 2007 (OS)]
Explain the selective pressure impression theory and
6. Write about the different methods of gingival retraction.
classify fixed partial denture. Explain the selection of
[MUHS Nov 2006]
abutment for a fixed partial denture. Advantages of por-
7. Role of special trays in fixed partial denture impres-
celain veneer crown. [RGUHS Jun/Jul 2010 (OS)]
sion making. [RGUHS Aug 2005]
2. Describe the methods to control saliva and soft tissue
8. Impression materials in FPD. [NTR-NR Oct 2004]
management for fixed partial denture procedure. [TN
9. What do you understand by the term 'tissue dilatation'
Aug 2009]
and what are the different methods to obtain the same?
3. What are the objectives of an impression and explain
[GOA 2004]
your techniques in recording the impressions of a FPD?
10. Methods of gingival dilatation. [MUHS Dec 2002]
[TN Aug 2005]
11. Rubber base impression materials. [NTR-NRApr2000]
4. Describe the technique of impression making in fixed
12. Double impression technique in FPD? [NTR-OR Oct
partial denture treatment. [NTR-NR Apr 2002]
1998]
5. Describe the gingival tissue management in fixed pros-
13. Impression procedures in fixed partial denture. [NTR-
thesis. [MUHS Oct 1998]
OR Apr 1998, Mar 1995]
6. What do you understand by the term 'tissue dilatation'
14. Methods of gingival retraction. [MUHS Oct 1997]
and what are the different methods to obtain it? [MUHS
15. Gingival management. [MUHS 1995]
Nov 1994]
16. Describe the various methods of gingival retractions in
fixed prosthodontics. [BUHS Mar-1992]
Short Essays 17. Gingival dilation. [MUHS Oct 1990]
18. Elastomeric impression materials. [MUHS Nov 1989]
1. Various retraction methods in FPD. [RGUHS Jun/Jul
2011 (RS2)]
2. Gingival retraction. [NTR-NR Oct 2002, NTR-OR Oct Short Notes
2001, Oct 1998, Apr 1996, Oct 1995, Apr 1995, Nov
1. Selective pressure impressions technique. [GOA Jul
1992; TN Sep 2002; NTRUHS Aug 2009, Jul 2011
2006; TN Apr 2001, Feb 2013]
(OR), RGUHS Jul 2008, Feb 2008 (RS)]
2. Functions of saliva. [NTRUHS July 2011 (OR)]
3. Indications and advantages of all-ceramic crown.
3. Gingival retraction techniques. [TN Aug 2010]
[NTRUHS Aug 2009]
Section I 111 Previous Years' Question Bank

4. Gingival retraction [NTRUHS Aug 2009; TN Aug 14. Purpose of gingival retraction. [NTR-NR 2004]
2004, 2006, Apr 2003, Nov 2001, Feb 2005, 2007, 15. Cantilever fixed partial dentures. [RGUHS Mar 2004]
2010; GOA 2004, 2002, 1999; TN Oct 2003] 16. Ante's law. [GOA 2004]
5. Triple tray impression. [NTRUHS Aug 2009] 17. McLean's physiologic impression. [TN Oct 2003]
6. Fluid wax impression. [TN Aug 2004, Feb 2009] 18. Impression materials in fixed partial dentures. [MUHS
7. Enumerate the various impression materials used for Jun 2002; TN Nov 2001]
crown and bridge work. [RGUHS Jul 2008 (RS2)] 19. Selective pressure technique. [TN Apr 2001]
8. Gingival tissue retraction. [RGUHS Jul 2008 (RS2)] 20. Write the four advantages of subgingival margin.
9. Recent advances in FPD. [RGUHS Aug 2006] [MUHS Dec 1999]
10. Reversible colloid. [NTR-NR Apr 2005] 21. Maryland bridges. [NTR-OR Apr 1997, Feb 1990]
11. Write the various types of gingival retraction cords. 22. Double impression technique in fixed partial prosth-
[MUHS 2005] odontics. [GOA 1997]
12. Tissue management in FPD. [TN Aug 2005] 23. Impressions. [RGUHS Mar 1994, BUHS Mar 1994]
13. Retraction cord. [NTR-NR Oct 2004]

------------------ -<( Topic 8)

Temporisation or Provisional Restorations and Lab
Procedures Involved in Fabrication of FPD
Long Essays 6. Role of special trays in fixed partial denture impres-
sion making. [RGUHS Aug 2005]
1. Discuss in detail the fixed partial denture failures. [TN
7. Describe the die systems used in FPD and describe any
Feb 2013]
one of them. [RGUHS Mar 2005, Sep 2004]
2. Discuss temporization in fixed partial denture.
8. Treatment protection to prepared abutment. [RGUHS
[NTRUHS Mar 2012 (NR)]
Aug 2005]
3. What is the need for temporization after tooth prepara-
9. Requirements of provisional restoration. [RGUHS
tion? Discuss the various methods to achieve it. [MUHS
Mar 2005, Sep 2004]
Aug 2005]
10. Indirect procedure of fabricating provisional restora-
4. What is provisional restoration? What are the require-
tion. [RGUHS Mar 2004]
ments of a provisional restoration? Write an account of the
11. Define die and name the various die materials. [MUHS
various types of provisional restorations. [TN Apr 2004]
May 2003]
5. What are provisional restorations? Justify their need
12. List temporary tooth protection materials. Explain
and discuss their limitations. [MUHS Jun 1998]
anyone technique of temporary tooth preparation.
6. Discuss the role of provisional restorations in FPD and
[RGUHS Sep 2002]
describe the different types used. [MUHS May 1997]
13. Advantages of porcelain jacket crown. [NTR-NR Apr
7. Dies and die materials. [MUHS Dec 1995]
2002]
8. Describe the clinical and laboratory steps in the prepa-
14. Temporary protection of prepared tooth. [TN Apr
ration of a porcelain jacket crown. [NTR-OR Sep 1985]
2001]
15. Write about try-in of FPD. [MUHS Apr 2000]
Short Essays 16. Give your method of cementing 3-unit fixed partial
1. Failures in FPD. [RGUHS Dec 2010 (RS)] prosthesis and instructions and aftercare to patients.
2. Temporization in fixed partial prosthesis. [RGUHS Jun/ [GOA Dec 1999]
Jul 2010 (RS2)] 17. Write the requirements of provisional restoration.
3. Provisional restoration. [NTR-NR Oct 2005, Oct 2002; [MUHS May 1999]
RGUHS Dec 2010 (RS)] 18. Provisional restorations. [MUHS Dec 1994, 1997]
4. Enumerate the die materials and die systems. Write in 19. Temporization. [MUHS Oct 1995; NTR-OR Oct 1995]
brief on divestment technique. [MUHS May-Jun 2008] 20. Porcelain jacket crown. [NTR-OR Apr 1995]
5. Enumerate the various failures in fixed partial denture. 21. Temporary tooth protection. [NTR-OR May 1993,
[RGUHS Jul 2008 (RS2)] Nov 1992]
 Quick Review Series for BOS 4th Year: Prosthodontics

