Complete Dentures Question Bank

AestheticsDiagnosisDuplicationGerodonticsImmediate replacement denturesImpressionsMaterialsMiscellaneousOcclusionPrinciplesRelinesRest position, vertical dimension etcRetentionSingle dentures SpeechStomatitis etc

Aesthetics

Describe the clinical procedure when at the first recall of a complete denture patient dissatisfied with the appearance of the interior teeth.

Discuss the various guidelines which can be used to estimate the position in which artificial teeth should be set.

Discuss aesthetics with reference to complete dentures

Diagnosis

A patient presents with complete dentures that are 10 years old, and complains that they are loose and that her lips have “fallen in”. What information can you obtain by examining the patient’s existing dentures and how does this help you formulate a treatment plan?

Describe the psychological factors which may affect the relationship between the dentists and the edentulous patient. What possible bearing do these factors have on complete denture treatment and on the results obtained?

At the recall appointment, your patient complains that his lower denture hurts him in a particular area when he eats. How would you determine the cause of the pain and how would you solve the possible causes?

Your patient is a first-time denture wearer, after being edentulous for 2 years. After you have delivered the upper and lower complete dentures, he returns for the recall. He complains that the lower denture is loose. What are the possible causes?

It is often said that success in complete denture fabrication is unpredictable. Discuss the validity of this statement

Discuss the importance of a thorough evaluation of a patient’s existing dentures during the planning phase for new dentures

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Briefly discuss: “Information gained from existing dentures is an important aid in the construction of new dentures”.

Discuss the advantages of a careful evaluation of previous dentures An elderly female denture wearing patient complains that her lower complete denture has always been painful and loose. Discuss the possible causes for this patient’s complaints

Review the possible causes of looseness of a lower denture

A patient seeks advice because the lower denture is loose. Outline the approach you would use in investigating the cause of this complaint.

A patient seeks your advice because the lower denture is loose and pain is experienced when biting hard on it. Discuss your approach in investigating the cause of the complaint and list some possible solutions

How would you investigate a complaint from a new patient that the existing lower denture had always been painful when eating.

It has been said that “success in denture construction is not routine”. Outline the possible reasons for success being unpredictable in providing a patient with dentures

Discuss common prosthetic problems and complaints and their management in complete denture wearers

You are presented with an edentulous patient who has extreme resorption of the mandibular alveolar ridge. Discuss your approach to the treatment of this patient.

A 78yr old female patient presents, unaccompanied, in your surgery. Her main complaint is that her complete dentures are “blunt” and she cannot chew properly. She has been wearing dentures successfully for 41 years. Her current complete dentures are the fourth set she has had, and they were made 12 years before. In addition, she is taking moderate doses of an antihypertensive drug, a diuretic and a benzodiazepine to induce sleep.What oral clinical findings do you expect in this patient, how would you counsel this patient before you start treatment, and what problems would you expect in the making and the recall or follow up of new complete dentures for this patient?

A 60 year old edentulous female patient complains of a dry mouth, a burning sensation in the palatal area covered by her maxillary complete denture, and pain and discomfort from her mandibular complete denture. Both dentures have been worn for five years. What are the possible causes of this patient’s complaints? What special measures would you employ to address these problems and what treatment options could you offer the patient?

The arrangement of the twelve anterior teeth in a complete denture is important in achieving successful outcome for both operator and patient. There are many factors which determine their positioning, form, and appearance. The literature offers guidelines on how to yield good results and also draws attention to problems which complicate acquiring such results. Discuss this topic from a clinical and materials science stance.

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Duplication

Briefly describe and evaluate the use of a duplication method for providing new dentures for an elderly patient .

What are the clinical procedures involved in the duplication of complete dentures?

Describe in point form the laboratory steps taken during duplication of complete upper and lower dentures.

Describe the steps of a technique for the construction of a set of complete dentures which have become loose and lost 2-3 mm of vertical height, but which otherwise are entirely satisfactory, for a patient who has difficulty coming to your surgery and requests that you use as few visits as possible.

