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Notify me of follow-up comments by email. Notify me of new posts by email. Been Medical Video Lectures Dr. The lesion should be cured and the lo tissue should be given adequate rest for sufficient Hypermobile tissues result due to excessive residual ridge resorption. These mobile tissues should For patients with normal tissues, hour rest be recorded carefully using a mucostatic with frequent tissue massage is sufficient. The impression.
Tissue-conditioning materials can be used to reline the existing dentures to reduce tissue inflammation and thus facilitate in subsequent llib. Removal of Retained Dentition The decision to remove or preserve the tooth is a. An OPG Fig. Additional relief in the labial notch of the denture may be sufficient. Frenectomy is indicated for cases with a hypertrophic lingual frenum.
In case of a hypertrophic tongue-tie, surgical llib. Tongue-tie test Fig. The patient is asked to touch his upper Treatment of Epulis Fissuratum lip with his tongue. If the lingual frenum pro- a. It is commonly seen in imme- diate denture cases where rapid ridge resorp- tion occurs Fig. Shortening and smoothening the denture border is sufficient.
Hence, radiological evaluation is be left untouched. Treatment of Sharp Spiny Ridges Figs 4. Usually rection alveoloplasty, ridge augmentation. Sometimes they become very prominent due All three ridges have a sensitive mucosal lin- to ridge resorption Fig. Care should be taken to protect the mucosa. Interference of speech b. Loss of posterior palatal seal c. Poor denture stability. The exposed area is allowed to heal by r. It is a surgical procedure to increase the vestibular that a full thickness graft is placed over the expo- depth.
It can be done using one of the following sed region allowing it to heal by primary techniques: intention. Depending on the technique:. Hand manipulation for functional movements. Depending on the type of tray: with these tissues. Depending on the material used: mouth.
Impres- sions are made to produce a negative replica of compound. CD is fabricated. A primary impression is made after the pre- Mucostatic or Passive Impression a. It is used to It was first proposed by Richardson and later nt. If the patient did not require popularised by Henry Page.
In this mucostatic preprosthetic surgery, then the diagnostic cast technique, the impression is made with the oral made from the diagnostic impression can be used mucous membrane and the jaws in a normal, de.
Border moulding is not done here. Classification The impression is made with an oversized tray. Impressions can be classified as: Impression material of choice is impression 1. Depending on the theories of impression plaster. Retention is mainly due to interfacial making: surface tension. Pressure or pressureless peripheral seal. Thus, these dentures will have impressions can be made using this technique. Closed-mouth Impression Mucocompressive Impression Carole Jones This method records the tissues in the functional The mucocompressive technique records the oral.
In this technique, record blocks trays tissues in a functional and displaced form. The with occlusal rims are used instead of impression materials used for this technique include impres- trays. The patient is forces are relieved. Dentures made by this asked to close his mouth exerting pressure on the technique tend to get displaced due to the tissue occlusal rims and perform functional movements rebound at rest. During function, the constant such as swallowing, grinning and pursing of the.
Hence the blood supply is decrea- possible to confine the forces acting on the den- sed leading to ridge resorption. This is achieved through the design of the special tray in which Hand Manipulated Functional Movements the nonstress-bearing areas are relieved and the r. Dynamic Impression stress-bearing areas are allowed to come in ra. It is a mucofunctional technique, which involves contact with the tray Fig.
Border moulding or llib. Relief is given using wax in the special tray, functional movements of the lips and cheeks to which should be removed before impression obtain a functional impression of the vestibular making. It is discussed in detail in the Chapter 7. The patient is also asked to perform move- ments of the tongue to record the alveololingual Open-mouth Impression sulcus. Active opening and closing movements The open mouth method includes the impression of the jaws are performed to record the disto- 46 techniques, which record the tissues in an buccal portion of both the impressions.
Primary Impressions in Complete Denture. Diagnostic Impression Once the tray is ready, the peripheral struc- 5 tures are recorded by a procedure called Border It is made to prepare diagnostic cast, which is moulding or Peripheral tracing. Tracing compound used for the following purposes: or elastomers can be used. The amount balance. The paste and medium-bodied elastomeric impres- preliminary impression is made with a stock tray.
The the tray is tilted downwards and the posterior agar is taken from the tempering section, which y. The impression is made using this tray.
Similarly, the mandibular tray should It has excellent surface detail reproduction be raised anteriorly to check for posterior upto 25 microns. But it has poor dimensional extension upto the retromolar pad. It is an r. Generally elastic impression materials are The preliminary impression can be made indicated for recording undercuts. Irreversible Hydrocolloid Impression Secondary Impressions or Wash Impression Alginate is the hydrocolloid used for this type of impression.
It is available as a powder, which can This is a clinical procedure in complete denture be mixed with water in a rubber bowl. Spatulation a. This is is carried out until a homogeneous mix is done after mouth preparation is complete. It is a nt. The mix is loaded onto an impression very important step as it should record the den- tray and the impression is made.
They are This method makes use of a custom tray or economical. They do not cause cross-infections special tray prepared from the primary cast.
The as they are used only once. The tray can be made of stability due to syneresis and imbibition. All auto-polymerizing resin or reinforced shellac base hydrocolloid impressions should be poured plate. Modelling Plastic Impression This variety of silicone does not undergo dimensional change. The casts can be poured Impression compound is a reversible thermoplastic even after a week. Apart from tubes and cart- material, which is used for making preliminary ridges, the material is available in jars Putty.
Thiokol Rubber Impression The impression is made using a stock tray. It has good dimensional materials. They are available as base and accele- rator pastes. Manipulation is similar to other. Polysulfide materials are hydrophobic. As it is highly Precaution should be taken to avoid any moisture viscous, it can displace the tissue surface.
