PROSTHODONTICS (Y3T1)

1. What is gerodontology?

The study of the dentition and dental problems in aged or aging persons

2. What are the skin changes related to edentulism and aging?

o Skin becomes thin, wrinkled and dried

o Patient may request the dentist to place the artificial teeth in undesirable relation to
the support, to over contain the borders, or to decrease the interocclusal distance
o Reduced concavity and pout of the upper lip
o Atrophy at subcutaneous end buccal pads of fat (hollow cheeks)
o Upper lip drops over maxillary teeth
o Naso-labial groove deepens, which produce a sagging look to the middle third of the
face.
o Angular chilitis
o Flattened philtrum
o Decrease in horizontal labial angle
o Increase in columella-philtral angle
o Prognathic appearance

o Difficulty in hearing and diminishing vision

3. What are the changes occur in natural teeth of elder patient?

o chroma and hue of teeth will change as enamel is abraded, exposing the underlying
dentin to extrinsic stains or medication containing heavy metals
o Natural teeth take on a jagged brownish appearance of an aging dentition when the
incisal edges break and the exposed denture gather extrinsic stains

4. What are the changes in patient oral mucosa that are relevant to old age? And why
(factors)? What these could lead to?

o Becomes thin, easily abraded, and frequently reacts unfavorably to the pressure of
dentures
o Less saliva flow
o Stomatitis and other mild inflammations are the mucosal lesions encountered most
frequently in older edentulous mouths
(especially denture wearer, tobacco smoker and excessive drinkers)
More damaging in old patients
o Increased risk of oral cancer
5. What are concerns for personal appearance in old age patient enumerate them shortly?

o Feelings of social rejection and physical collapse compounded by inadequate

dentures.
o Cosmetic industry, is concerned by women more than men may inhibit or damage
personal relationships
o Society frowns on anyone, young or old, (especially on elderly men) who use
cosmetics to look younger.

6. What does the following states mean for you

a. the need for complete denture may increase in the coming decades

People tend to live longer these days

b. the elder patient is having decrease in cells turnover and poor blood circulation

Wounds heal more slowly

c. the mouth is a good and accurate sensor of systemic stability

Mucosa and underlying bone supporting complete dentures heal more slowly from the
trauma of ill-fitting dentures

d. new dentures are not accepted easily by older patient what you need to do to manage this?

o Modify dentures that are familiar to the patient

o Make new one by duplicating the general shape and tooth arrangement of old denture

7. What is TMD? What does it include?

TMD is a group of musculoskeletal conditions affecting the temporomandibular area

Includes:

o Muscular conditions (myofacial pains)

o Disorders affecting the TMJ complex (arthritis/ disc displacement)

8. State some symptoms that are in TMD patient

o Headache
o Impaired mandibular mobility
o Tinnitus
o Impaired hearing
o Ear pain
o TMJ sounds
9. What are the predisposing factors for TMD?

o Young and middle age

o Female
o Tooth loss (edentulous)
o Exogenous Hormones (contraceptives/ hormone replacement)

10. In management of TMD, discuss briefly

a. the reassurance and self-care regimen

Reassure patients of TMDs frequent occurrence, good prognosis and merits of management
strategies

Self Care:

1. Moist heat (10-20mins, 4 times a day)

Cold Application (5min each time)

2. Soft Diet

3. Avoid muscle strain (gum chewing/ clenching)

b. Pharmacotherapy

o Analgesics
o Muscle relaxants
o NSAIDs
o COX2 Inhibitor

c. Physical modalities (pain relief)

o Heat and cold therapy

o Ultrasound
o Massage
o Joint mobilization
o Passive stretching

d. Behavioral modalities (provide coping skills for pain control and other disabilities)

o Biofeedback
o Stress management
o Relaxation
o Hypnosis
o Education
o Modify habits/ lifestyle patterns
11. Define Diagnosis, treatment planning, prognosis.