22. Temporary crowns. [MUHS Nov 1989] 10. Temporization in fixed partial denture. [MUHS May 2007]
23. Metal-ceramic crown. [TN Feb 2008] 11. Provisional crowns. [TN Feb 2007]
24. PFM (Porcelain-fused metal restoration). [TN Feb 12. Different polishing agents used in dentistry. [RGUHS
2008] Feb 2007 (OS)]
13. Temporary crown. [RGUHS Aug 2006]
14. Suck back porosity. [NTR-NR Apr 2006]
Short Notes
15. Types of fixed partial dentures. [GOA Jul 2006]
1. Provisional restorations. [GOA 2004; NTRUHS Jul 16. Management of endodontically treated teeth [GOA Jul
2011 (OR); TN Aug 2005, Feb 2009, 2012] 2006]
2. Temporization. [GOA Jul 2006, RGUHS Dec 201 I/Jan 17. Casting defects. [NTR-NR Apr 2005]
2012 (RS2); TN Nov 2001] 18. What is temporization? Give its importance and the
3. Requirement of provisional restoration. [RGUHS Jun/ technique. [MUHS Oct 2004]
Jul 2011 (OS)] 19. Importance of provisional restorations in fixed partial
4. Abrasives and polishing agents. [RGUHS Jun/Jul 2011 denture. [MUHS May 2003]
(OS)] 20. Give the biologic requirements of provisional
5. Polycarbonate crowns. [RGUHS Mar 2004, RGUHS restorations. [MUHS Oct 2003]
Jun/Jul 2011 (RS2)] 21. Difference between natural and artificial occlusion.
6. Need for temporization. [NTRUHS Feb 2010] [GOA 2003]
7. Cements used in fixed prosthesis. [RGUHS Jun/Jul 22. Luting agents. [GOA 2002]
2010 (RS2)] 23. Jacket crown. [NTR-NR Apr 2002]
8. Temporary protection of prepared abutment. [TN Aug 24. Cementation of a fixed partial denture. [GOA Oct/Nov
2010] 2000]
9. Enumerate the requirements of a provisional restoration. 25. Metal-ceramic restoration. [BUHS Aug 1995]
[MUHS Jun 2008] 26. Cast porcelain crowns. [BUHS Apr 1987]

-------------------<( Topic
Cementation of Fixed Partial Dentures
and Miscellaneous
Long Essays
1. Soldering. [NTRUHS Jan 2012 (OR)]
2. Luting agents used in fixed prosthesis. [MUHS Dec
1990, 2003]
3. Explain in detail cementation ofFPD. [MUHS Oct 2000]
Short Essays
1. Castable ceramics. [RGUHS Dec/Jan 2012 (RS)]
2. Compare and contrast acrylic partial denture with cast
partial dentures. [RGUHS Dec/Jan 2012 (RS)]
3. Casting defects. [NTRUHS Mar 2008, RGUHS Dec/Jan
2012 (RS)]
4. Die materials. [NTRUHS Feb 2011]
5. Sprue former. [RGUHS Dec 2010 (OS)]
6. Porosities in casting. [RGUHS Dec 2010 (OS)]
7. Working cast and die preparation. [RGUHS Jul
2008 (OS)]
9)
8. Factors affecting colour of ceramics. [RGUHS Jul
2008 (RS2)]
9. Porosities in noble metal castings. [RGUHS Jul 2008
(RS2)]
10. Cements used in fixed partial dentures. [RGUHS Aug
2005; NTRUHS Oct 2007]
11. Veneering materials. [NTR-NR Apr 2006]
12. Diagnostic aids for FPD evaluation. [RGUHS Aug
2006]
13. Ceramics. [NTR-NR Oct 2005]
14. Luting agents in FPD. [NTR-NR Oct 2005]
15. Luting cements for FPD. [NTR-NR Apr 2004]
16. List temporary tooth protection materials. Explain
anyone technique of temporary tooth preparation.
[RGUHS Sep 2002]
17. Porcelain teeth. [NTR-ORApr 1999]
18. Splints. [NTR-OR May 1994]
Section I 111 Previous Years' Question Bank

Short Notes 9. Tooth coloured cements for all-porcelain crowns.

[NTR-NR Apr 2006]
1. Welding and soldering. [RGUHS Dec 2011/Jan 2012
10. Cements used in fixed partial dentures. [RGUHS Aug
(OS)]
2005]
2. Porcelain fused to metal crown. [RGUHS Jun/Jul 2011
11. Casting failure. [TN Aug 2005]
(OS)]
12. Phosphate-bonded investment. [TN Aug 2005]
3. Metal-free ceramics. [RGUHS Jun/Jul 2010 (RS2)]
13. Enumerate the tooth coloured veneering material.
4. Removable dies. [RGUHS Jun/Jul 2010 (RS2)]
[NTR-NR Apr 2004]
5. Titanium alloy. [RGUHS Jun/Jul 2010 (OS)]
14. Dicor. [NTR-NR Oct 2002]
6. Die spacer. [RGUHS Jul 2008 (OS)]
15. Cerestore. [NTR-NR Apr 2003]
7. Prothero's cone theory. [NTR-NR Apr 2006]
16. Nickel-chromium alloy. [NTR-NR Apr 2002]
8. Solders for dental cast units assembly. [NTR-NR Apr
17. Dental ceramics. [GOA Dec 1999]
2006]