Gerodontics

Discuss the changes in facial appearance resulting from long-term edentulousness.

List ten significant problems which may be found in elderly patients.

Describe the aspect of ageing which influence the construction of dentures for a patient.

Immediate replacement dentures

Briefly explain the advantages and disadvantages of immediate replacement complete dentures to (a) the patient and (b) the dentist.

What are the contra-indications for immediate replacement dentures? What alternatives would you propose?

What factors influence the choice of immediate replacement dentures? List the advantages and disadvantages of such dentures.

A female patient presents at your surgery with an edentulous lower jaw, and an upper jaw with the following clinical findings:

A very prominent premaxillaThe second molars, third molars, and premolars are missing on both sides.The teeth are all periodontally compromised, and require extraction.The patient does not want the appearance to change.

Discuss fully all the clinical and laboratory steps involved in the management of this patient.

Briefly describe the follow-up prosthetic service you would render to a patient for whom a full clearance has been performed, and you have inserted complete maxillary and mandibular immediate replacement dentures.

List the indications for prescribing immediate replacement complete dentures.

Describe the cast trimming procedures required for the fabrication of a maxillary complete immediate replacement denture where the natural posterior teeth are missing, and where the extraction of the six maxillary anterior teeth is planned with interseptal alveolotomy

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Describe how cast trimming is performed when the teeth will be removed by simple extractions. Use diagrams to illustrate your answer

Discuss the follow-up treatment required during the first nine months after the placement of maxillary and mandibular complete immediate replacement dentures

Discuss the reasons that cast trimming procedures are performed during fabrication of immediate replacement complete dentures.

Impressions

a) Describe how and why stock trays are prepared prior to taking alginate primary impressions of edentulous patients.

b) Why and where are alginate primary impressions marked with a marking stick prior to being poured in the laboratory?

c) How is an alginate primary impression disinfected and then transported to the lab?

a) When and why would you use a spaced special tray for a secondary impression of an edentulous ridge?

b) When and why would you use a close fitting special tray for a secondary impression of an edentulous jaw?

c) How would you evaluate and prepare a maxillary spaced special tray prior to taking the secondary impression?

What are the anatomical landmarks which should be recorded by a lower impression?

Describe the techniques for taking final impressions for the following: A patient with an upper anterior flabby ridgeA patient with a lower resorbed and flabby ridge.

Describe some denture impression techniques you would use in order to ensure a correctly extended denture without having to use laboratory-constructed special trays.

Describe an impression technique you would use in order to ensure correctly extended complete dentures without having to use laboratory constructed special trays. Indicate the clinical conditions under which you would use this technique.

Discuss the indication for a functional impression and describe the technique you would use.

List the number of impression techniques you know for use in the construction of complete dentures and the clinical situations in which they would be most appropriate.

Describe two different techniques for the recording of a primary impression for the construction of complete dentures

Discuss the objectives you hope to achieve when making primary impressions

What material is usually used for secondary impressions for edentulous patients? What are the constituents of this material and what properties of this material make it suitable for this purpose?

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List an appropriate type of tray, the material to be used, and brief reasons for using these, to obtain a final impression for the following situations:

(a) a well formed upper ridge with bony undercuts in the tuberosity region(b) a well formed upper ridge, for which you have only one appointment to make the final

impression(c) an extremely resorbed lower ridge(d) an upper ridge with an anterior flabby area(e) a lower ridge which is flabby along the crest of the ridge

Materials

a) When and why are tissue conditioners used?b) What are the constituents of tissue conditioning materials?c) Why is a lubricant supplied with tissue conditioning material and what are its constituents?

a) When and why would you place a tissue conditioner in a patient’s denture?b) What are the disadvantages of tissue conditioning materials?

a) What factors affect the setting time of alginate and how do they affect the setting time?b) How is an alginate primary impression disinfected and transported to the laboratory?c) How would you mark and pour the impression to obtain a model suitable for making a special

tray?

Describe the methods of testing the hardness of dental materials

Discuss the composition, properties, handling and uses of tissue conditioners.

