Denture Midterm

Front 1

Inner/tissue surface of a denture?

Back 1

Intaglio surface

Front 2

Outside/cheek surface of a denture?

Back 2

Cameo surface

Front 3

Tissue extensions of denture?

Back 3

Flange

Front 4

Periphery of denture flanges?

Back 4

Border

Front 5

Is “Complete Denture” or “Full Denture” the proper terminology?

Back 5

“Complete Denture”

Front 6

Are tooth loss trends rising or falling?

Back 6

falling rate

Front 7

Are the number of edentulous patients increasing or decreasing?

Back 7

increasing (due to increased pop and living longer)

Front 8

What percent of edentulous patients are dissatisfied with their complete dentures?

Back 8

5-20% (7.7% on pi chart)

Front 9

What percent of edentulous patients are fully satisfied with their complete dentures?

Back 9

66.7%

Front 10

What percent of edentulous patients are moderately satisfied with their complete dentures?

Back 10

25.6%

Front 11

T/F.. Increase in esthetic awareness has prompted an increase in patient demand for prosth?

Back 11

true

Front 12

What are several consequences of tooth loss in a patients overall profile?

Back 12

loss of facial support and muscle tonus

Front 13

What are the factors that decrease with age, affecting the proper fit and function of dentures?

Back 13

Denture support area, neuromuscular control, chewing force, salivary flow due to medication(s), Healing capacity, quality of denture bearing tissues

Front 14

As a consequence of tooth loss, an edentulous patient will experience residual ridge resorption of the maxilla in a __________ and _________ direction at a rate of _______ per year?

Back 14

vertical and palatal direction, rate of 0.1mm/year

Front 15

As a consequence of tooth loss, an edentulous patient will experience residual ridge resorption of the mandible in a __________ and _________ direction at a rate of _______ per year?

Back 15

vertical and oriented along cross sectional shape of mandible, rate of 0.4mm/year (4x maxillary)

Front 16

When is residual ridge resorption the greatest?

Back 16

the 1 year after extractions

Front 17

What are the two components to a Pre-treatment patient evaluation?

Back 17

1. Interview & 2. Detailed intra/extra-oral evaluation

Front 18

What is the most important component of a new patient interview, and is even more important than the treating your patient?

Back 18

Getting to know your patient

Front 19

What are some helpful intra-oral areas to evaluate during an exam?

Back 19

denture bearing sufaces, soft palate, tosillar regions, vestibule, buccal mucosa, hamular notch and definition of tuberosities

Front 20

Where is the first sign of oral cancer often palpable?

Back 20

a palpable lymph node

Front 21

What are some diseases that can be evalualted/identified through a thourough oral exam?

Back 21

Diabetes, Malignancies, HIV infection

Front 22

What oral manifestations does Diabetes type I present?

Back 22

Epithelium that is thin and less keratinized resulting in compromised support and impaired tolerance of complete dentures

Front 23

What is the potential outcome of leukoplakia/erythroplakia in the oral cavity?

Back 23

transformation into squamous cell carcinoma

Front 24

What is the survival rate of patients with squamous cell carcinoma?

Back 24

less than 50% (with early detection can better)

Front 25

Are early oral cancers easy to detect?

Back 25

No, can be confused with other phenomina

Front 26

Are late oral cancers easy to detect?

Back 26

Yes, but cure rates are low at this point

Front 27

Retention is the resistance to _______ displacement of the denture from the denture bearing surface during function?

Back 27

Vertical displacement

Front 28

Stability is the resistance to _______ displacement of the denture from the denture bearing surface during function?

Back 28

Lateral displacement

Front 29

Support is the resistance to _______ displacement of the denture from the denture bearing surface during function?

Back 29

Vertical forces of occlusion (resists or absorbs occlusal loads during function)

Front 30

Factors that impact retention, stability, and support of a denture are?

Back 30

Quality of oral mucosa (denture bearing surfaces), Alveolar ridge contour, Muscle attachments, Saliva, Neuromuscular control

Front 31

How is the quality of the oral mucosa determined?

Back 31

degree of keratinization, amount of attached mucosa vs unattached

Front 32

In which arch is the availability of keratinized tissue most important?

Back 32

the mandible (for better support = more resistant to occlusal forces)

Front 33

Keratinized attached mucosa id the remnant of what?

Back 33

attached gingival

Front 34

Is it better to have more or less keratinized tissue on denture bearing surfaces?

Back 34

more (better support = more resistant to occlusal forces)

Front 35

Where is keratinized tissue found on a maxillary edentulous patient?

Back 35

covering the entire palate and alveolar ridges

Front 36

Where is keratinized tissue found on a maxillary edentulous patient?