Diagnosis:

the identification of the nature of an illness or other problem by examination of the

symptoms.

o Examination of the physical state

o Evaluation of the mental/ psychological makeup
o Understanding the needs of each patient
o To ensure predictable results

By:

1. Patient Evaluation

2. Clinical History Taking

3. Clinical Examination (Extraoral and Intraoral)

4. Radiographic Examination

5. Examination of Existing Prosthesis

Treatment Planning

A process of matching possible treatment options with patients needs and systematically
arranging the treatment in order of priority but in keeping with a logical or technically
necessary sequence.

o Adjunctive care
o Prosthodontic care

Prognosis:

an opinion, or judgement given in advance of a treatment for the prospects for success in
the fabrication of dentures and for their usefulness

o Complete Denture Evaluation

o Diagnosis
o Treatment Planning
o Prosthodontics Diagnostic Index (PDI)

12. What does double examination mean?

 Observing the patient while he walks in/ when he is talking

o Gait
o Age
o Sex
o Personality
o Cosmetic Index
o Mental attitude (philosophical, exacting, hysterical, indifferent)
o Profession

13. How can observing the patient gait be helpful for your diagnosis?

Patient with neuromuscular disorders may have difficulty in adapting dentures

14. What is house classification of mental attitudes?

o Philosophical
o Exacting
o Hysterical
o Indifferent

15. Discuss the house classified different mental attitudes of patients (one, two or all)

Philosophical:

Easy going & cooperative

Confident of the dentist (good prognosis)

Exacting:

Seriously concerned with appearance and efficiency of dentures

Doubt dentist

Very difficult to satisfy

Hysterical:

Discouraged with bad health and long neglected pathological mouth conditions, unstable,
nervous
 Demands appearance and efficiency of denture to equal to that of perfect natural teeth

Most difficult patient to please

Poor prognosis

Indifferent:

Unconcerned about appearance and feel no necessity for dentures

Uncooperative

Will not maintain denture

Do not appreciate effort and skills of dentist

16. List (some) the categories that you need to investigate when you are taking prostho
patients dental history

o Medical history
o Dental history (periodontal disease/ edentulous period/ worn dentures before?)
o Chief complaint (comfort, function, social, appearance)
o Health History

17. List (some) the categories that you need to investigate when you are making prostho
patients extra-oral examination

o Facial examination and features (face profile & midline of prosthesis with phitrum)
o Neck (lymph node/ lumps/ masses)
o Muscle tone (tenderness & dysfunction)
o TMJ examination (pain/tenderness/ popping&clicking)
o Mandible (irregular movement/ deviation)
o Lips and Skin (lesion/ nevi/ angular chelitis)
o Neuromuscular Examination (speech & coordination)
o Lip when denture in place (length, thickness and curvature)

18. List (some) the categories that you need to investigate when you are making prostho
patients intra-oral examination

o General evaluation of oral mucosa (flabby/ mobility/ colour)

o Soft palate
o Hard palate (deep/ shallow/ torus?)
o Tongue (lateral borders/ size type1,2,3)
 o Residual ridge (size/ form/ contour/ parallelism/ inter-arch space)
o Bony undercut (tori)
o Floor of mouth (if shallow, reduces lower denture retention

19. What are the 3 classes of the soft palate?

Class I: horizontal with little muscular movement

Class II: Soft Palate makes 45 angle to hard palate

Class III: Soft Palate makes 70 angle to hard palate

20. How can Orthopantomograph (OPG) be helpful for Tx of edentulous patient?

To note:

o Unerupted teeth
o Retained root tips
o Residual cyst
o Bony pathology
o Unusual TMJ abnormally
o Sinus position and health

21. In diagnosis there are some additional aids that can support your diagnosis. List these aids.

o Diagnostic cast
o Prosthodontics Diagnostic Index (PDI)

22. Define the PDI, list the advantages.

A diagnostic tool to help dentist identify the complexity of their denture patient

1. Help indentify difficult denture patients

2. Help dentist understand when to refer patient
3. Help insurance company to qualify patients
4. Identify diagnostic modifiers that can be expected to increase complete denture
diffuculty

23. What are the general diagnostic assessment criteria that PDI use?

1. Mandibular bone height

 2. Maxillomandibular ridge relationship (MMR)
3. Residual ridge morphology
4. Muscle attachment

24. What are the requirements of treatment planning?

1. Broad knowledge of treatment possibilities

2. Knowledge of patients needs
3. Consequences of both treatment and no treatment is considered
4. Parallel process of developing prognosis, patient health considerations and attitudes into
account.
5. Treatment that dentist feels competent to deliver

25. In your discussion with your patient, what are the key issues that you need to highlight
with your patient?

1. Treatment sequence
2. Length of completion
3. Treatment cost

26. To decide about a surgical, non surgical or combination of Tx plan, what can you do
convince the patient of the necessity for the suggested treatment

o Logical explanations
o Radiographs
o Diagnostic cast

27. In the pre-prosthetic evaluation, what can you find through the radiograph? What can you
find in maxillary/ mandibular arch?