-------------------,(Topic 1 o)
Maxillofacial Prosthetics and Implant Dentistry
Short Essays Short Notes
1. Dental solder. [NTRUGHS Jul 2014] 1. CAD/CAM restoration. [NTRUGHS Jul 2014]
2. Die materials. [NTRUGHS Aug 2013] 2. Osseointegration. [RGUHS Jul 2008(RS); TN Feb
3. Casting defects. [NTRUGHS Aug 2013] 2007, 2013; NTR-NR Apr 2005]
4. Obturators. [NTRUHS Jan 2012 (OR), Mar 2008] 3. Sub-periosteal implants. [RGUHS Dec/Jan 2012
5. Ear prosthesis. [NTRUHS Jul 2011 (OR)] (RS)]
6. Armani's classification. [NTRUHS Jul 2011 (OR)] 4. Dowel post. [NTRUHS Mar 2012 (NR)]
7. Implant materials. [NTR-NR Apr 2002, 2001; RGUHS 5. Osseointegration of dental implants. [RGUHS Jun/Jul
Jun/Jul 2011 (RS2)] 2011 (OS); TN Feb 2012]
8. Biomaterials used in implants. [RGUHS Dec 2010 (OS)] 6. Endosseous implants. [NTRUHS Feb 2011]
9. Permanent obturator. [RGUHS Jun/Jul 2010 (RS)] 7. Post and core crowns. [NTRUHS Feb 2011]
10. Osseointegration. [RGUHS Jun/Jul 2010 (RS)] 8. Management of mutilated tooth. [TN Feb 2011]
11. Endosseous implants. [NTRUHS Mar 2008] 9. Obturators. [GOA Dec 2005, Oct/Nov 2000, 1999,
12. Requirements for successful osseointegration. 1997; TN Aug 2005, Apr 2004, 2001, Oct 2003, Feb
[RGUHS Jul 2008 (RS2)] 2011]
13. Arrangement for segregation and disposal of clinical 10. Implant. [BUHS Aug 1993; NTRUHS Jul 2011 (OR);
waste of all kinds. [RGUHS Jul 2008 (RS2)] TN Feb 2010]
14. Role of occlusal equilibration in the treatment ofMPD 11. Surgical obturator. [RGUHS Dec 2010 (OS)]
syndrome. [RGUHS Feb 2007 (OS)] 12. Classification of dental implants. [RGUHS Dec 2010
15. Types of obturator. [RGUHS Feb 2007 (RS)] (RS)]
16. Advantages of implant prosthodontics over conven- 13. Subperiosteal implants. [RGUHS Jun/Jul 2010 (RS2)]
tional complete denture. [RGUHS Feb 2007 (RS)] 14. Endosseous implants. [RGUHS Jun/Jul 2010 (RS)]
17. Osseointegration of dental implants. [RGUHS Aug 2006] 15. Write in brief the treatment planning for maxillary
18. Retention in maxillofacial prosthesis. [NTR-NR Oct obturator prosthesis. [TN Aug 2010]
2005] 16. Splints. [NTRUHS Mar 2008]
19. Materials used for maxillofacial prosthesis. [NTR-NR 17. Speech-aid prosthesis. [RGUHS Jul 2008 (RS)]
Apr 2005] 18. Dowel core. [RGUHS Jul 2008 (RS)]
20. Osseointegration. [NTR-NR Apr 2000] 19. Classify obturators. [RGUHS Jul 2008 (OS)]
21. Implant denture. [NTR-OR May 1994, 1992; RGUHS 20. Types of obturator. [RGUHS Feb 2007 (RS)]
Jan 1991] 21. Advantages of implant prosthodontics over conven-
22. Implant. [RGUHS Aug 1993] tional complete denture. [RGUHS Feb 2007 (RS)]
23. Indication for dental implant. [RGUHS Apr 1987] 22. Dowel pin. [TN Aug 2005]
 Quick Review Series for BOS 4th Year: Prosthodontics

23. Types of implants. [NTR-NR Oct 2005] 28. Retention form for a post-retained crown. [TN
24. Parts of implant. [NTR-NR 2004] Apr 2003]
25. Mention the materials used for fabrication of maxillo- 29. Implant denture. [BUHS Jan 1991; TN Sep 2002]
facial prosthesis. [NTR-NR Apr 2004] 30. Dental implants. [GOA 2002]
26. Hallow bulb obturator. [TN Aug 2004] 31. Implants in prosthodontics. [GOA 1999, 1997]
27. Implant biomaterials. [TN Apr 2004] 32. Indication for dental implant. [BUHS Apr 1987]
Section I 111 Previous Years' Question Bank

Part Ill
Removable Partial Dentures

------------------ - <( Topic 1)

Introduction and Terminology

Long Essays 3. Kennedy's
1. Classify partially edentulous areas according to Apple-
4.
gate-Kennedy's classification and mention Applegate's
rules for Kennedy's classification. [RGUHS Jun/Jul
5.
2011 (RS2)]
2. Present the entire Applegate-Kennedy's classification 6.
of partially edentulous situation with the latest nomen-
clature and modification. [RGUHS Feb 2007 (OS)] 7.
3. What is removable partial denture prosthesis? How do
you classify the partially edentulous situations? Discuss 8.
the principles in designing of tooth-tissue-supported
and tooth-supported removal partial denture prosthesis.
[RGUHS Feb 2007 (OS); BUHS Mar 1988] 9.
4. What are the requirements of classifying partially eden-
tulous arch? Explain Kennedy's classification of par- 10.
tially edentulous arch with diagram. List Applegate's
rules applied for classification of partially edentulous 11.
arch. [RGUHS Apr 2003]
5. Explain the mode of classification of removable partial 12.
denture with a diagram. Give the importance of such a 13.
classification. [TN Apr 2001]
6. Describe the Kennedy's classification of partially eden- 14.
tulous arches along with the rules governing the classi-
fication. Draw diagrams. [NTR-OR Oct 1995]
7. Classify semi-edentulous arches as per Kennedy's clas-
sification and give Applegate rules for Kennedy's clas-
sification. [RGUHS Aug 1995; Feb 1993] Short Notes
8. Discuss the importance of diagnostic and treatment 1. Kennedy's
planning in removable partial denture prosthodontics.
Enumerate the Applegate's rule for applying the Ken- 2.
nedy' classification. [NTR-OR Febl990] 3.
9. Describe in detail about Kennedy's classification of
partial dentures. [RGUHS May 1986] 4.
Short Essays 5.
1. Swing-lock dentures. [NTRUHS Jan 2012 (OR)]
6.
2. Kennedy's classification of partially edentulous arches.
[RGUHS Dec 2010 (RS)]
classification. [NTRUHS Feb 2010;
RGUHS Aug 2005]
RPD design options for Kennedy's class II situation in
maxillary arch. [RGUHS Feb 2007 (OS)]
Kennedy-Applegate's classification for partially eden-
tulous arches. [NTRUHS Oct 2007]
State Kennedy's classification and state Applegate's
rules. [MUHS Oct 2004]
Kennedy's classification in removable partial denture.
[MUHS Nov 2003, 2002]
Give the requirements of acceptable classification
system in partially edentulous arches. [MUHS Nov
2003, 1999]
Kennedy's classification of partially edentulous condi-
tions. [TN Sep 2002]
Describe Applegate-Kennedy's classification. [MUHS
Jun 1999]
Discuss the requirements of acceptable classification
system. [MUHS Mar 1999]
Ideal classification system in RPD. [MUHS Mar 1998]
Need for bilateral design in Kennedy's Cl II partial
denture. [MUHS Jun 1997]
Classify partial edentulous jaw. Give in detail about
the Kennedy's classification of partial edentulous jaws
with Applegate's rules. [GOA 1997]
classification. [NTR-OR Apr 2000;
NTRUGHS Jul 2014]
Define immediate partial denture. [RGUHS Aug 2006]
Applegate rules for Kennedy's classification of partially
edentulous arches. [NTR-NR Mar 2005]
End of reversible partial denture. [RGUHS, Mar 2005,
Sep 2004]
Kennedy-Applegate's classification. [RGUHS Mar
2005, Sep 2004; TN Nov 2001]
Advantages of tooth-supported prosthesis. [RGUHS
May 2005]

