Section 28 - Edentulous Histology & Tissue Conditioning

Handout Abstracts 001. Lytle, . !. T"e #anage#ent o$ abused oral tissues in co#%lete denture construction. & 'rost"et (ent )*2)-+2, 1,-). 002. C"ase, .. .. Tissue conditioning utili/ing dyna#ic ada%tic stress. & 'rost"et (ent 11*80+81-, 1,01. 001. 2a%ur, 2. and S"3lar, 4. T"e e$$ect o$ co#%lete dentures on al5eolar #ucosa. & 'rost"et (ent 11*1010-101), 1,01. 00+. 2a6ano, 7. et al. T"e in$luence o$ so$t lining #aterials on %ressure distribution. & 'rost"et (ent 1+* 2-+, 1,)-. 00-. .atson, 8. !. and 9ac(onald, (. 4. egional 5ariations in t"e %alatal #ucosa o$ t"e edentulous #out". & 'rost"et (ent -0*8-1-8-,, 1,81. 000. Ettinger, . L. T"e etiology o$ in$la##atory %a%illary "y%er%lasia. & 'rost"et (ent 1+*2-+, 1,)-. 00). Tautin, 7. S. S"ould dentures be 6orn continuously: & 'rost"et (ent1,*1)2, 1,)8. 008. (u3es, !. S. An e5aluation o$ so$t-tissue res%onse $ollo6ing re#o5al o$ ill- $itting dentures. & 'rost"et (ent +1*2-1-2-1, 1,80. 00,. Lytle, . !. Co#%lete denture construction based on a study o$ t"e de$or#ation o$ t"e underlying so$t tissues. & 'rost"et (ent ,*-1,---1, 1,-,. 010. Lytle, . !. So$t tissue dis%lace#ent beneat" re#o5able %artial and co#%lete dentures. & 'rost"et (ent12*1+-+1, 1,02. 010a. !ouc"er, C. ;. (iscussion. 12*++-+0, 1,02. 011. 2elly, E. C"anges caused by a #andibular re#o5able %artial denture o%%osing a #a<illary co#%lete denture. & 'rost"et (ent 2)*1+0-1-0, 1,)2. 012. C"a#berlain, !. !., !ernier, S. H., !loe#, T. &. and a//og, 9. E. (enture %la=ue control and in$la##ation in t"e edentulous %atient. & 'rost"et (ent -+*)8, 1,8-. 011. 2ra>ice3, (. (., (ooner, &. and 'orter, 2. ;bser5ations on t"e "u#an edentulous ridge. a. 'art 8. 9ucosal e%it"eliu#. & 'rost"et (ent -2*-20, 1,8+. b. 'art 88. Connecti5e tissue. & 'rost"et (ent-2*082, 1,8+.

01+. (es>ardins, . '. Etiology and #anage#ent o$ "y%er#obile #ucosa o5erlying t"e residual al5eolar ridge. & 'rost"et (ent 12*01,-018, 1,)+. 01-. Le7eb5re, C.A., Sc"uster, 4.S., Caug"#an, 4.!. and Caug"#an, ..7. E$$ects o$ denture base resins on oral e%it"elial cells. 8nt & 'rost"odont +*1)1-1)0, 1,,1. Section 28: Edentulous Histology/Tissue Conditioning (Handout) Handout not a5ailable at t"is ti#e ............. - Abstracts 28-00 ! "ytle# $!%! T&e 'anage'ent o( abused oral tissues in co')lete denture construction! * +rost&et ,ent -: 2--.2# /0-! 'ur%ose* 8t is e<tre#ely i#%ortant t"at t"e so$t tissues t"at "a5e been abused and de$or#ed by ill-$itting dentures be allo6ed to reco5er and return as closely as %ossible to nor#al $or# be$ore i#%ressions $or ne6 dentures are #ade. To stress t"e i#%ortance $or t"e need $or abused tissues to reco5er %rior to i#%ressions and #easures to ta3e $or t"at to "a%%en. (iagnosis* T"e %rost"odontist s"ould be a6are o$ t"e necessary ste%s to i#%ro5e tissue "ealt" in order to %reser5e underlying structures t"at su%%ort t"e dentures. 8ll-$itting dentures #ay alter t"e c"aracter, condition, and $or# o$ t"e underlying so$t tissues. Syste#ic $actors #ay %lay a role in abused underlying tissues. Age %lays a role in so$t tissue reco5ery. ?oung %atients "a5e a better tissue reco5ery t"an older %atients, and t"eir ridges s"o6 #ore de$or#ation because o$ "ig"er tone o$ t"eir #uscles o$ #astication. Cross sections o$ casts be$ore and a$ter tissue reco5ery can s"o6 #agnitude and c"ange in tissue contours. A C;9'A AT; is used to s"o6 t"ese tissue c"anges. Ce%"alo#etric radiogra%"s 6it" dentures in %lace and #ar3ers in t"e #olar and bicus%id regions #a3e t"ese contour tissue c"anges #ore e<act to #easure. Loss o$ retention, loss o$ stability, and occlusal relations"i% c"anges can be cause o$ ill-$itting dentures and t"ese discre%ancies can be "idden because o$ t"e ability o$ so$t tissues to acco##odate. (e$or#ed tissues s"ould not be i#%ressed unless t"ey are allo6ed to reco5er. Si#ilarly, >a6 relation records 6ill be inaccurate i$ #ade on abused tissues and stable record bases 6ill be di$$icult. (entures 6"ic" "a5e been constructed on abused tissues i#%inge on t"e $ree-6ay s%ace. eco##endation $or lea5ing dentures out %rior to i#%ressions $or +8-)2 "rs is #ade, and discouraging t"e dentist $ro# ta3ing t"e dentures a6ay $ro# t"e %atient in order to a5oid inaccurate i#%ressions. Treat#ent %lans to correct abused tissues s"ould include*

correction o$ syste#ic %roble#s

correction o$ occlusion or ot"er de$ects causing instability relie$ o$ %ressure area in denture %lacing a liner to i#%ro5e unstable dentures and condition tissues so$t diet to eli#inate e<cessi5e %ressure on tissues #assaging tissues to sti#ulate ridges +8-)2 "rs lea5ing dentures out o$ #out" %rior to i#%ressions