Explain what is meant by the term cross-linking when related to polymers, and the importance of cross-linking in the manufacture of acrylic teeth.

Discuss special trays under the following headings:1. Materials used2. types of design3. fabrication

Discuss polymethylmethacrylate (heat cured) in detail under the following headings:1. Composition1. Manipulation2. Curing3. Properties

Write notes on defects which may arise during the finishing stages of acrylic dentures.

Discuss the following:-1. The reason for distortion of dental waxes2. Flow of dental wax3. Setting stages of dental plasters4. Wet strength and dry strength of dental plasters

Write short notes on:1. Stress-strain curve2. The control of the settings time of alginate hydrocolloids

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3. Dimensional stability on storage of impressions taken with alginate hydrocolloids and zinc oxide impression paste.

Discuss irreversible hydrocolloid impression material under the following headings:1. Composition2. Settings reaction3. Manipulation4. Dimensional stability on storage.

Write short notes on:1. Wet strength of dental plaster.2. Effect of water temperature on the setting time of alginate impression material.3. Distortion of waxes.4. Dimensional stability of:

Zinc-oxide eugenol impression material. Plaster impression material.

Setting stages of dental plaster.

Name 2 types of porosity occurring in polymethylmethacrylate. Describe how you would differentiate between the 2 types; explain how each type of porosity occurs, and how each type of porosity can be avoided in denture processing.

Discuss alginate impression materials under the following headings1. Composition2. Setting reaction3. Dimensional stability on storage

Describe what defects or undesirable changes may occur during the flasking, curing and deflasking of complete acrylic dentures. How would you prevent/ rectify these?

Describe the setting stages of model plaster.

Describe the stages the polymer/monomer mixture of acrylic resin goes through on standing.

Describe, in point form, the advantages and disadvantages of irreversible hydrocolloid impression materials.

What properties of the following materials make them suitable for the application stated?1. Alminax as an inter-occlusal recording material2. Zinc oxide-eugenol paste as a final impression material3. Polymethylmethacrylate as a denture base resin4. Polyethylmethacrylate as a tissue conditioner

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Miscellaneous

At the delivery appointment, what advice and/or instructions would you give your patient on cleaning and getting used to the new denture, and returning for recall appointments?

Discuss the important of recall visits for patients with complete and partial dentures.

In what circumstances would you consider the need for a surgical approach to treatment of soreness under a denture.

Discuss the indications for preprosthetic surgery in complete denture wearers and outline the benefits that can be anticipated.

Describe the steps you would take in delivering a finished complete denture to your patient.

Discuss the rationale for (tooth borne) overdenture treatment. Mention briefly the indications and contra-indications for treatment. What follow-up treatment would you advocate after overdenture construction?

Write notes on the following:1. The uses of close fitting and spaced special trays2. The reasons for the post flasking remount of complete dentures3. The reasons for face bow recording

Write short notes on freeway space.

Write short notes on:1. A single complete maxillary denture opposing natural mandibular teeth.2. The clinical features of denture stomatitis.3. The use of tissue conditioners4. The wrought gold combination clasp system.5. Positioning the upper central incisors in complete denture.

Write short notes on:1. Vertical dimension of occlusion (VDO)2. Closest speaking space.3. Physiological rest position.4. Freeway space5. The treatment of denture hyperplasia

Write short notes on the following:1. The clinical and laboratory procedures for adding a tooth to an acrylic partial denture2. The problems which might arise when a denture has been fabricated at an excessive occlusal

vertical dimension3. The reason for recontouring natural teeth in preparation for a partial denture.

Write short notes on the laboratory steps for the following1. duplication of complete dentures2. relining3. re-mounting using the indexed-cast method

a. What is meant by the “ position of neutrality”? b. Discuss the rationale for the need to establish the “position of neutrality” in complete denture fabrication

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What is meant by and also what is the importance of determining the “position of neutrality”?

In what way would the setting-up of the artificial teeth be similar or different from the natural dentition in: 1. The horizontal plane? 2. The saggital plane? 3. The frontal plane?