7. Classification of partially edentulous arches. [NTR-
NR Mar 2005]
8. Fulcrum line. [NTR-NR Apr 2003]
9. Immediate partial denture. [NTR-OR Oct 2002]
10. What points should be checked when a partial denture
is placed in the mouth? [MUHS 2002]
--------------------,( Topic 2)
Introduction, Treatment Planning, and Mouth Preparation
Long Essays
1. Discuss the mouth preparation in removable partial
dentures. [TN Apr 2004]
2. Describe the importance of mouth preparation in the
designing of partial dentures. [TN Apr 2003]
3. Define removable partial denture prosthesis. Describe in
detail mouth preparation for removable partial denture.
[RGUHS Aug 1993]
4. Describe in brief the various types of mouth preparation
procedures undertaken in a case of removable partial
denture service. [RGUHS Feb I 989]
5. Discuss the importance of diagnostic and treatment
planning in removable partial denture prosthodontics.
Enumerate the Applegate's rule for applying the
Kennedy's classification.
------------------<( Topic
Major and Minor Connectors
Long Essays
1. Write briefly on the requirements of major connectors.
Add notes on the advantages and disadvantages of max-
illary major connectors. [NTRUGHS Aug 2013]
2. Define major connectors in removable partial denture.
Discuss with diagrams different mandibular major con-
nectors. [TN Feb 2012]
3. Explain in detail the various types of minor connectors.
Add a note on the function of minor connector. [RGUHS
Dec/Jan 2012 (RS)]
4. Discuss the diagnostic choice of major connectors in the
treatment of mandibular partial edentulous condition.
[RGUHS Jun 1989]
Quick Review Series for BOS 4th Year: Prosthodontics
11. Describe the sequelae to loss of teeth. [MUHS May 1999]
12. Limitations of Kennedy's classification of partially
edentulous spaces. [NTR-OR Apr 1998]
13. Swing-lock partial denture prosthesis. [BUHS Mar
1992]
14. Denture base. [BUHS Feb 1990]
Short Essays
1. Treatment partial dentures. [RGUHS Dec/Jan 2012 (RS)]
2. Splints. [RGUHS Dec 2011/Jan 2012 (RS2)]
3. Mouth preparation for removable partial denture.
[RGUHS Jun/Jul 2011 (OS)]
4. Uses of diagnostic casts in removable partial dentures.
[RGUHS Dec 2010 (OS)]
5. Diagnostic cast and its uses. [RGUHS Jul 2008 (RS2)]
6. Pre-prosthetic surgery. [GOA 2004]
Short Notes
1. Refractory cast. [NTRUGHS Jul 2014]
2. Disinfection of impressions. [NTRUHS Mar 2012 (NR)]
3. Importance of mouth preparation in partial denture
treatment. [TN Feb 2006]
4. Mouth preparation prior to RPD services. [TN Apr 2001]
3)
5. Maxillary major connectors. [RGUHS Jun/Jul 2011 (OS)]
6. What is major connector? Describe the different types
of maxillary and mandibular major connectors. [TN Feb
2011]
7. What is the major connector? Describe in detail
the mandibular major connectors. [MUHS June
1991]
8. Enumerate the various components of a removable partial
denture and discuss major connectors. [TN Feb 2010]
9. Enumerate the parts of removable partial denture. De-
fine major connector. Give their ideal requirements and
describe maxillary major connectors. [NTRUHS Aug
2009]
Section I 111 Previous Years' Question Bank
10. Mention the parts of a cast partial denture and describe
the different maxillary major connectors. [TN Feb
2007]
11. Classify major connectors and discuss the role of
major connector in removable partial dentures
prosthodontics. [NTR-OR Mar 1991]
12. Discuss the requirements of major connectors. Explain
the indications, contraindications, advantages, disad-
vantages, and design features of mandibular major
connectors. [TN Aug 2006]
13. Write the components of cast partial denture and write
in detail about direct retainers. [TN Aug 2006]
14. Draw a design for a partially edentulous patient, men-
tioning each component. [MUHS Jun 2005]
15. Define a major connector in removable partial denture.
Discuss with diagram the various types of maxillary
major connector. [TN Aug 2004]
16. Write an essay on 'Minor Connector'. [TN Apr
2004]
17. Define major connector. Write in detail about the re-
quirements and types of mandibular major connectors.
[NTR-NR Oct 2005, Apr 2004]
18. Describe mandibular major connectors and write in
detail about lingual bar. [RGUHS Mar 2004]
19. Discuss in detail the principles of designing a cast
partial denture. [TN Nov 2001]
20. Classify the major connections. Write briefly on the
principles and indications in major connector design-
ing. [TN Apr 2001]
21. What are major and minor connectors? Describe their
different types and discuss the requirements. [MUHS
May 1999]
22. Define major corrector. What are the design require-
ments for major connector? Discuss in detail the man-
dibular major connector. [NTR-OR Apr 1995]
23. Name the different components of cast removable
partial denture. Describe in detail the different types
of major connectors used in mandibular removable
partial denture. [RGUHS Jan 1991]
Short Essays
1. Non-rigid connectors. [NTRUHS Jan 2012 (OR)]
2. Mandibular major connectors. [MUHS I 998, NTRUHS
Mar 2012 (NR)]
3. Mandibular major connectors. [RGUHS Dec 201 I/Jan
2012 (RS2)]
4. Occlusal rest. [RGUHS Dec 201 I/Jan 2012 (RS2), Jul
2008 (OS)]
5. Bar clasp. [RGUHS Dec 201 I/Jan 2012 (OS)]
6. Neutral zone. [NTRUHS Feb 2011; TN Apr 2001]
7. Maxillary major connectors. [RGUHS Dec 2010 (RS)]
8. Function of major connector. [RGUHS Jun/Jul 2010
(RS2)]
9. Lingual bar. [RGUHS Jun/Jul 2010 (RS)]
10. Maxillary major connectors. [NTR-NR Apr 2006, Mar
2005: MUHS 2005, RGUHS Jun/Jul 2010 (OS)]
11. Define rest. Describe the functions and design of oc-
clusal rests. [NTRUHS Aug 2009]
12. Stress breakers. [RGUHS Jul 2008 (RS)]
13. Abutment preparation for removable partial denture.
[RGUHS Jul 2008 (OS)]
14. Define major connector. Enumerate the indications for
use oflinguoplate major connector. [MUHS Nov 2008]
15. Functions of reciprocal arm. [RGUHS Feb 2007 (RS)]
16. Minor connectors. [NTRUHS Oct 2007]
17. Occlusal rest. [NTRUHS Oct 2007]
18. Advantages of lingual plate major connector. [MUHS
Mar 2007]
19. Selection of major connectors in various Kennedy's
classifications of mandibular arch. [MUHS Nov 2007]
20. Write in brief about the different types of mandibular
major connector. [MUHS Oct 2006]
21. Major connector in maxilla. [NTR-NR Apr 2005,
NTR-OR Nov 1995, Nov 1994]
22. Minor connectors. [NTR-NR Mar 2005, NTR-OR Oct
1997, Apr 1995, MUHS 1994, 1998, 2005]
23. What will be the Kennedy's classification for a maxil-
lary arch with both first molars missing? Name the
components of a removal cast partial denture for such
a situation with reason. [MUHS 2005]
24. Define and classify major connectors. Discuss their
indications and contraindications. [GOA Dec 2005]
25. Requirement of major connectors in removable partial
dentures. [RGUHS Aug 2005]
26. U-shaped or horseshoe-shaped major connector.
[NTR-NR Apr 2004]
27. Minor connectors - definition and types. [MUHS Jun
2004]
28. Describe designing a lingual bar with diagrams. Name
two indications of the same. [RGUHS Apr 2003]
29. Define major connectors and mandibular major con-
nectors. [MUHS May 2003]
30. Give the advantages and disadvantages of lingual plate
major connector. [MUHS May 2003]
31. Describe designing a lingual bar with diagrams. Name
two indications of the same. [RGUHS Apr 2003]
32. Define and explain the various types of minor connec-
tors. [RGUHS Sep 2002]
33. Enumerate the major connectors. [MUHS Nov 2002]
34. U-shaped maxillary major connector. [RGUHS Sep
2002]
35. Define major and minor connectors. Describe the dif-
ferent types of major connectors. [GOA 2002]
36. Name the different components of removable partial
denture. Discuss the various maxillary major connec-
tors. [GOA 2002, 2001]
37. Posterior palatal bar. [NTR-NR Oct 2001]
 Quick Review Series for BOS 4th Year: Prosthodontics