(iscussion* A c"ange o$ 0.0-- inc" 6as obser5ed in a %atient 6it" abused tissues 6"ereas only 0.010 inc" c"ange 6as e5ident 6it" ne6 dentures. @o c"anges in t"e la#inagra%"ic studies 6as seen. Conclusion* 7ro# t"e ti#e o$ diagnosis to denture deli5ery t"e so$t tissue "ealt" is 5ery i#%ortant $or success$ul dentures. 28-002! C&ase# 1ilson 1! Tissue conditioning utili2ing dyna'ic ada)ti3e stress! * +rost&et ,ent : 80.-8 0# /4 ! 'ur%ose* Study t"e conce%t called dyna#ic ada%ti5e stress. (iscussion* 1. T"e $irst tec"nical ste% to #a3e t"e %atient co#$ortable is an ad>ust#ent o$ t"e occlusion and %lace#ent o$ t"e conditioning #aterial in t"e dentures. 2. ;cclusion is t"e #ost i#%ortant $actor in denture $abrication. 1. T"e continuous and si#ultaneous s"a%ing o$ t"e denture basal seat and t"e i#%ression sur$ace o$ t"e denture under t"e $orce and #otion a%%lied to dentures is a "el%$ul ad>unct to t"e $abrication o$ #ore co#$ortable dentures. +. (yna#ic ada%ti5e stress is not a cure-all $or denture di$$iculties, neit"er 6ill it co#%ensate $or careless and inade=uate tec"ni=ues. 'ro%er "andling o$ t"e treat#ent #aterial s"ortens t"e %eriod o$ conditioning, and better i#%ressions are %roduced. -. 'ro%ortions o$ 1 A %arts o$ %o6der to 1 %art li=uid is best. 8$ t"e denture is %laced in t"e #out" too soon, #ost o$ t"e #aterial 6ill be s=uee/ed out. Ta%%ing t"e teet" toget"er too "ea5ily or too great a 5ertical o%ening 6ill lead to t"e sa#e result. 0. T"e necessity $or ad>ust#ents o$ dentures 6orn a$ter treat#ent 6as caused, in decreasing order, by t"e i#%ression, t"e occlusion, and curing , in a ratio o$ about +*+*1. ). T"ere 6as little di$$erence in t"e conditioning and i#%ression results obtained by t"e di$$erent #et"ods 6it" one e<ce%tion. ."en ne6 dentures 6ere #ade $ro# t"e dyna#ic i#%ression %roduced 6it" t"e denture base $itted 6it" occlusion ri#s, t"e nu#ber o$ indi5idual denture ad>ust#ents 6as 20B abo5e t"e a5erage. T"is #ay indicate t"at su%erior i#%ressions are %roduced by t"e $orce and #otion deli5ered to t"e su%%orting tissues by t"e occlusion o$ teet". !ot" t"e #ucosal conditioning and t"e i#%ressions are i#%ro5ed i$ t"ey are acco#%lis"ed in dentures 6it" a coordinated occlusion. 8. (entures #ade $ro# i#%ressions $or#ed in old dentures re=uired slig"tly less ad>ust#ents t"an t"ose #ade $ro# i#%ressions #ade in ne6 denture bases 6it" occlusion ri#s. T"is see#s to indicate t"at occlusion o$ t"e teet" is necessary to con$or# t"e i#%ression to t"e tissue sur$ace in $unction. Conclusion*

1. (yna#ic ada%ti5e stress %ro#otes a condition and a contour o$ t"e denture-base #ucosa t"at are co#%atible 6it" denture $unction. 2. A non-setting #aterial 6"ic" $lo6s, yet is resistant, is necessary to utili/e dyna#ic 1. ada%ti5e stress. +. E<cellence is ac"ie5ed in denture $abrication i$ certain $actors are %er$or#ed 6it" care, li3e* recording >a6 relations"i%s, t"e curing %rocess, and t"e coordination o$ t"e occlusion. -. (enture ad>ust#ents $or di$$icult %atients, 6ere reduced by t"e use o$ dyna#ic treat#ent. 0. T"e treat#ent #aterial %er$or#s its $unction best i$ it is co#%letely re%laced about e5ery t"ird day. ). T"e tissue-conditioning treat#ent is an ad>unct o$ denture construction 6it" "ig" %otential $or %ro#oting denture co#$ort. 28-005! 6a)ur# 6! and S&7lar# 8! T&e e((ect o( co')lete dentures on al3eolar 'ucosa! * +rost&et ,ent 5: 050- 05-# /45! 'ur%ose* To in5estigate t"e c"anges occurring in denture-bearing #ucosa a$ter t"e use o$ re#o5able dentures. A bio%sy study 6as conducted on t"e indi5idual %atients %rior to and a$ter t"e use o$ dentures. 9aterialsC9et"ods* T"is study in5ol5ed nine sub>ects Dages 10-+,E, eac" 6it" only si< anterior teet" re#aining in t"e #a<illary arc" and a $ull or %artial co#%le#ent o$ teet" in t"e #andibular arc". T"ese sub>ects 6ere sc"eduled $or an 8C( on t"e #a<illary arc" and %ossible D6it" or 6it"outE '( on t"e #andibular arc". @one o$ t"ese %atients "ad %re5iously used re#o5able %rost"eses on t"e #a<illary arc". ;ne side o$ t"e edentulous ridge and gingi5a around t"ree anterior teet" 6ere sti#ulated 6it" a %o6er dri5en toot"brus", on 6ee3days < + 6ee3s Ddi5ided in sections $or 1- seconds eac" dayE. T"e ot"er side 6as used as a control. At t"e ti#e o$ 8C( insertion, bio%sies 6ere ta3en $ro# bot" areas. T6el5e 6ee3s a$ter insertion o$ 8C(, bio%sies 6ere again ta3en $ro# bot" sides on t"e dental arc". esultsCConclusions*