Back 36

narrow zone of attached mucosa confined to the alveolar ridges

Front 37

When keratinized tissue is lost the result is?

Back 37

reduced support, reduced tolerance to occlusal load

Front 38

What are the three factors negatively impacted by residual ridge resorption?

Back 38

Retention, Stability, Support

Front 39

Which alveolar ridge contour resorbs faster?

Back 39

mandibular is 4x faster (.4mm/yr) than maxillary (.1mm/yr)

Front 40

What tends to result with residual ridge resorption in the mandible, and the mylohyoid attachment?

Back 40

The mylohyoid ridge becomes sharp on the lingual surface (continued calcification of attachment), overlying mucosa is poorly keratinized and prone to perforation from denture trauma

Front 41

What are the primary support areas of a mandibular complete denture?

Back 41

Retromolar pad, buccal shelf, alveolar process

Front 42

Of the primary support areas of a mandibular complete denture (Retromolar pad, buccal shelf, alveolar process), which is most affected by the process of bone resorption?

Back 42

alveolar process

Front 43

Of the primary support areas of a mandibular complete denture (Retromolar pad, buccal shelf, alveolar process), which is least affected by the process of bone resorption?

Back 43

Retromolar pad (relatively unchanging structure, does NOT resorb from denture use)

Front 44

What is the retromolar pad made of?

Back 44

glandular tissue, loose areolar connective tissue, lower margin of the pterygo mandibular raphe, fibers of the buccinators/ superior constrictor/ temporal tendon

Front 45

What are the boundaries of the buccal shelf?

Back 45

crest of the alveolar ridge and external oblique line (Masster groove area)

Front 46

What limits the extension/access of the buccal shelf?

Back 46

attachment of the buccinator

Front 47

Why is the buccal shelf a primary support area?

Back 47

it is parallel to the occlusal plane, is relatively resistant to resorption

Front 48

What is the dimensional pattern (not direction) off residual ridge resorption in the mandible?

Back 48

1)buccal-lingual narrowing (compromising support) 2)Height reduced (compromising support, stability, retention)

Front 49

Immediately following extraction of maxillary teeth, residual ridge resorption occurs in what direction?

Back 49

Mostly due to the thin labial plate on the maxilla, resoption is from buccal-labial towards the lingual (palatal direction), affecting stability and support

Front 50

What is the result of continued loss of vertical height of the alveolus?

Back 50

less stability of denture, pseudo class III jaw relation, less retention (secondary to less stability – peripheral seal can be broken with lateral displacement)

Front 51

What is “Combination Syndrome”, and what causes it?

Back 51

When an edentulous maxilla is opposed by a partially dentate mandible (anterior dentition) that has a steep anterior guide, the lack of contacts in working, balancing and protrusive movements during chewing causes the denture to tip anteriroly in the maxilla compressing the mucoperiosteum in the premaxilla (anterior), resulting in specific pattern of bone resorption of the premaxillary area

Front 52

What negative effects does “combination syndrome” present?

Back 52

resorption of the premaxilla, hypertrophy of maxillary tuberosity, and occlusal plane problems

Front 53

Can combination “syndrome occur” in the mandible?

Back 53

Yes, if a dentate maxillary arch opposes a mandibular arch

Front 54

What are some measure you can take to prevent or slow resorption?

Back 54

1) well adapted and properly extended dentures with good design and good occlusion 2) retention of residual tooth roots in key locations 3) implants 4) tissue bar connected to implants

Front 55

What is the frenum made of?

Back 55

mucous membrane containing fibrous connective tissue

Front 56

What is the main concern of the frenum?

Back 56

may limit denture extensions or make seal difficult to maintain

Front 57

Can the tongue position affect the stability and retention of the denture?

Back 57

yes

Front 58

Can the floor of the mouth affect the stability and retention of the denture?

Back 58

yes it affects the lingual flange, the longer the flange the better it is referred to as “floor of the mouth posture”

Front 59

What is a good way to test the functional depth of the alveolingual sulcus in the retromylohyoid sulcus?

Back 59

place a mirror in the retromylohyoid space and ask patient to move tongue from side to side, if mirror not displaced much than space if favorable

Front 60

What is a good solution to a retruded tongue position and unfavorable alveolingual sulcus?

Back 60

1) Dentures retained with osseointegrated implants 2) skin graft vestibuloplasty

Front 61

What is the purpose of a skin graft vestibuloplasty?

Back 61

to augment (widen) keratinized skin zone and results in a lower muscle attachments in the floor of the mouth

Front 62

What is present in the posterior palate that permits the compression of the tissues, helping create a peripheral denture seal (“posterior palatal seal”)?