38. Lingual bar. [NTR-NR Oct 2001] 15. Compare retentive and reciprocal arm in removable
39. Write the various major connectors used in RPD and partial dentures. [TN Feb 2010]
discuss mandibular major connectors. [MUHS 1999] 16. Gingivally approaching clasp. [TN Aug 2010]
40. Define direct retainers in removable partial prosthesis. 17. Lingual bar. [RGUHS Jun/Jul 2010 (OS)]
Classify and give different designs. [GOA 1999] 18. Indirect retainers. [GOA 2004; TN Aug 2010]
41. Mirror connectors used with denture bases. [MUHS 19. RPI clasp. [TN Feb 2009]
1997] 20. Principles of indirect retention. [TN Feb 2009]
42. Mandibular major connector used with high lingual 21. Selection of mandibular major connector. [TN Aug
frenum. [MUHS 1997] 2009]
43. Different types of minor connectors. [MUHS 1995] 22. Functions of occlusal rest. [TN Aug 2009]
44. Minor connector in partial denture. [NTR-OR May 1994] 23. Advantages of metallic denture bases. [TN Aug 2009]
45. Major connector. [NTR-OR May 1993, Nov 1992; 24. Cingulum rest [NTRUHS Aug 2009]
RGUHS Jul 1991] 25. Part of surveyor. [NTRUHS Aug 2009]
46. Swing-lock partial denture prosthesis. [NTR - NR Oct 26. Advantages of vertical projection clasps [NTRUHS
2001] Aug 2009]
27. Major connectors. [GOA Jul 2006; TN Feb 2009]
28. Role of stress breakers. [RGUHS Jul 2008 (RS2)]
Short Notes
29. Internal occlusal rests. [RGUHS Jul 2008 (RS2)]
1. Precision attachments. [NTRUGHS Aug 2013] 30. Indirect retention. [TN Feb 2007]
2. Bar clasp. [TN Feb 2013] 31. Clasp assembly. [TN Feb 2007]
3. I-bar clasps. [TN Feb 2012] 32. Factors affecting support in distal extension. [TN Feb
4. Canine rest. [RGUHS Dec/Jan 2012 (RS)] 2007]
5. Combination clasp. [NTRUHS Mar 2012 (NR); TN 33. Define path of insertion and path of removal in partial
Aug 2004] denture. [NTRUHS Oct 2007]
6. Ring clasp. [RGUHS Dec 201 I/Jan 2012 (OS)] 34. RPI system. [NTRUHS Oct 2007]
7. Non-rigid connectors. [RGUHS Dec 201 I/Jan 2012 35. Minor connectors. [GOA 2003, 1999, TN Feb 2005,
(RS2)] 2007]
8. Circumferential clasp. [RGUHS Dec 201 I/Jan 2012 36. Aker's clasp. [RGUHS Feb 2007 (OS); TN Feb
(RS2)] 2005]
9. Stress breakers. [RGUHS Dec 201 I /Jan 2012 (RS2); 37. Circumferential clasp. [RGUHS Feb 2007 (RS)]
TN Oct 2003, Feb 2005, Aug 2009] 38. Fulcrum axis and its importance in RPD design. [TN
10. Reciprocal arm. [RGUHS Jun/Jul 201 I (RS2)] Feb 2006]
11. Stress equalizers. [TN Feb 2011] 39. Requirement of a clasp design. [TN Aug 2004]
12. Maxillary major connectors. [NTRUHS Feb 2011] 40. Occlusal rest seat. [GOA 2004; TN Aug 2004]
13. Splints. [NTRUHS Feb 2011] 41. Radicular retainers. [GOA 1999]
14. RPI concept. [NTRUHS Jul 201 I (OR); TN Aug 2004] 42. Internal attachment prosthesis. [GOA 1997]