Occlusion

Define the following terms: Occlusion Centric occlusion Centric relation Terminal hinge axis

Write short notes on: The rationale of balancing occlusion Lingualised occlusion

a) What in your opinion, is the ideal occlusal scheme when making complete dentures, and why do you recommend it?

b) In this scheme, which teeth and / or cusps are in contact in centric occlusion?c) In this scheme, which teeth and /or cusps are in contact in a protrusive excursion?d) In this scheme, which teeth and /or cusps are in contact in a right lateral excursion?

Discuss the possible advantages of using a semi-adjustable articulator in constructing partial and single dentures.

Draw and label the border movements of the mandibular mid-incisal point in the sagittal plane.

Discuss mandibular movements and their control.

Discuss the advantages of a lingualised occlusion in complete dentures.

Give definitions for the following.1. Occlusion.2. Centric occlusion.3. Centric relation.4. Lingualised articulation.5. Working interference.

On remounting a set of complete dentures after de-flasking, the occlusion in no longer balanced and the vertical dimension has increased by 1.5mm. Describe the procedures you would undertake to correct these errors.

Discuss the need for balancing denture occlusion.

Discuss the factors which must be considered in developing a balanced articulation. Explain how these factors interact in Class I, Class II and Class III jaw relationship set-ups.

Describe the factors you would consider in balancing Class I, Class II, and Class III set-ups.

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Explain what steps you would take in a complete denture setup to ensure correct arch form and compensating curves of occlusion.

Define balanced articulation and its function.

Discuss occlusion with reference to complete dentures.

Describe :1. How you would determine centric relation for a complete edentate patient2. The problems which may arise in the event that centric relation and centric occlusion do not

coincide in the completed denture3. Your approach to the solutions of such a problem

Compile a list of instructions to a laboratory which could be used in correcting occlusal errors of finished dentures one step at a time.

Discuss the use of compensating curves when setting teeth for balance.

Describe the laboratory procedures use in the correction of occlusal errors of finished complete dentures.

Describe the technique for removing centric and eccentric interferences in complete dentures

What is the purpose of a post-flasking laboratory remount, and how is it performed?

At the try-in stage for complete dentures you notice that the teeth (which are cusped) do not occlude in a balanced excursive scheme. Describe how you would alter them to do so assuming you are using an articulator set to average condylar guidance angles and there is a normal skeletal jaw relationship.

Wear of dentures teeth may be a disadvantage: why is this so?

Discuss the role of articulators in the construction of complete dentures.

Discuss the use of anatomical articulators in developing an occlusal scheme for eccentric balance.

What, in your opinion, are the most important features of occlusion and articulation for removable prostheses (complete dentures, single complete dentures, and partial dentures of different classes)?

Discuss the occlusal problems with and solutions to setting up teeth for complete dentures for a patient with a Class III jaw relationship. Discuss the selection of an appropriate articulator for the following:

a) Construction of a complete denture for a patient with a skeletal Class II relationshipb) Construction of distal extension base lower partial denture.

Present a critical analysis of different occlusal schemes used in complete dentures. Indicate appropriate applications of each scheme you discuss.

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Principles

Discuss the design of the postdam in the maxillary complete denture.

Discuss the biomechanical principles of support in a complete lower denture and the application of these principles to making an impression for the denture base.

a) Define “support” in terms of complete dentures.b) What area(s) of the edentulous maxilla are primary stress bearing areas for a complete

denture, and why?c) What area(s) of the edentulous mandible are primary stress bearing areas for a complete

denture, and why?

Briefly explain the problem of support in complete dentures, the areas which provide the best support and why they do so.

Explain how the anatomy of the following structures contribute to retention and/or stability and/or support of complete dentures:

the hard palate the buccal shelf the retro - mylohyoid fossa

Draw and label a diagram showing th primary and secondary stress bearing areas for :

1. a maxillary complete denture2. a mandibular complete denture

List factors affecting the stability of a full mandibular denture

Describe alternative strategies for the management of an undercut caused by a bulbous maxillary tuberosity and comment on the advantages and disadvantages of each one

With the aid of a diagram show the changes of arch from that occur subsequent to the extraction of all the teeth. Why is it important to be aware of such changes?