Alveolar Mucosa Prior to Denture Insertion - t"e 'ucosa sti'ulated 9it& t&e electric toot&brus& s&o9ed generali2ed increased 9idt& o( t&e stratu' corneu' as co')ared to unsti'ulated 'ucosa. Al5eolar 9ucosa 7ollo6ing .earing o$ (entures $or T"ree 9ont"s - ;5erall, bot& sides o( t&e 'ucosa s&o9ed an increased a'ount o( 7eratini2ation o( t&e stratu' corneu' T"is initial study suggests t"at 9ell-ada)ted dentures sti'ulate rat&er t&an irritate t&e underlying 'ucosa!

28-00.! 6a9ano# :!# et al! T&e in(luence o( so(t lining 'aterials on )ressure distribution! * +rost&et ,ent 40:04---0# // !

'ur%ose* To e<a#ine cree% be"a5ior and cus"ioning e$$ect o$ so$t liners 6"en used as tissue conditioners. 9aterials and 9et"ods* Si< #aterials, Hydro-cast, Fiscogel, So$tone, 78TT, So$t-liner, and Coeco#$ort, 6ere used in t"e study. T"ey 6ere #i<ed and %laced bet6een glass %lates 6it" 6ires o$ 1, 2, and 1## ser5ing as s%acers to yield di$$erent t"ic3nessG o$ s%eci#ens. T"e indi5idual sa#%les 6ere loaded. A load transducer #easured t"e stress and a %ressure transducer #easured t"e %ressure distribution in $our areas. esults* T"e results are c"arted in $i5e tables in t"e article. T"e instantaneous elasticity, delayed elasticity, and 5iscosity $or eac" #aterial is c"arted, as is t"e %ressure distribution and %ressure #easure#ent. T"e results s"o6 t"at so$t lining #aterials can distribute $unctional stress uni$or#ly on t"e su%%orting tissue and act as a s"oc3 absorber $or $unctional $orces. T"e 5ariations bet6een t"e #aterials decreased as t"e t"ic3ness increased to 1##. Conclusion* T"e e$$ect o$ t"e %ro%erties and t"ic3nessG o$ so$t lining #aterials on t"e %ressure distribution on t"e su%%orting tissue under t"e denture 6ere obser5ed. T"e results suggest so$t lining #aterials act to distribute $unctional stress uni$or#ly 6"en t"ey are %laced 6it" a 1## t"ic3ness. 8$ a 1## t"ic3ness is not used t"e #aterial s"ould be re%laced in a $e6 days. 28-000! 1atson# ;an %! and <acdonald# 8ordon ,! $egional 3ariations in t&e )alatal 'ucosa o( t&e edentulous 'out&! * +rost&et ,ent 00: 805-80/# /85! 'ur%ose* E<a#ine and =uanti$y regional 5ariations in edentulous %alatal e%it"eliu# and related connecti5e tissue. (i$$erences in %alatal #ucosa bet6een #en and 6o#en, and t"e e$$ect o$ aging on oral #ucosa 6as also e<a#ined. (iscussion* 1. E%it"eliu# 6as t"ic3est and rete ridges longest at t"e crest o$ t"e ridges. T"ere are t"ree %ossible reasons $or t"is* a. $ollo6ing t"e e<traction o$ teet", t"e crest 6as co5ered by e%it"eliu# gro6ing in $ro# bot" sides, and t"e $usion o$ t"e e%it"eliu# #ig"t "a5e %roduced a region o$ t"ic3er e%it"eliu# 6it" longer rete ridges, b. t"e cre5icular e%it"eliu# $ro# one side o$ t"e soc3et #ig"t "a5e $used 6it" t"e cre5icular e%it"eliu# $ro# t"e ot"er side at a dee%er le5el, c. or , t"at t"e #idline is $or#ed e#bryologically by t"e $usion o$ t6o s"el5es, and t"e >oining o$ t"e t6o se%arate e%it"elial /ones #ig"t "a5e %roduced a region o$ t"ic3er e%it"eliu# 6it" longer rete ridges. 2. T"e t"ic3ness o$ %alatal #ucosa 6as greater in edentulous %atients t"an in dentate %atients. 1. T"e e%it"eliu# 6as t"ic3est at t"e crest o$ t"e ridge and t"innest at t"e %ara#edian sites. +. T"e rete ridges 6ere longest at t"e crest o$ t"e residual ridge. -. T"e e%it"elial #or%"ology 6as directly related to e%it"elial t"ic3ness. 0. T"e connecti5e tissue t"ic3ness 6as greater in t"e region "al$6ay bet6een t"e crest o$ t"e residual ridge and t"e #idline o$ t"e %alate. ). Age and se< "ad no e$$ect on t"e %ara#eters, e<ce%t t"at t"e e%it"elial t"ic3ness 6as greater in #ale cada5ers.