-------------------<( Topic 4)
Rests and Rest Seats
Long Essays 2. Define occlusal rest and rest seat and describe the
preparation of occlusal rest. [RGUHS Mar 2004]
1. Classify 'Rests' in removable partial denture. Describe
3. Rest seat preparation. [TN Sep 2002]
the function and topography of occlusal rest, illustrating
4. Indirect retainers. [MUHS 2002]
with diagram the occlusal rest seat. [TN Feb 2009]
5. Write the characteristics of occlusal rest seat. [MUHS
1999, 1995]
Short Essays 6. Rests and rest seats. [MUHS 1997]
7. Define occlusal rest and explain the designing of occlu-
1. Occlusal rest. [RGUHS Sep 2004, Mar 2005; TN Sep
2002] sal rest seat.
Section I 111 Previous Years' Question Bank
Short Notes
1. What are the different components of cast partial den-
ture? Give details about the rest and rest seat prepara-
tion. [MUHS 2007]
2. Occlusal rest and rest seat. [MUHS 2006]
3. What are the requirements of an occlusal rest seat
preparation for a premolar? [MUHS 2005]
4. Write the procedure of occlusal rest seat preparation in
enamel. [MUHS 2005]
5. Occlusal rest seat preparation. [RGUHS Sep 2005;
NTR-OR Apr 2002]
6. Rests in RPD. [NTR-NR Oct 2005]
7. Define occlusal rest and rest seat and describe the
preparation of occlusal rest. [RGUHS Mar 2004]
-------------------<( Topic 5)
Direct and Indirect Retainers
Long Essays
1. Define direct retainers. Classify extracoronal direct
retainers. Discuss the application and design of RH
clasp. [MUHS 2008]
2. Define direct retainer. Write the various principles of
designing a clasp. Add a note on the various types of
clasp. [RGUHS Aug 2006]
3. Draw a design for a partially edentulous patient men-
tioning each component. [MUHS 2005]
4. Define direct retainers in removable partial dentures.
Classify them and discuss their indications. [MUHS
2005, 1997]
5. Define direct retainer. Discuss in detail the extracoro-
nal direct retainer. [MUHS 2004]
6. Define direct retainers. Classify them and discuss the
principles of designing them for a successful remov-
able partial denture. [MUHS 2003]
7. Write in detail about the various modifications of cir-
cumferential clasps and add a note on intracoronal di-
rect retainers. [TN Apr 2003]
8. Define a removable partial denture. How do you
choose a direct retainer for a removable partial denture
case? [NTR-NR Oct 2002]
9. Classify extracoronal retainers in removable partial
dentures. Discuss the factors which influence the qual-
ity and efficiency of clasp. [MUHS 2002]
10. Discuss the RPI system and describe the design.
[MUHS 2002, 1995]
8. Define major connector and give its ideal require-
ments. [MUHS 2004]
9. Occlusal rest seat. [RGUHS Mar 1994, May 1986; NTR-
OR May 1992, Nov 1992, Febl990; TN Apr 2004]
10. Give the functions of rest in removable partial den-
tures. [MUHS 2003]
11. Rests and rest seats. [GOA 2002]
12. Occlusal rest. [GOA 2004; TN Nov 2001]
13. Functions of occlusal rest. [NTR-OR Apr 1998]
14. Function of rest in RPD. [MUHS 1997]
15. Occlusal rest - functions, diagnosis, and rest seat
preparation. [NTR-OR Apr 1995]
16. Define occlusal rest and explain the designing of
occlusal rest seat. [BUHS Oct 1991]
17. Rest seat. [RGUHS Aug 1988]
11. Define indirect retainer. Describe the indications and
reasons for the use of indirect retainer and its require-
ments. [NTR-OR Apr 1998]
12. Discuss the indirect retention in removable partial
prosthodontics. [GOA 1998]
13. What is direct retainer? Describe the parts of direct
retainer. What are the requirements of an ideal clasp
design? [NTR-OR Oct 1997]
14. Discuss the factors which determine the choice of di-
rect retainer. [MUHS 1994]
15. What is direct retainer? Describe the parts of a direct
retainer and mention its function [RGUHS Mar 1992;
BUHS Mar 1992]
16. Discuss the role of indirect retainers in a distal exten-
sion partial denture. Name the various types of indirect
retainers and discuss the principles for correct location
of indirect retainers. [MUHS 1991, 1990]
17. What are the internal attachments in removable partial
dentures? [RGUHS Jun 1989]
18. Define retainer, connector, and stress breakers. Describe
in brief the various types of maxillary direct retainers
used in removable prosthodontics. [RGUHS Aug 1988]
19. Classify 'rests' in removable partial denture. Describe
the function and topography of occlusal rest, illustrat-
ing with diagram the occlusal rest seat. [TN Feb 2009]
20. Classify direct retainers in removable partial denture.
Explain the different occlusally approaching clasps.
[RGUHS Jun/Jul 2011 (OS)]
 Quick Review Series for BOS 4th Year: Prosthodontics

21. Define direct retainer. Write the various principles of Short Notes
designing a clasp. [TN Aug 2010]
1. Direct retainers. [GOA Dec 2005, NTRUHS Jul 2011
22. Define a clasp. Describe the parts of clasps. Illustrate
(OR); TN Sep 2002]
with diagram about the various configurations of clasps
2. Reciprocation. [NTRUHS Feb 2010]
and their relevance to survey lines. [TN Feb 2006]
3. Porosities in casting. [RGUHS Dec 2010 (OS)]
23. Write the components of cast partial denture and write
4. Roach clasp. [RGUHS Dec 2010 (OS)]
in detail about direct retainers.
5. Reciprocal arm. [RGUHS Jun/Jul 2010 (OS)]
24. Define a clasp. Describe the parts of clasps. Illustrate
6. Enumerate the factors influencing effectiveness of in-
with diagram about the various configurations of clasps
direct retainers. [MUHS 2008]
and their relevance to survey lines.
7. Reciprocation. [NTRUHS Mar 2008]
8. Guiding planes. [NTRUHS Mar 2008]
Short Essays 9. Indirect retention. Add a note on deciding the location
1. RPI concept. [NTRUGHS Jul 2014] of the same. [MUHS 2007]
2. Indirect retainer. [NTR-ORApr 1997, Nov 1995, 1994, 10. Ring clasp. [NTRUHS Oct 2007]
1992, May 1993; MUHS 2003, NTRUHS Jan 2012 11. What is indirect retainer? And what are the different
(OR), Feb 2010] forms of indirect retainer? [MUHS 2006]
3. Radicular retainer. [RGUHS Dec 2011/Jan 2012 12. Indirect retainers. [RGUHS Sep 2004, Mar 2005, Sep
(RS2)] 2002, 1992, Jan 1991]
4. Circumferential clasp. [RGUHS Dec 2010 (RS)] 13. Extracoronal retainers. [RGUHS Mar 2005, Sep
5. Indirect retainers in RPD. [RGUHS Jun/Jul 2010 2004]
(RS2)] 14. Aker's clasps with diagram. [TN Apr 2004]
6. Bar clasp. [RGUHS Jun/Jul 2010 (RS2)] 15. Parts of clasp. [RGUHS Mar 2004]
7. Retentive and reciprocal arms. [RGUHS Jun/Jul 2010 16. Indications of embrasure clasp. [NTR-NR Apr
(RS2)] 2004]
8. Compare between direct and indirect retention in re- 17. Precession attachment. [RGUHS Mar 2004]
movable partial dentures. [RGUHS Mar 2006] 18. Requirements of extracoronal direct retainers. [MUHS
9. Gingivally approaching clasp. [RGUHS Aug 2005; 2004]
NTR-NR Apr 2001] 19. Infrabulge. [RGUHS Mar 2004]
10. What are direct retainers? Discuss the different types 20. Parts of clasp. [RGUHS Mar 2004]
of direct retainers in removable partial prosthesis. 21. Types of bar clasps. [TN Apr 2004]
[GOA 2004] 22. Indirect retainers. [GOA 2004]
11. Direct and indirect retention. [NTR-NR Apr 2003] 23. Ring clasp. [NTR-NR Apr 2003]
12. Direct retainers in RPD. [NTR-NR Apr 2003; NTR- 24. Classify extracoronal direct retainers by giving exam-
OR Apr 1998] ples. [MUHS 2003]
13. Aker's clasp. [NTR-NR Apr 2002] 25. Circumferential clasp. [GOA 2003]
14. Define direct retainers. Discuss in detail an ideal cir- 26. Clasp assembly. [NTR-NR Apr 2002; TN Apr 2003]
cumferential clasp direct retainer. [GOA 2002] 27. Half and half claps. [NTR-NR Oct 2002]
15. Define direct retainers. Enumerate and discuss the dif- 28. Occlusally approaching clasps. [TN Apr 2001]
ferent types of direct retainers in removable partial 29. Radicular retainers. [GOA 1999]
denture prosthesis. [GOA Oct/Nov 2000] 30. Functions of indirect retainer. [MUHS 1998]
16. Ring clasp. [NTR-OR Apr 1999] 31. Clasp units. [GOA 1998]
17. Define direct retainers in removable partial prosthesis. 32. Gingivally approaching clasp. [RGUHS Mar 1995]
Classify and give the different designs. [GOA 1999] 33. Bar clasp. [RGUHS Aug 1993, Feb 1990]
18. Combination clasp. [NTR-OR Oct 1998, Nov1994] 34. Intracoronal retainers. [BUHS Feb 1990; RGUHS Feb
19. Classification of clasp. [NTR-OR Nov1998] 1990]
20. Direct retainers (clasp). [NTR-ORApr 1996, Nov 1992] 35. RPI clasp. [RGUHS Aug 1993, Feb 1989]
21. Factors governing the clasp design. [NTR-OR Oct 1995] 36. Combination clasp. [RGUHS Jun 1989]
22. Requirements of clasp design. [MUHS 1995] 37. RPI clasp. [BUHS Feb 1989]
Section I 111 Previous Years' Question Bank

