1. How many clinical appointments are necessary for proper fabrication and adjustment of dentures?
2. The 6th and 7th appointments should be held approximately how many days after the delivery of the final denture?
6th after 24 hours; 7th after 1 week
3. This quarter, we started with the lab procedures that follow which clinical appointment?
4. After the wax trial denture try-in appointment (#4), what is the necessary lab procedure?
Process the dentures
5. Clinically, the occlusal plane is parallel to _____________ ______________. This anatomical landmark runs from the ______________ to the ________________ on the patient.
Camper�s Line; Tragus of the ear, ala of the nose
6. Clinically, the occlusal plane is determined and confirmed utilizing what?
Determined using wax occlusion rims and trial denture, confirmed by esthetics and phonetics
7. How far up the retromolar pad should the occlusal plane be positioned?
8. The position of the anterior teeth is dictated by what?
Esthetics and phonetics
9. What do intraoral and soft tissue landmarks serve as for tooth positioning?
Serve as guides to support esthetics and phonetics
10. How is phonetics utilized when determining the anterior tooth placement?
�Fricative F and V� sounds are used for maxillary incisor positioning when they touch the wet line; maxillary to mandibular anterior tooth relationship is determined by the �sibilant S sounds�.
11. The smile line follows what anatomic landmark clinically?
Contour of the Lower lip line
12. Which two maxillary anterior teeth touch the occlusal plane?
Central incisors and canines
13. T/F Only the mesial portion of the incisal edge of the central incisor touches the occlusal plane.
F, the entire central incisor edge touches the plane
14. What are the two planes of the maxillary canine and how are they arranged when placing the anterior teeth on the wax trial denture set up?
Mesial and Distal; Mesial is arranged in the same plane as the incisors and the distal establishes the plane for the posterior teeth
15. The long axis of the canine should be ________________when viewed from the distal.
Vertical/perpendicular to occlusal plane
1. What type of anatomic tooth form do we use and what angle are the posterior teeth at?
Pilkington-Turner 30 degree posteriors
2. Describe the acceptable deviations from ridge relationship for the maxilla and the mandible.
Maxillary posterior teeth can be slightly buccal; mandibular posteriors can be slightly lingual
3. What is the Curve of Spee and how does this relate to Hanau�s Quint?
The gradual rise in occlusion established by the maxillary posterior teeth, relates to compensating curve with Curve of Wilson, has large effect on excursive movements
4. What is the Curve of Wilson and how is it established when placing the maxillary posterior teeth?
Lingual cusps of maxillary posterior teeth should be inferior to the buccal cusps, large effect on the balancing side of excursive movements.
5. What cusps of the maxillary posterior teeth touch the occlusal plane?
Both first premolar, lingual second premolar, ML 1st molar
6. What angle is the long axis of both the maxillary first and second premolars at related to the occlusal plane?
7. How is the long axis of the first maxillary molar arranged? How is this achieved with the alignment of the MB and DB cusps?
Long axis inclines slightly mesially; MB aligned with facial surfaces of premolars and distal surface of canine, DB cusp aligned slightly lingual to establish the second plane of the posterior facial surfaces.
8. What is the definition of a �record base�?
provisional appliance used to record the relationship between the maxilla and the mandible
9. When are record bases fabricated during the sequence of appointments and lab procedures?
After the second appointment from the master casts
10. The facebow record and maxilla-mandibular relation record are utilized to mount the master casts. This creates a representation of what and enables the establishment of what relationships?
Creates a relationship of the patient�s jaw relationship on the articulator and allows us to establish the proper maxillary to mandibular relationship
11. What does blocking out allow you do accomplish when fabricating record bases?
Keeps them from getting stuck onto the master casts due to undercuts of the acrylic
1. What are the three characteristics of Organic Occlusion (Natural Dentition)?
2. What are the three characteristics of Complete Denture Occlusion and how are they similar/different from Organic occlusion?
Bilateral posterior centric occlusion, �balanced� occlusion, centralized forces; both have bilateral posterior centric occlusion, but denture occlusion must be balanced and centralized in order to prevent tipping and allow for uniform forces on the residual ridges
3. What three fundamental differences of occlusion explain the inherent differences between complete denture occlusion and organic occlusion?