28-004! Ettinger# $!"! T&e etiology o( in(la''atory )a)illary &y)er)lasia! * +rost&et ,ent 5.:20.-240# /-0! 'ur%ose* To describe t"e incidence o$ %a%illary "y%er%lasia and e5aluate a nu#ber o$ %ossible etiologic $actors. 9aterials and 9et"ods* )00 edentulous %atients 6ere studied. 280 #en and +1+ 6o#en 6it" an a5erage age o$ 01.,. T"e %atients 6ere %redo#inantly $ro# t"e lo6er socioecono#ic grou%s. T"e $ollo6ing 6ere e5aluated* Stability, occlusion, e<ostosis, relie$ in denture, day and nig"t 6earing, denture sto#atitis, and angular c"elitis. esults* T"e incidence 6as 11.,B T"e incidence 6as slig"tly "ig"er in #en t"an 6o#en and in younger t"an older %atients. T"e "ig"est %art o$ t"e %alatal 5ault 6as t"e #ost co##on site o$ t"e "y%er%lasia. All but one %atient 6ere %ain $ree. T"e condition 6as treated 6it" 9ycostatin and t"e dentures 6ere re#o5ed $ro# t"e #out" 6"en t"e %atient sle%t. T"is eli#inated t"e s#aller lesions, but t"e larger lesions "ad to be surgically re#o5ed. 8n e5ery %atient 6it" in$la##atory "y%er%lasia it 6as %ossible to relate t"e lesion to a relie$ or s%acer in t"e #a<illary denture. T"e condition #ost $re=uently %resents in t"e 1rd to -t" decade o$ li$e. Conclusion* T"e results de#onstrated a #ulti$actorial nature o$ t"e etiology o$ in$la##atory "y%er%lasia. T"e e5idence suggested t"e lesion occurs a$ter t"e #ucosa "as been aggra5ated by local trau#a but not 6"y t"e lesion 6ill occur in so#e but not all %atients. So#e suggestions to a5oid in$la##atory "y%er%lasia include* re#o5e t"e dentures at nig"t, clean t"e dentures regularly, #assage t"e tissue, and 5isit t"e dentist regularly $or #aintenance 5isits. T"e dentist s"ould a5oid %lacing arbitrary relie$, educate t"e %atients, and treat lesions 6"en t"ey are encountered. 28-00-! Tautin# :!S! S&ould dentures be 9orn continuously= * +rost&et ,ent 5/: 5-2# /-8! 'ur%ose* to eli#inate so#e o$ t"e doubts t"at e<ist, and to encourage all dentists to include s%eci$ic in$or#ation regarding continuous denture 6earing in t"eir %atient education %rogra#s. (iscussion* 8n 1,0) t"e Acade#y o$ (enture 'rost"etics too3 t"e stand t"at, in general, co#%lete dentures s"ould be re#o5ed 6"en t"e %atient goes to slee% at nig"t. Se5eral researc"ers "a5e $ound t"at t"ere are so#e interesting correlations 6it" )alatal )a)illary &y)er)lasia and t"e continuous 6ear o$ dentures. Anot"er correlation 6it" continuous denture 6earing is bone resor)tion. !ot" o$ t"e abo5e e$$ects #ay be due to t"e constant %ressure on t"e so$t tissues 6"ic" is t"en trans#itted to bone. Letters 6ere sent to all accredited dental sc"ools in t"e H. S. re=uesting oral and 6ritten %ostinsertion instructions t"at are gi5en to C( %atients, and res%onses 6ere recei5ed $ro# 2) institutions. ;$ t"ese res%onses, 1- o$ 2) stated t"at dentures s"ould be re#o5ed at nig"t, or $or 0-8 "ours daily. T"e re#aining 12 sc"ools, le$t it u% to t"e %atient, or $elt t"at it #ade no di$$erence 6"et"er or not t"e dentures 6ere 6orn continuously. Conclusion* Alt"oug" t"e re#o5al o$ dentures during t"e nig"t "as %ro5en to be bene$icial, t"ere still is no unani#ity or consensus on t"is #atter. (ental sc"ools 6ere not in total agree#ent 6it" t"e sub>ect o$ continuous denture 6ear. 7or #a<i#u# bene$it o$ all denture 6earers, t"ere needs to be re5ision in t"e %atient education boo3lets on oral tissue "ealt" and t"e lengt" o$ ti#e t"at dentures s"ould be 6orn daily.