o Pathologic lesions
o Retained roots
o Impacted teeth
o Overall ridge morphology

Mandibular:

Relationship between inferior alveolar canal and the ridge crest

Position of the mental foramen to the ridge crest

Maxilla:

Relationship between the floor of the antrum and the alveolar crest
Anterior nasal spine
Anterior maxillary alveolar crest
Hard tissue component vs soft tissue components of hyperplastic tuberosities
28. List the non surgical procedures that you may follow to prepare your patient for complete
denture

1. Rest for Denture Supporting Tissues

2. Occlusal Correction of old prostheses
3. Good Nutrition
4. Musculature Conditioning

29. Explain the non surgical procedures that you may follow to prepare your patient for
complete denture (one of them) or( in long essay Q all of them)

30. List the objectives of Preprosthodontic Surgical Prescriptions.

1. Correcting conditions that prelude the optimal prosthetic functions

(unfavourable frenum location/ bony prominence/ pressure on mental foramen)
2. Enlargement of denture bearing areas (vestibuloplasty & ridge augmentation)
3. Provision of tooth root analogs (implants)

31. What is your management when a flabby ridge is interfering in patient mouth and the
patients health does not allow you to go for surgical intervention.

Modify impression technique and design of denture base to accommodate it and minimize
distortion.

32. List the pre-prosthetic surgical procedures that can be made before starting prosthodontic
treatment (the blue ones on lecture notes)

1. Vestibuloplasty
2. Ridge augmentation
3. Implants
4. Frenectomy
5. Surgical excision of mobile tissues
6. Removal of bony prominences, undercuts, tori
33. Explain how the pressure can be generated on mental foramen in some edentulous
patients wearing complete denture? How can that be managed?

Extreme bone resorption caused the mental foramen to open near or directly at the crest of the
residual bony process. Bone margins of the foramen is higher than surrounding, causing a sharp
edge that will pinch the tissue and cause pain if denture is worn.

Denture pressure is altered to relief the area.

34. Define vestibuloplasty

A surgical procedure whereby the oral vestibule is deepened by changing the soft tissue attachments

35. List the basic requirements to achieve successful impression and denture

o Knowledge of Oral Anatomy

o Knowledge of a reliable and basic technique
o Knowledge and understanding of materials
o Skill
o Patient management

36. Define mucostatic/mucocompressive/selective pressure impression tecniqueand state

which is the best technique

Mucostatic: The surface contour of the ridge is recorded at its resting form (no occlusal load)

Mucocompressive: tissue recorded under functional pressure

Selective Pressure: Both mucostatic and mucocompressive

37. List the advantages/disadvantages of mucostatic/mucocompressive/selective pressure

impression technique

38. What is closed mouth impression techniques

Supporting tissues are recorded in functional relationship.

Patient is asked to close on the rims

Closing, grimacing, sucking and swallowing movements are done.

39. What are the impression objectives

1. Preservation of remaining residual ridge

2. Stability
3. Retention
4. Support
5. Aesthetics

40. List the Common faults in impression making

1. Insufficient depth in the facial and lingual sulci

2. Edge of ridge exposed through the impression
3. Excess material extending beyond borders
4. Asymmetrical impression
5. Deficiency in midline of palatal vault

41. Explain the disinfection of impression

o Iodophors
o Household bleach
o 2% glutaraldehyde
o 10% sodium hypochloride
o Other synthetic phenols

42. Explain relief areas and state the common areas to relief in compete denture

Reduction or elimination of undesirable pressure or force from a specific region under

denture base

o Incisive papilla
o Mid palatal raphe
o Mandibular ridge crest
o Flabby ridge
o Sharp bony projections
43. Define border molding

shaping of the border areas of an impression tray by functional or manual manipulation of

the tissue adjacent to the borders to duplicate the contour and size of the vestibule.

44. List the steps for tray preparation just before final impression (after border molding) and
state why do you need to make escape holes?

1. Remove wax relief

2. Remove wax spacer
3. Make escape holes
4. Reduce borders
5. Apply adhesive
6. Protect mouth
7. Dry mouth

Escape holes to:

o Reduce buildup of hydrostatic pressure

o Facilitates escape of excessive materials
o Provide relief to areas