------------------ - <( Topic 6)

Denture Base Considerations
Long Essays Short Notes
1. Discuss how you will minimize the stress on abutment in 1. Denture bases for cast RPD. [TN Apr 2003]
case of distal extension partial denture. [MUHS 1990] 2. What is the concept of stress breakers? Write the differ-
ent types of stress breakers. [MUHS 2002]
Short Essays
1. Stress breakers. [MUHS 1994, NTRUHS Jan 2012
(OR), Jul 2014]

------------------ - <( Topic 7)

Principles of RPD Design
Long Essays 2. Stress breakers. [NTR-ORApr 1997, Nov1994; RGUHS
Mar 1994, Sep 1994, RGUHS Jul 2008 (RS2)]
1. Describe the principles involved in RPD designing.
3. Problems encountered in distal extension partial den-
[NTRUHS Jan 2012 (OR)]
ture. [NTR-NR Apr 2002]
2. Discuss the various components of removable partial
4. Stress breaking principle. [NTR-NR Oct 2001]
denture designed for Kennedy's class II situation.
5. Disadvantages of stress breakers. [NTR-OR Oct 1998]
[NTR-NR Apr 2002]
6. Stress breakers in partial denture. [NTR-OR May 1994]
3. Enumerate the components of removable partial den-
7. Denture base. [RGUHS Feb 1990]
ture. Discuss the principles of partial denture design.
[NTR-OR May 1993, Nov 1992]
4. Discuss the principles in removable partial denture de- Short Notes
sign. [RGUHS Mar 1992, BUHS Mar 1992] 1. Stress breakers. [NTR-NR Oct 2002, GOA 2004]
2. Precision attachment. [RGUHS Mar 2004]
Short Essays 3. Fulcrum line. [NTR-NR Apr 2003]

1. Factors influencing design of RPD. [RGUHS Dec 2010

(RS)]

------------------ - <( Topic 8)

Surveying and Preparation of Mouth for RPD

Long Essays 3. Define dental cast surveyor. Enumerate the functions.

Describe the surveying procedure. [RGUHS Jun/Jul
1. Discuss the role of surveyor in removable partial den-
2010 (RS2)]
ture treatment. [NTRUHS Mar 2012 (NR)]
4. What is a surveyor? Mention its uses and describe step
2. Describe in detail the denture surveyor. [RGUHS Dec
by step procedure of surveying a diagnostic cast. [TN
2011/Jan 2012 (OS)]
Aug 2009]