28-008! ,u7es# %! S! An E3aluation o( So(t Tissue res)onse :ollo9ing $e'o3al o( ;ll-(itting ,entures! * +rost&et ,ent .5:20 -205# /80! 'ur%ose* To #easure t"e c"ange in t"ic3ness o$ t"e so$t tissues $ollo6ing t"e re#o5al o$ ill$itting dentures $or )2 "ours. 9et"ods and 9aterials* 1+ sub>ects 6it" ill-$itting dentures 6ere e5aluated using intraoral radiogra%"s to e5aluate so$t tissue and residual ridge. esults* 8#%ro5ed color and $ir#ness o$ so$t tissues a$ter re#o5al o$ dentures $or )2 "ours. A5erage c"ange 6as 0.110 ##. (iscussion* C"anges in contour, tone, and t"ic3ness o$ so$t tissues 6ere seen >ust by re#o5ing t"e irritating denture $or )2 "ours. 28-00/! "ytle# $!%! Co')lete denture construction based on a study o( t&e de(or'ation o( t&e underlying so(t tissues! * +rost&et ,ent /: 05/-00 # /0/! 'ur%ose* To study t"e e$$ects o$ %ressure on t"e de$or#ation o$ so$t tissues beneat" co#%lete dentures. (iscussion* 8t is e5ident t"at %ressure %lays a role in t"e osteoclastic resor%tion o$ bone tissue. 8$ t"is %ressure is increased beyond t"e li#its o$ tolerance, t"en destruction o$ bone by resor%tion #ay occur. T"e cause is %robably due to a circulatory disturbance in t"e nutriti5e tissue o$ bone Die. in t"e %eriosteu# or bone #arro6.E ."en t"ese e<cessi5e %ressures are re#o5ed, re%arati5e c"anges #ay occur. Satis$actory tissue "ealt" Dto #a3e i#%ressions E #ay be obtained i$ t"e dentures are le$t out o$ t"e #out" $or +8-)2 "ours. T"is is usually ade=uate ti#e in t"e absence o$ un$a5orable syste#ic $actors or e<tre#ely abused tissues. 8$ t"e dentures cannot re#ain out o$ t"e #out" $or t"at %eriod o$ ti#e t"en ot"er treat#ent o%tions can be considered. T"e dentures are to be le$t out o$ t"e #out" o5ernig"t, and all t"e e<cessi5e %ressure areas o$ t"e denture are relie5ed. Dincluding any o5ere<tended borders.E Te#%orary treat#ent relining #aterial is %laced i$ t"ey are not stable. T"is so$t relining #aterial is re%laced e5ery t"ird day. Eit"er I;E or silicone i#%ression #aterial #ay be used $or t"is %rocedure. A so$t diet and tissue #assage are %rescribed. Healt"y tissues are also i#%ortant 6"ile recording #a<illo#andibular records, as i$ t"ese 6ere #ade on de$or#ed tissues, occlusal errors 6ould be %er%etuated on t"e ne6 denture. T&e article also re3ie9ed t&e (our 'ain destructi3e 'ec&anical (actors in co')lete dentures: ( ) i')ro)er contour o( t&e i')ression sur(ace o( t&e denture (2) i')ro)er co3erage by t&e denture i')ression sur(ace (5) insu((icient interocclusal sur(ace (.) occlusal dis&ar'ony! A$ter e<tractions, it is i#%ortant to relie5e any e<cess denture base #aterial t"at #ay "a5e e<tended into any destructi5e %ressure areas. T"e border e<tensions #ust also "a5e ade=uate co5erage %articularly in areas suc" as t"e #a<illary tuberosity, t"e #andibular buccal s"el$, and t"e retro#olar area. Ade=uate border co5erage distributes stresses o5er a large area, t"us #ini#i/ing t"e dangers associated 6it" o5erloading t"e denture $oundation. 8nsu$$icient interocclusal distance and occlusal dis"ar#ony 6ill cause e<cessi5e %ressures on su%%orting structures 6"en t"e teet" co#e into contact. 8t is i#%ortant t"at t"e occlusal discre%ancies be eli#inated %rior to t"e %atient 6earing t"e dentures. T"e ter# J%atient re#ount %rocedureJ is used as a $inal #a<illo#andibular registration %rocedure. A centric relation record is #ade in t"e #out" and t"is is #ounted on t"e articulator.

T"en a second C record is #ade in t"e #out", i$ t"is #atc"es t"e sa#e recording on t"e articulator, t"en t"e #ounting "as been 5eri$ied. ;nce t"is "as been done, a %rotrusi5e interocclusal record is #ade on t"e %atient , and t"e condylar guidances are t"en ad>usted. T"e re$ine#ent o$ occlusion is carried out by selecti5e grinding to t"e desired occlusal %attern. 28-0 0! "ytle# $!%! So(t tissue dis)lace'ent beneat& re'o3able )artial and co')lete dentures! * +rost&et ,ent 2:5.-.5# /42! 'ur%ose* To deter#ine t"e #agnitude o$ so$t tissue dis%lace#ent beneat" dentures. 9aterials and 9et"ods* Cast 6ere #ade o$ %atients 6earing re#o5able %artial dentures and co#%lete dentures and t"en cast 6ere #ade o$ t"e sa#e %atients a$ter allo6ing t"e tissue to reco5er by lea5ing t"e dentures out o$ t"e #out" $or 00 "ours. T"e di$$erence in t"e so$t tissue location 6as #easured. 'lastic %lat$or#s 6ere used in t"e %artial denture cases and a co#%arator 6as used $or t"e co#%lete denture cases. esults* 'atients younger t"an 10 years old s"o6ed greater c"ange in t"eir so$t tissue $or#. T"e greatest a#ount o$ dis%lace#ent in t"e #a<illary arc" occurred on t"e crest o$ t"e ridge in t"e anterior region. T"e a5erage dis%lace#ent 6as .0- to .0) inc". 'ro>ections o$ t"e denture bases into un"ealed soc3ets caused gross so$t tissue dis%lace#ent. 're#ature interce%ti5e occlusal contacts also caused grossly dis%laced tissue. Conclusion* T"e $or# o$ t"e so$t tissues beneat" co#%lete dentures is a$$ected by %ressures on t"e teet" or denture base o%%osite t"e i#%ression sur$aces, t"e contour o$ t"e denture i#%ression sur$ace, and t"e si/e o$ t"e area co5ered by t"e denture. 8n %artial dentures t"e so$t tissues is a$$ected by t"e sa#e t"ings e<ce%t t"e su%%orting rest and bracing ele#ents in$luence t"e so$t tissue dis%lace#ent. ."ere t"ere is e<tre#e abuse o$ t"e so$t tissues t"ey #ay stay dis%laced $or "ours or days. T"e i#%ortance o$ conditioning so$t tissue abused and de$or#ed by ill $itting dentures can be easily >usti$ied 6"en t"e #agnitude o$ so$t tissue dis%lace#ent is recogni/ed. 8n order to #ini#i/e t"e dis%lace#ent o$ so$t tissues beneat" denture bases, t"e $ollo6ing s"ould be used* co5er t"e #a<i#u# a5ailable area 6it" t"e denture base, do not e<tend t"e denture base into un"ealed soc3ets, and eli#inate interce%ti5e occlusal contacts. 28-0 0a! %ouc&er# C >! ,iscussion! 2:..-.4# /42! A discussion on so$t tissue dis%lace#ent under dentures. 'ressures are a%%lied to tissues t"roug" denture bases. LytleKs article is cited $or Jt"e so$t tissues o$ t"e denture bearing areas #ay acco##odate ill-$itting denturesL because o$ t"eir ability to #a3e t"is acco##odation, gross occlusal discre%ancies #ay be concealed, and t"e retention and stability #ani$ested #ay be at t"e e<%ense o$ t"e "ealt" o$ t"e so$t tissues. (entists s"ould %ay attention*