Describe the pattern of ridge resorption in the human jaws. How does this knowledge help you to achieve correct arch form?

How does bone resorption determine the position of teeth in complete dentures?

Describe the pattern of bone resorption in human jaws, and explain the relationship of the artificial teeth to the resorbed ridges in the maxilla and the mandible.

Describe the anatomy and clinical importance of the following: lingual pouch, retromolar pad, vibrating line, rugae, buccal shelf, pterygomandibular raphe and hamular notch.

Discuss the surface anatomy of the denture bearing areas, and explain the importance of each structure in complete denture construction.

Describe the anatomical features affecting complete dentures in the lower jaw, and explain the importance of those features for retention, stability or support.

Discuss the anatomy of the mandibular denture bearing area with reference to retention, stability and support.

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Describe the anatomy of the denture bearing area of a complete mandibular denture, and indicate the importance of each structure in denture fabrication.

Discuss the concepts of the neutral zone and describe and justify its use for the patient requiring complete dentures.

What factors in denture fabrication lead to optimal retention and stability of mandibular complete dentures? Explain how and why they do.

Relines

a) Define relining and rebasing.b) When is relining a complete denture indicated?

Discuss the indications for rebasing a denture

(a) Discuss the indications and contraindications for relining a complete lower denture(b) What is the difference between a reline and a rebase?(c) Describe the procedures, step by step, you would use to reline a complete lower denture with

a Cawood and Howell Class V ridge

Under what circumstances would you recommend to a patient that an existing denture be relined?

What are the indications for relining a denture? Describe some of the advantages of this procedure.

Write short notes on the laboratory steps for relining a denture.

Summarize in point form the steps taken during relining a denture

Describe in point form the laboratory steps during relining and rebasing of complete dentures.

Enumerate the reasons for permanently relining1. a maxillary complete denture2. a mandibular complete dentureWhat problems would you anticipate and what precautions would you take in both the clinical and laboratory situations?

What are the indications for relining a maxillary complete denture? Briefly describe the procedure and its possible disadvantages

Discuss the use of resilient denture lining materials. Include in your discussions, the difference materials available, the indications for using each type, special considerations in their application, replacement and maintenance intervals, and the instructions you would give patients for the careof these materials.

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Rest position, vertical dimension etc

You are making complete dentures for a patient, aged 68 years, whose previous dentures are 15 years old. He has been happy with dentures, except that they have been loose for a few months. You measure the freeway space of the old dentures at 7mma) At the jaw relation recording, what factors would you consider when deciding how much

freeway space should be present in the new dentures?b) What are the consequences of providing too little or no freeway space for complete

dentures?c) At the try-in stage, in the patient’s mouth, how would you assess:

i) the occlusal plane, and ii) the arch form?

You are at the try in stage of making new complete dentures. When examining the patient you record VDR = 70mm with the Willis gauge. The vertical dimension in occlusion (VDO) = 68 mm and the inter-alveolar distance (IAD) of the trial dentures is 21mm, when measured with figure-of-8 callipers. You had planned a freeway space (FWS) of 5mm for the patient with the new dentures.a) Is there too much freeway space or too little freeway space with the trial denture?b) What should the VDO measure when you have corrected it?c) What should the IAD measure when you have corrected it?

You have decided that the correct freeway space for your patient is 4mm. The vertical dimension at rest measures 70mm. When the patient closes on the occlusion rims, the vertical dimension of occlusion is 68mm. Briefly describe the steps you would take when adjusting the occlusion rims, in order to achieve the desired freeway space.

You are delivering a new set of complete dentures to your patient. When the patient closes into centric relation, you notice that some of the posterior teeth on the patient’s right side contact before the rest of the teeth contact.a) What is your diagnosis?b) How could this have happened?c) How do you correct this?d) Why should it be corrected?

Briefly describe the guidelines which may be useful in establishing an acceptable vertical height of occlusion for an edentulous patient and comment on the use of these guidelines for a patient who has not been wearing a denture for many years, and for a patient who has worn the same set of dentures for many years and who has a measurable freeway space of 8mm.

