Introduction to Prosthodontics

• Complete denture assessment - the history:

  • Reason for attendance
  • Presenting complaint
  • History of the presenting complaint
  • Denture history
  • Medical history
  • Social history

  The history should be in the pt's own words.
• Extra-oral observations will start being made as soon as you see the patient and start talking to them:

  • Does it look as though the dentures are providing any lip support for the upper lip
  • Does it look as though the patient is over-closed, such that the lower face height looks reduced compared to the other aspects of the face
• Intra-oral observations:

  • Ask pt to remove dentures - have a denture pot filled with a bit of water handy.
  • Look & feel around denture-bearing tissues.
  • Describe ridge form - is it rounded/flat? Is it well/poorly formed? Does it look atrophic in areas? Are there any bony undercuts/protuberances?
  • Look at colour of tissues too - do they look pink & healthy? Does it look erythematous; could indicate issues w/ denture hygiene.
  • Look at position of frenal attachments - sit high on ridge or further away - see if they're going to impinge on fit of the denture on peripheral extensions.

  
• Palpate the ridges too - are they firm or is there mobility of the tissues:

  • Class I is the situation present in a dentate patient.
  • Class II is the ridge form immediately after extraction.
  • Class III is a well-rounded ridge form with adequate height and width.
  • Class IV is a knife-edged appearance with adequate height but inadequate width.
  • Class V is a flat ridge form with inadequate height and width.
  • Class VI is a depressed ridge form with some potential loss of basalar bone too.

  
• Retention vs stability:

  • Ask pt to put dentures back in and gently open their mouth a few millimetres. Note what you see:
  • Are the dentures staying in place?
  • Are the maxillary dentures displaced vertically?
  • Is there any visible displacement of the mandibular denture?

  
• Retention = the capacity of the dentures to resist displacement away from the tissues
• Stability = the capacity of the dentures to resist movement whilst in contact with the tissues (so horizontal and rotational forces)
• Support = the the resistance of vertical movement towards the ridge - how much the denture covers the denture-bearing anatomy without impinging on anything that will displace it
• When examining occlusal surfaces check:

  • Relationship of RCP (retruded contract position) to ICP (intercuspal position)
  • Occlusal contacts
  • Freeway space
• Denture assessments - polished surfaces:

  • Anterior tooth position
  • Labio-palatal/lingual
  • Incisal level
  • Orientation of the incisal plane
  • Size, shape and shade of teeth
  • Posterior teeth
  • Orientation of the occlusal plane
  • Bucco-lingual/palatal position
• Assessment of implant supported overdentures:

  • In principle similar to conventional dentures
  • ISODs gain retention and stability from implant attachments located within the fitting surface of the denture
  • Addition to conventional denture assessment
  • Assess the implants
  • Periodontal health around implants components within denture base
• Prognosis:

  • Prediction of success of replacement dentures
  • Factors that might influence pt satisfaction
  • Previous denture wear - number of pairs they've worn in the past
  • Satisfaction with denture aesthetics
  • Pt expectations
  • Ridge anatomy
  • Note - the evidence in this area is poor, further well-conducted studies required
  • Aligning pt expectations and your own