abused tissues %rior to i#%ressions not ta3e t"e 6ord o$ t"e #anu$acturer t"at t"e best denture #aterials are out in t"e #ar3et because dentures c"ange a$ter %rocessing. letting t"e dentures settle %rior to occlusal ad>ust#ents on teet" dentures c"ange a$ter insertion in t"e #out" and occlusion c"anges t6o 6ee3s a$ter insertion because o$ absor%tion o$ $luids in t"e acrylic. e#ount is essential a$ter t6o6ee3 insertion $or c"anges 6"ic" occur.

28-0 ! 6elly# E! C&anges Caused by a <andibular $e'o3able +artial ,enture >))osing a <a?illary Co')lete ,enture! * +rost&et ,ent 2-: .0- 00# /-2! (iscussion* 9oderate inter#ittent $orces e<erted on t"e bony ridge by a %rost"esis #ay be sti#ulating and "el% %reser5e rat"er t"an destroy t"e bony ridge. E<cessi5e $orce causes resor%tion o$ t"e residual ridge. (eFan stated co#%ressi5e $orces 6ere tolerated but not s"earing $orces. A co##on $inding is t"e loss o$ bone in t"e anterior %art o$ t"e #a<illa broug"t about by natural anterior teet" occluding a co#%lete u%%er denture. T"e anterior %art o$ t"e #a<illa is t"e 6ea3est %art o$ t"e u%%er arc". 7i5e c"anges constitute JCo#bination Syndro#eJ*

Loss o$ bone $ro# t"e anterior %art o$ t"e #a<illary ridge. ;5ergro6t" o$ t"e tuberosities. 'a%illary "y%er%lasia in t"e "ard %alate. E<trusion o$ t"e lo6er-anterior teet". T"e loss o$ bone under t"e %artial denture base.

T"e early loss o$ bone $ro# t"e anterior %art o$ t"e #a<illary >a6 is t"e 3ey to t"e ot"er c"anges. A$ter t"e bone loss, $labby "y%er%lastic connecti5e tissue #a3es u% t"e anterior %art o$ t"e ridge. As bone and ridge "eig"t are lost anteriorly, t"e %osterior ridge beco#es larger 6it" t"e de5elo%#ent o$ enlarged tuberosities. T"e occlusal %lane #igrates u% in t"e anterior and do6n in t"e bac3. Su%raeru%tion o$ t"e natural teet" $ollo6s. ;5er ti#e, est"etics beco#es %oor due to t"e anterior denture teet" disa%%earing under t"e %atientKs li%. E<cessi5e bony resor%tion under t"e lo6er '( continues and in$la##atory %a%illary "y%er%lasia de5elo%s in t"e %alate. T"e connecti5e tissue re%lace#ent is a narro6 %ro>ection o$ tissue 5irtually unsu%%orted on t"e labial or lingual. 9ec"anics o$ t"e syndro#e* ."ile bone is lost in t"e anterior o$ t"e #a<illa, resor%tion also occurs in t"e %osterior #andible causing a ti%%ing. T"e enlarged tuberosities #ay be caused by t"e suction o$ t"e %osterior %alatal seal. Si< out o$ 20 %atients in a 1 year study "ad ce%"alo#etric radiogra%"s ta3en and t"e so$t tissue outlined $or i##ediate dentures. A second $il# 6as ta3en 0-8 #ont"s later. 'atients lost 11 ## o$ ridge "eig"t in t"e anterior region and gained 1-2.- ## o$ "eig"t o$ t"e tuberosity. Treat#ent %lanning can %re5ent t"e syndro#e by retaining 6ea3ened %osterior teet" or $abricating an o5erlay denture. Surgical correction o$ c"anges in t"e !asal Seat. T"e $labby D"y%er%lasticE tissue can be re#o5ed, t"e %a%illary "y%er%lasia can be eli#inated, and t"e enlarged tuberosities can be reduced. T"e occlusal %lane raised and #a<i#u# area %ossible $or t"e su%%ort o$ t"e '( including t"e retro#olar %ad and buccal s"el$. 28-0 2! C&a'berlain# et al! ,enture )la@ue control and in(la''ation in t&e edentulous )atient! * +rost&et ,ent 0.: -8# /80! 9ucosal in$la##ation under dentures is related to %la=ue accu#ulation A literature re5ie6 o$ $actors o$ denture sto#atitis is %resented in t"is article.