Discuss the mechanical and physiological methods of determining and then assessing the vertical jaw relations during the construction of complete dentures.

Define freeway space and describe the problems which are likely to arise if a complete denture patient is given:

1. too much freeway space2. too little freeway space

Briefly discuss this statement: “The rest position of the mandible is constant and therefore plays a vital role in the construction of complete dentures “.

Describe the information conveyed from the surgery to the laboratory by occlusion rims.

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Retention

a) Referring to any denture, what is retention?b) What types of retention apply to partial dentures, and how are they achieved?

Discuss the importance of a peripheral seal in denture retention.

You are delivering a new set of complete dentures to your patient. When you place the upper denture into the mouth, it has very poor retention. What are the possible reasons for the poor retention, and how can they be solved?

At delivery of a complete upper denture you find that it has very poor retention. List the steps you would take to correct this.

You are delivering a new set of complete dentures to your patient. When you place the upper denture into the mouth, it has very poor retention. What are the possible reasons for the poor retention, and how can they be solved?

Write short notes on peripheral and posterior palatal seal, using diagrams.

What factors affect the retention of complete dentures? Briefly state the effect of each factor.

Single dentures

Highlight the differences in approach and techniques when providing a single denture opposed by natural teeth in contrast with the provision of complete upper and lower dentures. A patient presents with a mild-line fracture of a complete upper denture. Enquiry reveals that this is the third time this has occurred, and each time the fracture occurred whilst the patient was eating. Examination reveals a denture that is three years old, and that it is a single upper denture opposed by the following dentition:47 45 43 42 41 31 32 33 34 37. The lower molars are tipped mesially, and the 45 is rotated. Discuss the possible causes of he repeated fractures, and the treatment options you would advise.

Discuss the problems associated with a single mandibular denture, what measures could you take to improve on or resolve these problems

Discuss the differences in approach and techniques when providing a single denture opposed by natural teeth in contrast with the provision of complete upper and lower dentures Briefly describe the problems that would be expected in a patient wearing a single maxillary denture.

Describe the management of problems which are unique to treatment of those patients who have a complete mandibular dentition and require a complete maxillary denture.

Describe all the possible differences in the procedures used, when constructing a single upper denture opposing a lower natural dentition, as compared to the construction of a set of complete dentures.

A patient presents requesting a complete upper denture but examination reveals a flabby anterior ridge. List the options for the management of this condition and discuss the rationale for each.

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Discuss in point form the variety of factors which you would consider as important in planning a complete single maxillary denture for a 50 year old patient with an upper edentulous mouth and with 35 to 45 present in the mandible.

Speech

a) How is the ‘s’ sound produced, and how could dentures affect or impair the production of ‘s’ sounds.

b) What phonetic tests could be used to evaluate the positioning of the anterior teeth?

Stomatitis etc

Discuss the management of denture stomatitis.

Write brief notes on denture stomatitis.

Describe the classification and clinical appearance of denture stomatitis.

Describe the classification, clinical presentation and treatment of denture stomatitis

A patient who consults you about new complete dentures wears old dentures which are ill-fitting and unhygienic. You notice that the patient’s palate has a diffuse erythematous and oedematous appearance and you have diagnosed this condition as a Newton type II denture stomatitis. In addition you notice an area of denture hyperplasia (epulis fissuratum) in the regions of the genial tubercles. In view of the presence of these two pathological conditions, discuss the special measures that you would adopt in the treatment of this patient

What is denture hyperplasia (epulis fissuratum) and how is caused?

Denture stomatitis: What are the common aetiological factors? Name the 3 basic types and describe the clinical presentation of each by means of diagramsBriefly describe how you would treat each of these types Write short notes on denture stomatitis in relation to the following headings:

Clinical signs and/or symptomsPrevalencePredisposing factorsTissue coverageOrganisms involvedHistopathology and pathogenesis Types1, 2 and 3Treatment modalities By practitioner By patientInstructions to patients