Back 62

posterior palatine salivary glands (is compressible and gives leeway to overcome discrepancy caused by acrylic resin shrinkage)

Front 63

What happens to the tissues of the posterior palate when posterior palatine salivary glands atrophy?

Back 63

the tissues become less compressible (difficult to obtain peripheral seal)

Front 64

What is compromised when salivary flow rates decrease?

Back 64

adhesion and cohesion of the peripheral seal in maxillary denture, and results in more friction in mandibular denture degrading denture bearing surfaces

Front 65

How important is neuromuscular control in patient satisfaction of complete denture?

Back 65

good neuromuscular control can overcome unfavorable bearing surface contours and anatomy and will be able to chew efficiently

Front 66

What are the tissue factors affecting support of the mandibular complete denture?

Back 66

retromolar pad, alveolar ridge contours, amount of attached keratinized mucosa, buccal shelf area

Front 67

What are the tissue factors affecting support of the maxillary complete denture?

Back 67

amount of keratinized mucosa, alveolar ridge contours, palatal shelf area and contour

Front 68

What are the tissue factors affecting the stability of the mandibular complete denture?

Back 68

alveolar ridge height, floor of mouth contour, tongue position, neuromuscular control, presence of flabby, moveable denture bearing surface tissues

Front 69

What are the tissue factors affecting the stability of the maxillary complete denture?

Back 69

alveolar ridge height, well formed maxillary moveable denture bearing surface tissues and tuberosities, presence of flabby ridges (mobile)

Front 70

What factors affect mandibular denture retention?

Back 70

Primary: tongue position, floor of mouth posture, neuromuscular control Secondary: peripheral seal, adhesion, cohesion

Front 71

What factors affect maxillary denture retention?

Back 71

Shape of palatal vault (peripheral seal), drape of soft palate (house classification), quality and quantity of saliva, compressibility of posterior palatal seal area, well shaped tuberosities, height of alveolar ridge

Front 72

What are 3 anatomical factors impacting retention, stability, and support?

Back 72

mucosa, bone and muscle attachments

Front 73

What factors are consider when evaluating mucosa for dentures?

Back 73

attached vs unattached, degree of keratinization

Front 74

What factors are consider when evaluating bone for dentures?

Back 74

height of contour of alveolar ridge, presence of tori, resorption patterns

Front 75

What factors are consider when evaluating muscle attachments for dentures?

Back 75

frenum, floor of mouth, mylohyoid, retromylohyoid space, tongue position

Front 76

What structure defines the border of the denture in the oral cavity?

Back 76

vestibule

Front 77

What produces naroow vertical notch in denture flange?

Back 77

labial frenum

Front 78

What bony structure provides support, prevents denture from rotating, and improves stability?

Back 78

canine eminence (not always present)

Front 79

What area should always be relieved to avoid a disruption in blood flow and impingement on the nerve?

Back 79

incisive papilla, produces a concavity in intaglio of denture

Front 80

Lack of what may result in inadequate lip support on a denture?

Back 80

canine eminence

Front 81

What is the tuberosity used for in a denture?

Back 81

primary support area and resistance to horizontal movements

Front 82

What is another term used when referring to the junction of the hard and soft palate?

Back 82

vibrating line

Front 83

Where is the posterior palatal seal are located in relation to the vibrating line?

Back 83

distal

Front 84

Can rugae be used as support for a maxillary complete denture?

Back 84

yes, as secondary support and resistance to anterior displacement

Front 85

Does the hamular notch need to be captured in the denture impression?

Back 85

yes, it is critical for retention of max. denture

Front 86

What type of resistance do the tuberosities provide?

Back 86

resistance to lateral movement and rotation in the horizontal plane

Front 87

The width of the distobuccal flange will be contoured by the anterior border of the _________?

Back 87

coronoid process, if too thick, coronoid process impinges on border

Front 88

What are the two pits/depressions in the posterior portion aspect of the palate, on each side of the midline, near vibrating line (1.31mm in front of), and are useful in determining the posterior extent of the denture?

Back 88

foveae palatine

Front 89

Where are the minor salivary gland located in the palate?

Back 89

posterior third of the hard palate, very glandular and displaceable

Front 90

What is represented in the denture border as concavities on the posterior lateral borders?

Back 90

Coronoid process

Front 91

When you border mold, you should ask the patient to move the mandible from side to side, why?

Back 91

to accomodate coronoid process movements

Front 92

If the posterior palatal seal is lost in a maxillary denture, what will result?