9aterials and 9et"ods* 8- co#%lete denture %atients %resented $or denture t"era%y and an atte#%t 6as #ade to balance t"e grou%s according to age, se< and a#ount o$ in$la##ation 6"ic" 6ere di5ided to 2 grou%s a control and a study grou%. 'T8 6as #easured at 10 and 00 days. .ilco<on #atc"ed %airs signed ran3s test and t"e #aedian test 6"ic" are non%ara#etric statistical #et"ods 6ere done $or bot" grou%s. esults* T"e control grou% e<"ibited no statistically signi$icant di$$erence in %la=ue score, but t"e #ean o$ tissue in$la##ation 6as signi$icantly greater. T"e brus"ing grou% e<"ibited signi$icant di$$erences a$ter 10 days. (iscussion* eduction in so$t tissue in$la##ation 6it"out i#%ro5e#ent in t"e %la=ue score 6as obser5ed in bot" grou%s. T"e need $or denture "ygiene %ractice by t"e %atient is a 5alid reason $or tissue #anage#ent, es"etics, control o$ #alodor, a$$ir#ation o$ %atientKs sense o$ 6ell-being. Su##ary and Conclusion* Signi$icant reduction in in$la##ation occurred 6it" brus"ing alt"oug" no signi$icant reduction in %la=ue score 6as $ound. 28-0 5a! 6raAice7# ,!,! ,ooner# *o&n #and +orter# 6endall >bser3ations on t&e &istologic (eatures o( t&e &u'an edentulous ridge! +art ;: <ucosal e)it&eliu'! * +rost&et ,ent 02: 024-05 # /8.! 'ur%ose* ;bser5e t"e "istologic relations"i%s bet6een all as%ects o$ t"e "u#an edentulous ridgeL e%it"eliu#, connecti5e tissue and bone. (iscussion* 1. A total o$ 1) edentulous sub>ects 6ere studied, o$ 6"o# 1+ "ad 6orn dentures and 21 "ad not. 2. T"e e%it"elial $eatures studied 6ere, t"e %ossible res%onses o$ t"e sur$ace e%it"eliu#, t"ic3ness and rete ridges* a. es%onses o$ t"e sur$ace e%it"eliu#*

nor#al $or t"e area non3eratini/ed- absence o$ 3eratin $or#ation "y%er3eratini/ed- t"ic3er t"an nor#al layer o$ 3eratin %ara3eratini/ed-3eratin t"at contains retained %y3notic nuclei

b. T"ic3ness

nor#al $or t"e area acant"otic- t"ic3er t"an nor#al e%it"eliu# atro%"ic- t"inner t"an nor#al e%it"eliu#

c. ete ridges

nor#al $or t"e area elongated blunted, and %resence o$ dys3eratosis

1. T"e ridge crest 6as considered nor#al 6"en it de#onstrated #oderate t"ic3ness 6it" rete %egs o$ #oderate lengt" %lus a t"in 3eratini/ed sur$ace layer. +. T"e a%%earance o$ t"e buccal e%it"eliu# 6as si#ilar to t"at o$ t"e crestal e%it"eliu#. -. T"e nor#al lingual e%it"eliu# 6as t"in, rete ridges 6ere absent, and t"e sur$ace 6as non3eratini/ed. 0. @o statistical di$$erences in t"e e%it"eliu# 6ere noticed bet6een t"e t6o grou%s. ). 9ore %ara3eratosis 6as seen in t"e nondenture -6earing grou% and t"e denture -6earing grou% s"o6ed #ore non3eratini/ation. 8. Acant"osis 6as %redo#inant in bot" grou%s, as 6ere elongated rete ridges. Conclusion* 7ro# t"ese obser5ations it a%%ears t"at 6earing dentures is not "ar#$ul to t"e e%it"eliu#. (i$$erences bet6een noncontrolled denture-6earing and nondenture-6earing grou%s do not a%%ear to e<ist. 28-0 5b! 6raAice7# ,! ,!# ,ooner# *!# and +orter# 6! >bser3ation on t&e Hu'an Edentulous $idge! +art ;; Connecti3e Tissue! * +rost&et ,ent 02:482-48-# /8.! 'ur%ose* To obser5e t"e "istologic relations"i% a#ong all as%ects o$ t"e "u#an edentulous ridge. 9et"ods and 9aterials* Sections o$ edentulous ridge in t"e $irst #olar region 6ere re#o5ed at auto%sy %rior to e#bal#ing. Sa#%les 6ere $i<ed in 10B bu$$ered neutral $or#alin, decalci$ied and %rocessed $or %ara$$in sections. 1) edentulous sub>ects 6ere studied. esults* ;n t"e ridge crest, a slig"tly greater but Dinsigni$icantE nu#ber o$ %ositi5e res%onses 6ere seen $or t"e non-3eratini/ed sur$ace in t"e grou% 6it" dentures. 8n t"e non-denture grou%, t"e greatest nu#ber o$ %ositi5e res%onses 6as $or %ara3eratosis. Acant"osis and elongated rete ridges 6ere $ound in bot" grou%s. ;n t"e buccal e%it"eliu#, t"e sur$ace 6as non3eratini/ed in bot" grou%s. 8n t"e non-denture grou%, t"e e%it"elial t"ic3ness and rete ridge lengt" 6ere nor#al, but acant"osis and blunted rete ridges 6ere seen #ore o$ten 6it" dentures. (iscussion* E%it"elial tissue o$ t"e edentulous ridge s"o6s c"anges, but t"ere is no a%%arent di$$erence bet6een denture 6earing grou%s or non-denture grou%s. 28-0 .! ,esAardins# $onald +! Etiology and <anage'ent o( &y)er'obile 'ucosa o3erlying t&e residual al3eolar ridge! * +rost&et ,ent 52:4 /-458# /-.! 'ur%ose* (iscuss t"e "isto%at"ology, etiology, and %rost"odontic and surgical #anage#ent o$ t"e "y%er#obile ridge crest. (iscussion* 1. #asticatory #ucosa o5er t"e residual ridge is 1.- - 2## t"ic3. 2. e<cessi5ely #ucosa undergoes #o5e#ent during $abrication and use o$ a co#%lete denture.'atient 6ill not be able to $unction success$ully. 1. inability to %ro5ide stability to t"e denture 6ill encourage continuation o$ t"e %roble# and increase its se5erity. +. "y%er#obile tissue M "y%er%lastic $ibrous connecti5e tissue. loo3s li3e $ibro#as, in$la##ation is usually absent, e%it"eliu# is #ost o$ten nor#al. -. etiology is s%eculati5e #ec"anis# o$ bone resor%tion and tissue atro%"y in t"e #out" is not understood.