Retention, stability, support
4. Define Retention in terms of dislodgement of the denture base.
Resistance to dislodgement forces in a vertical direction away from bearing surfaces
5. Define Stability of a denture base.
Resistance to laterally oriented dislodgement forces
6. Define Support in terms of the denture base and anatomic structures.
Factors of the bearing surface that resist forces in a vertical direction toward them
7. T/F: An adequate denture can be made for a patient with an atrophied ridge and mobile tissues.
False: problem with support
8. What are the 5 consequences of tooth loss?
Change in intraoral structures, mastication, RRR, potential psycho-social problems, decreased facial support and muscle tone
9. Define Residual Ridge Resorption and how it differs between the mandible and maxilla.
Loss of bone structure over time; maxilla 0.1mm/year; mandible 0.4mm/year
10. How does the difference in RRR between the maxilla and mandible affect complete denture set-up?
Because the mandible resorbs much faster than the maxilla, have to be sure that the vertical forces are on ridge and are not putting lateral forces on the susceptible part of the ridge (being too buccal or lingual)
11. What are the 4 main goals of Complete Denture Occlusion?
Decrease trauma to supporting structures, preservation of remaining structures, enhance stability, and esthetics, mastication and speech
12. What is the single most important factor in the successful manipulation of complete dentures under function?
13. How is tooth function biomechanical in nature?
Governs lip support, contributes to maintaining the firmness of muscle tone, scaffold for facial activity
14. The incisal edge placement is determined by what phonetic sounds?
Fricative (F and V)
15. Lou Holtz wants a new set of dentures because his current dentures make him talk with a lisp (slurring sound). What must be changed in the new set-up in order to reduce the slurring and what biological activity most likely caused this change over time (assuming she didn�t have a lisp when she first received the old set of dentures)?
Need to decrease the distance between maxillary and mandibular incisors; probably due to ridge resorption over time
16. Your next patient is on their fourth clinical appointment and you are testing the wax trial denture. When you ask them to count from sixty to seventy, you notice that they have a slight whistling sound upon annunciation of the sibilant sounds. What feature of the wax-trial denture was not accurately estimated and how do you fix this problem?
Distance between maxillary and mandibular incisors (anterior portion of the occlusal plane); increase this distance to minimize whistling sounds
17. Overtime, both ridges recede with age in edentulous patients. If a patient originally had Class I skeletal relationship, what Class would you expect 10-15 years from now? How does this affect the positioning of the teeth in the maxilla vs. the mandible?
Would expect Class III; mandibular teeth end up more anterior and maxillary teeth end up more palatal as bone resorption continues with age
18. What are the three functional determinants of denture tooth position?
Tongue function, neuromuscular control, tooth position relative to tongue
19. Your patient comes into your office for their 7th denture appointment unhappy about their new dentures. They claim that they are having a difficult time chewing their food, keeping food out of the sides of their mouth and the dentures keep tipping off. Initially, it wasn�t an issue, but now that they have had the dentures for a week, it has gotten a lot more noticeable. Where should be the first place that you evaluate on the denture that may be causing this problem and how do you fix it?
The occlusal plane is too high
20. Mr. Smith just received his first set of new dentures and is very excited to have them. At his 7th appointment, he mentions that he is having a bit of trouble keeping his tongue in a comfortable position when he is not speaking or eating and that he has noticed a bit of a difference in the way he pronounces certain words over the past week. Because you are such an astute dentist that EPR�d Dr. Hamada�s Complete Denture course, you immediately know what the problem is and how to fix it. How do you instruct the lab to fix the problem with Mr. Smith�s dentures?
The arch is too narrow in the buccal-lingual dimension; make sure that the teeth are properly on ridge especially in the mandible
21. Mary comes into your office for her annual dental visit. You inspect her dentures and ask her if she has had any problems lately. She said that ever since she got the dentures six months ago, she has noticed increased tongue biting and problems with chewing food. When you inspect the occlusal plane height, what do you expect to find and how do you instruct the lab to fix it?
Occlusal plane is probably too low; tell them to make the denture over with a lower occlusal plane height after you re-measure with the wax rim.
22. Jim Bob reports to your office complaining of his lower denture constantly tipping off. He says that he has tried everything to keep it on, but it just won�t stay in place. When he comes into your office for a realignment, you notice that he has more than expected lateral resorption on his lower arch on the right side. When you look at the lower denture, what do you expect to find on the right side regarding ridge relationship?
Mandibular posterior teeth on the right side have their central grooves too buccal causing denture tipping and rapid residual ridge loss.
23. What are the three controlling end factors that must be in harmony in order to develop a fully balanced occlusion?
right and left condylar inclinations and incisal guidance with cuspal inclination
24. How do you accomplish this harmony with placement of the teeth in a denture?
Accomplished by setting the denture with a compensating curve formed by the intersection of Curves of Spee and Wilson
25. Curve of Spee + Curve of Wilson=__________________