Back 92

loss of retention and patient will feel like gagging

Front 93

What would be responsible for producing concavities on the border of the denture adjacent to each tuberosity?

Back 93

pterygomandibular raphe

Front 94

How do you capture the pterygomandibular raphe in a denture impression?

Back 94

have the patient open wide and extend chin during border molding

Front 95

What define the posterior border of the edentulous ridge (posterior border of denture)?

Back 95

Hamular notches, need to always extend impression beyond

Front 96

What structure in the maxilla can be likened to the buccal shelf in the mandible as a stress bearing area?

Back 96

zygomatico-alveolar crest (not as good as load bearing, because mucosa is poorly keratinized)

Front 97

If the zygomatico-alveolar crest is overextended, the denture could cut into the vestibular mucosa during use, where would this be identified on a cast?

Back 97

a bony ledge extending form about the first molar region of maxillary vestibule

Front 98

Is a high palatal vault conducive to stability and support of a denture?

Back 98

no, due to underlying inclined planes

Front 99

Where should relief be provided on a maxillary denture?

Back 99

along midline palatal suture and major palatine foramen (except greater palatine foramen due to thick tissue)

Front 100

What are the primary load bearing areas of a maxillary denture?

Back 100

hard palate and posterior ridges

Front 101

When fabricating a mandibular complete denture, is the alveolar ridge considered a primary or secondary support area?

Back 101

secondary (due to high rate or resorption)

Front 102

When fabricating a mandibular complete denture, what is considered the primary load bearing area?

Back 102

buccal shelf

Front 103

When fabricating a mandibular complete denture, what is considered the primary support areas?

Back 103

buccal shelf, retromolar pad

Front 104

What determines the access to the buccal shelf on a mandibular impression/denture?

Back 104

buccinator muscle

Front 105

Where does the buccinators attach on the mandible?

Back 105

the external oblique line

Front 106

What does the external oblique line an anatomic guide for when fabricating a denture?

Back 106

the lateral termination of the buccal flange of the mandibular denture

Front 107

If the mandible has severely resorption, what happens to the buccal shelf?

Back 107

size and position change

Front 108

What results if you overextend denture borders?

Back 108

destabilizing forces and irritation to patient

Front 109

Movement of which muscle during border molding influences the thickness of the anterior flange of the lower denture?

Back 109

mentalis muscle, have patient elevate lower lip and purse lips during border molding

Front 110

If the custom tray raises on its own when tried in, what does that indicate?

Back 110

it is overextended

Front 111

What purpose does the alveolar ridge provide in mandibular denture?

Back 111

resistance to horizontal movement (should be free from undercuts)

Front 112

How would you accommodate for the lingual frenum when border molding?

Back 112

have patient elevate and extend tongue

Front 113

If mandible has severe residual ridge resorption, what foramen must be relieved to prevent nerve compression and pain?

Back 113

mental foramen

Front 114

Along with the external oblique ridge, what structure in a that same vicinity must be considered when contouring the distobuccal flange to avoid displacement and soreness?

Back 114

Masseter groove (masseter muscle)

Front 115

What space lies posterior to the alveolingual sulcus, and what is its purpose when fabricating a denture?

Back 115

retromylohyoid space (important for stability and retention), lingual denture flange should be extende into this area in mand denture

Front 116

Could the geniotubercle spines ever present a problem in denture fabrication?

Back 116

yes, in severe resorption cases, relief must be made for these cases

Front 117

What muscle determines the lingual flange extension of the mandibular denture?

Back 117

the mylohyoid muscle

Front 118

What are the two types of muscles origins of the tongue?

Back 118

Intrinsic and extrinsic

Front 119

What percent of tongues are abnormal in size, position or shape?

Back 119

35%

Front 120

What tongue position is most unfavorable for denture retention and stability?

Back 120

retruded

Front 121

Do the muscles of facial expression generally insert into bone?

Back 121

no

Front 122

What is the modiolus?

Back 122

concentration of several muscle groups and is lateral and slightly superior to the corner of the mouth, is very forceful

Front 123

What influences the labial flange thickness of maxillary denture?

Back 123

modiolus

Front 124

If you lose tension of your buccinators as you age, what results?

Back 124

cheek biting

Front 125

What muscle determines the length and thickness of the labial flange extension of the lower denture?

Back 125

mentalis muscle

Front 126

How can you capture the masseteric groove in a denture impression?

Back 126

have patient open wide, move chin forward and side to side (may not show up in every impression, that’s ok)

Front 127

Is the retromylohyoid space important to capture? How do you do this when taking an impression?

Back 127

yes, it provides great stability, have the patient extend and elevate the tongue and move it side to side