0. atro%"y - decrease in si/e o$ any %ortion o$ t"e body could be related to* %re5enting t"e %assage o$ nutritional ele#ents by, old age - decrease in blood su%%ly, disuse - narro6ing o$ blood 5essels, %ressure - co#%ro#ises t"e blood su%%ly. ). resor%tion - loss o$ osseous substance

%arat"yroid "or#one - nor#al le5el is 10-12#gCdl, "ig" le5els blood calciu# increases at t"e e<%ense o$ bone causing resor%tion. Fit A - "y%er5iti#anosis M increased osteoclastic acti5ity. Fit C - de$iciencies lo6er collagen %roduction $or bone #atri<. Fit ( - e<cess causes resor%tion o$ bone and de%osition in ot"er organs.

Lac3 o$ Fit ( lo6ers absor%tion o$ calciu# $ro# t"e intestine, decreases blood calciu#, %arat"yroid re#o5es calciu# $ro# t"e bone, resor%tion occurs. 8. %ressure and $unction e$$ects are s%eculati5e. Constant %ressure #ay cause resor%tion, inter#ittent %ressure #ay encourage bone #aintenance. $re=uency,intensity,duration,direction, #ay cause resor%tion in one %atient and bone #aintenance on anot"er. ,. because o$ t"e unans6ered =uestions about t"e initiation and continuation o$ bot" atro%"y and resor%tion, it is not %ossible to e<%lain t"e de5elo%#ent o$ t"e "y%er#obile ridge crest. 10. t"is condition is o$ten seen 6"en edentulous #a<illae are o%%osed by natural teet". esor%tion o$ t"e anterior %art o$ t"e #a<illae and $or#ation o$ a "y%er#obile ridge crest are also seen in Class 1 %atients, 6"ere t"e unstable #a<illary denture is o$ten created by %ositioning t"e #andibular denture-bearing area anteriorly, 6"ic" o%%oses t"e anterior as%ect o$ a #a<illary co#%lete denture. 11. #anage#ent* %rost"odontic - #ucostatic, $unctional, or selecti5e i#%ressions.

selecti5e is t"e best - t"e "y%er#obile tissue 6ould be recorded at rest 6it" $unctional %lace#ent o$ border tissues to en"ance denture retention and stability. stabili/ing balanced occlusion static records are used $or #a<illo#andibular relations"i%s i$ redundancy is e<cessi5e, it is unli3ely t"at a balanced occlusion can be #aintained in $unctional and %ara$unctional #o5e#ents. t"is unstable denture 6ill $urt"er encourage bone resor%tion and increased denture %roble#s. #anage#ent #ust be concentrated in t"e i#%ression-#a3ing and occlusal %"ases o$ denture construction. surgical - e<cising %atient #ay be le$t 6it" a $lat al5eolar %rocess 6it" #uscle attac"#ents a%%roac"ing t"e crest o$ t"e ridge.T"e o%%ortunity to %ro5ide e<tension and t"ereby retention and stability o$ a co#%lete denture is li#ited. T"ere$ore, consider a 5estibulo%lasty. idge aug#entation #ay also "el%. !SS; to correct a #a<illo#andibular ridge relations"i%.

8n>ection o$ sclerosing solution*

-B sodiu# #ort"uate

1B sodiu# tetradecyl sul$ate scar tissue $or#ed, $ir#er tissue on t"e ridge crest in +-0 6ee3s.

28-0 0! "e:eb3re# C! A!# et al! E((ects o( ,enture %ase $esins on >ral E)it&elial Cells! ;nt * +rost&odont .:5- -5-4# // ! 'ur%ose* To co#%are t"e bioco#%atibility o$ di$$erent $or#ulations o$ %oly#eri/ed denture base resins and to e<a#ine t"e e$$ect o$ 5aried lengt"s o$ %oly#eri/ation ti#e o$ t"ese resins on e%it"elial cell to<icity. 9et"ods & 9aterials* 9aterials tested 6ere Lucitone 1,,, Triad, Astron LC Hard, and E<toral. Tri%licate sa#%le dis3s o$ t"e denture base resins 6ere $abricated under ase%tic conditions in #olds 1 c#. in dia#eter and 1 ##. t"ic3. Sa#%le $abrication 5aried 6it" "o6 t"e air barrier 6as a%%lied. ando#-bred "a#ster c"ee3 %ouc" e%it"eliu# 6as cultured. Cellular %rotein synt"esis 6as #onitored. esults* All sa#%les o$ Triad 6ere in"ibitory $ollo6ed by Astron causing si#ilar to<ic res%onses on oral e%it"elial cells. E<toral 6as less to<ic. Ty%e o$ air barrier coating %roduced 5aried results. Triad and Astron air barrier coating 6as =uite to<ic, but E<toral 6as actually %rotecti5e. (iscussion* Lig"t-%oly#eri/ed denture base resins "a5e a to<ic e$$ect on oral e%it"elial cells. T"e e<tent o$ t"e e$$ect 6as related to t"e %roduct and not t"e %oly#eri/ation. T"e air barrier coating #ay increase t"e to<icity to t"e cells.