5. Define a surveyor. What is the purpose of surveying and
explain in detail about the step by step procedure in sur-
veying diagnostic and master cast? [RGUHS Aug 2006]
6. Define a surveyor. Mention its parts. Explain in detail step
by step procedure in surveying. [NTR-NR Oct 2004]
7. Define a surveyor. Describe the parts of a surveyor and
the importance of surveying. [GOA 2004]
8. Write in brief the importance of dental cast surveyor in
designing biologically acceptable removable partial
denture. [TN Aug 2004]
9. Mouth preparation in removable partial dentures.
[MUHS 2002, 1994]
10. Define path of insertion and path of removal in a re-
movable cast partial denture. Discuss the factors af-
fecting the same and the role played by the surveyor.
[TN Nov 2001]
11. Describe a dental cast surveyor. Describe the factors
responsible for the path of insertion of a removable
partial denture. [NTR-OR Nov 1999]
12. Selection of teeth for distal extension partial dentures.
[MUHS 1995]
13. Anterior teeth replacement in removable partial den-
ture. [MUHS 1995]
14. Define removable partial denture prosthesis. Describe
in detail mouth preparation for removable partial den-
ture. [RGUHS Aug 1993; BUHS Aug 1993]
15. Describe a dental cast surveyor. Describe the factors
responsible for the path of insertion of a removable
partial denture. [NTR-OR May 1992]
16. Discuss how you will minimize the stress on abutment in
case of distal extension partial denture. [MUHS 1990]
17. Describe in brief the various types of mouth prepara-
tion procedures undertaken in case of removable par-
tial denture service. [RGUHS Feb 1989]
Short Essays
1. Survey line. [RGUHS Dec/Jan 2012 (RS)]
2. Survey lines. [RGUHS May 1986, NTRUHS Jan 2012
(OR)]
3. Define surveyor. What are the objectives of surveying?
[NTRUHS Feb 2010]
4. Uses of surveyor. [RGUHS Jun/Jul 2010 (RS)]
5. Undercut gauge. [RGUHS Jun/Jul 2010 (RS)]
6. Guiding plane. [RGUHS Jun/Jul 2010 (RS)]
7. Surveyor. [RGUHS Jun/Jul 2010 (OS)]
8. Axioproximal grooves. [RGUHS Jul 2008(RS)]
9. Factors influencing design of removable partial
denture. [RGUHS Jul 2008 (RS)]
10. Define dental surveyor. Discuss the factors affecting
path of insertion and removal. [GOA Jul 2006]
11. Dental model surveyor. [NTR-NR Apr 2006]
12. Surveying line. [NTR-NR, Oct 2005, Apr 2002, Oct 200 I]
13. Surveying tools. [RGUHS Aug 2005; NTR-NR Apr 2001]
Quick Review Series for BOS 4 th Year: Prosthodontics
14. Preparation of mouth for impressions. [RGUHS Mar
2005, Sep 2004]
15. Infrabulge. [RGUHS Mar 2004]
16. Define surveyor. Give the classification and discuss the
uses of an articulator. [GOA 2004]
17. Discuss the importance of surveying and the various steps
in removable partial denture fabrication. [GOA 2003]
18. Refractory cast for removable partial denture. [TN Oct
2003]
19. List the types of surveyors and explain the various uses
of surveyors. [RGUHS Apr 2003]
20. Surveyor. [NTR-NR Apr 2003, 2002, NTR-OR Feb
1990]
21. Survey lines. [GOA 2001]
22. Dental cast surveyor. [RGUHS Feb 1993, Jan 1987;
TN Apr 2001]
23. Surveying. [NTR-OR Apr 2000]
24. Mouth preparation in RPD. [NTR-ORApr 2000, 1997]
25. Define surveying. Describe dental surveyor and its
uses in designing of a removable partial prosthodon-
tics. [GOA 1999]
26. Write a note on surveying. [GOA 1998]
27. Dental cast surveyor. [NTR-OR Apr 1996, 1995]
28. Dental surveyor. [NTR-OR Apr 1995, Feb 1990]
29. Stress breakers. [MUHS 1994]
30. Guide planes. [RGUHS Jul 1991]
Short Notes
1. Factors influencing the path of insertion on removable
prosthesis. [TN Feb 2011]
2. Surveying tools. [RGUHS Jun/Jul 201 I (OS)]
3. Provisional restoration. [NTRUHS Jul 201 I (OR)]
4. Uses of surveyors. [RGUHS Dec 2010 (OS); NTR-NR
Apr 2004]
5. Surveyors [RGUHS Feb 2007 (OS); TN Oct 2003]
6. Undercut gauges and their application in surveying.
[TN Feb 2006]
7. Height of contour. [RGUHS Aug 2006]
8. Tripoding. [NTR-NR Apr 2003; TN Oct, Apr 2003,
Feb 2005]
9. Dental surveyor. [GOA 1998; TN Aug 2004]
10. Remounting procedure. [TN Aug 2004]
11. Surveyor and its uses. [TN Apr 2004]
12. Surveyor - draw the diagram and label the parts. [TN
Apr 2004]
13. Tripoding the cast. [RGUHS Mar 2004]
14. What is the concept of stress breakers? Write the
different types of stress breakers. [MUHS 2002]
15. Factors determining path of insertion of removable
partial denture. [GOA 2002]
16. Survey lines. [GOA 2002; TN Nov 2001]
17. Factors affecting path of placement. [GOA Oct/Nov
2000]
Section I 111 Previous Years' Question Bank
------------------ 1( Topic
Impression Materials and Procedures for RPD
Long Essays
1. What is functional impression in removable partial den-
ture? How will you obtain such an impression? [RGUHS
Sep 1994, BUHS Sep 1994]
Short Essays
1. Impression techniques in removable partial dentures.
[RGUHS Dec/Jan 2012 (RS)]
2. Impression procedures in removable partial denture.
[RGUHS Mar 2004, Jun/Jul 2011 (RS2), Dec 2011/Jan
2012 (RS2)]
3. Surgical obturators. [RGUHS Jun/Jul 2011 (RS2)]
4. Functional form of impression in removable partial
denture. [RGUHS Jun/Jul 2010 (RS)]
-------------------<(Topic 1 o)
Support for the Distal Extension Denture Base, Occlusal
Relationship for RPD, Laboratory Procedures and Work
Authorization for RPD
Long Essays
1. Methods of establishing occlusal relationships in RPD.
[RGUHS Aug 2006]
2. Working model. [MUHS 2005, 2002]
3. Discuss the need for special impression procedures in
removable partial dentures and describe the various
methods in detail. [MUHS 2004]
4. Discuss stress optimization in bilateral long-span exten-
sion partial denture. [MUHS 2003]
5. State how indirect retainer helps in distal extension base
partial denture. Explain the effective method of record-
ing impression for the same. [MUHS 2002]
6. Explain altered cast technique. [MUHS 2000]
7. Dentures base material in RPD. [MUHS 1997]
Short Essays
1. Factors influencing the support of the distal extension
base. [RGUHS Dec 2011/Jan 2012 (OS)]
9)
5. Enumerate the methods of making a functional impres-
sion for removable partial dentures. What is the signifi-
cance of such functional impressions? [MUHS 2008]
Short Notes
1. Altered cast technique. [RGUHS Dec 2011/Jan 2012
(RS2); TN Sep 2002, Feb 2005]
2. Altered impression technique. [NTRUHS Jul 2011
(OR)]
3. Physiological impression in RPD. [NTR-NR Apr 2005]
4. Impression in distal extension partial denture. [TN Nov
2001]
5. Impression procedure for distal extension PD. [NTR-
OR Oct 1998]
2. Functional impressions for distal extension partial
dentures. [MUHS 1995, NTRUHS Feb 2011]
3. Distal extension denture base in removable partial
denture construction. [RGUHS Feb 2007 (RS)]
Short Notes
1. Lingualized occlusion. [TN Feb 2013]
2. Ring clasp. [NTRUHS Feb 2011]
3. Distal extension denture base in removable partial
denture construction. [TN Aug 2009]
4. Support for the removable partial denture. [RGUHS Jul
2008 (RS2)]
5. Define stress breaker (stress equalizer) and discuss in short
its role in distal extension partial denture. [MUHS 2007]
6. Methods of special impression procedure in removable
partial denture which is already in use with drawbacks.
[MUHS 2004]
7. Occlusal registration in removable partial denture.
[TN Aug 2004]
 Quick Review Series for BOS 4th Year: Prosthodontics

--------------------<(Topic 11)

Correction of RPDs, Repairs and Additions to RPD,

Relining and Rebasing the RPD and Miscellaneous
Long Essays 8. Soldering and its applications and procedures. [NTR-OR
Apr 1997]
1. Discuss why are dentures necessary for a serni-edentulous
9. Guide planes. [NTR-OR Apr 1997]
and completely edentulous patients. [BUHS Jan 1991]
10. Key and keyway attachment. [NTR-OR Apr 1996]
11. Path of insertion. [NTR-OR Oct 1995]
Short Essays
1. Kelly's combination syndrome. [NTR-NR Apr 2005] Short Notes
2. Block out procedure in cast partial denture. [NTR-NR
1. Combination syndrome. [TN Feb 2012]
Oct 2002]
2. Guiding planes in RPD. [RGUHS Aug 2006]
3. Path of insertion of removable partial dentures. [NTR-
3. Pressure indicating paste. [RGUHS Mar 2006]
OR Apr 1999, 1997]
4. Tensofriction. [NTR-NR Oct 2004]
4. Splints. [NTR-OR Apr 1999]
5. Refractory cast. [NTR-NR Apr 2004]
5. Surgical splints. [NTR-OR Apr 1998]
6. Reciprocation in RPD. [NTR-NR Oct 2004]
6. Pain control in tooth preparation for retained prosthesis.
7. Enameloplasty in RPD. [NTR-NR Oct 2004]
[NTR-OR Oct 1998]
7. Soldering and its implications and procedures. [NTR-
OR Oct 1998]