It also contamination on the tissue surface. Silicone and thiokol impression materials are. All other mentioned materials are used to make primary Type I dental plaster Soluble plaster is used here. The impression plaster is mixed with water in a For more information refer books on dental.
This material has potato starch which helps in easy separation of the cast from the impression. The starch in the maxilla and mandible is very important for the y. The consistency of the mucosa impression thus making it easy to remove the cast.
A thorough knowledge of these landmarks is essen- ra. Both of mucosa. This mix is used to make the impression. When it is thin, it easily gets trauma- When cartridges are used, they have to be dis- tized. When it is loosely attached, inflamed 48 pensed in dispenser guns and used accordingly. Primary Impressions in Complete Denture 5. Notice that the submucosal layer lateral hard palate. Notice the abundance of gland tissue is sufficiently thick to provide resiliency for support to complete dentures and that bone covering the crest of the y.
The submucosal layer is thin or may nt. This reduces the resistance of epithe- lium to trauma. Removing the dentures for hours everyday Fig.
Toothbrush anterolateral part of the hard palate. Notice that the physiotherapy over the soft tissues can stimulate 49 submucosa contains abundant adipose tissues keratinisation of the epithelium. It is divi-. The vestibule is covered Supporting Structures by the lining mucosa. Orbicularis oris is the main muscle of the lip.
Its fibers run horizontally and. The buccal frenum separates the labial and buccal vestibule. It has attachments of the following r. Limiting Structures muscles, ra. They determine and confine the extent of the Levator anguli - Attaches beneath the fre- denture.
Labial Frenum ward direction. It is a fibrous band covered by mucous membrane Buccinator - Pulls the frenum in the that extends from the labial aspect of the residual backward direction. It has no muscle fibers. Hence it These muscles influence the position of the a. A V-shaped notch should be buccal frenum hence it needs greater wider and recorded during impression making to accom- relatively shallower clearance on the buccal nt. The labial notch of the flange of the denture Fig.
Buccal Vestibule de. It extends from the buccal frenum anteriorly to Labial Vestibule the hamular notch posteriorly. Showing the orbicularis oris O,O ,. It is the area between the anterior and The ramus and coronoid process of the mandi- posterior vibrating lines explained later Fig.
When the mouth is opened and the mandible is moved from side to side, the coronoid process of the mandible will. The distal end of buccal flange of the denture should be adjusted in such a way that lo there is no interference to the coronoid process during mouth opening. It is soft area r.
The tissues in this region Functions of the posterior palatal seal The ra. The distolateral border of the denture duced in the denture, has the following functions: base rests in the hamular notch. The denture border should extend till the contact with the soft palate during functional hamular notch. If the border is located anteriorly movements like speech, mastication and near the maxillary tuberosity, the denture will not deglutition. It Postpalatal seal.
It contains loose connective ences the position of the posterior border of tissue and few fibres of Tensor Veli Palatini muscle the denture.
The denture can extend mm. The across the fovea palatina. The posterior extent obtain a good peripheral seal. The fovea is formed by coalescence llib. This acts as a guide to locate the posterior border of the denture. It should end mm posterior to the vibrating line.
Another school of thought considers the de. It can be located by asking primary stress-bearing area. Valsalva the ridge was the primary stress-bearing area, the maneuver: the patient is asked to close his nostrils rugae was the secondary stress-bearing area and firmly and gently blow through his nose. The anterior the posterior part of the hard palate was the. This concept is not accepted now. The horizontal plate of the palatine bone forms the. Posterior vibrating line It is an imaginary line located at the junction of the soft palate that lo shows limited movement and the soft palate that shows marked movement.
It also represents the y. This line is usually straight. Blue—Primary support area ra. Green—Secondary support area. The submucosa in the mid-palatine suture is llib. Hence, relief should be provided in the part of the denture covering the suture. The horizontal portion of the hard palate lateral to the midline acts as the primary support area.
The trabecular pattern in the bone is a. The rugae area acts Fig. The incisive papillae, de. These areas are the load-bearing areas. They show Residual Ridge Fig. The tion of the last tooth is called the Alveolar tubercle. Relief Areas The crest of the ridge may act as a secondary These areas resorb under constant load or contain stress-bearing area. Loosely attached tissues along fragile structures within.
The denture should be the slopes of the ridge cannot withstand the forces designed such that the masticatory load is not. The posterolateral portion of the concentrated over these areas. Incisive Papilla Rugae lo It is a midline structure situated behind the central These are mucosal folds located in the anterior incisors. It is the exit point of the nasopalatine y.
They act as a nerves and vessels. It should be relieved if not, secondary support area. The folds of the mucosa the denture will compress the vessels or nerves play an important role in speech. Metal denture and lead to necrosis of the distributing areas Fig. Mid-Palatine Raphe Fig. It should be relieved during denture de.
It is a bulbus extension of the residual ridge in fabrication. This area is the most sensitive part of the second and third molar region. The posterior the palate to pressure Fig.
The fovea is formed by coalescence of the ducts 54 5. Relief Areas Fig. The denture can extend mm Limiting Structures beyond the fovea palatina. The secretion of the r. It is a fibrous band similar to that found in the In patients with thick ropy saliva, the fovea maxilla. The muscles, incisivus and orbicularis palatina should be left uncovered or else the thick oris influence this frenum. Unlike the maxillary llib.
The mandibular labial can increase the hydrostatic pressure and displace frenum receives attachment from the orbicularis the denture. Hence, it is quite sensitive and active. On opening wide, the sulcus gets narrowed. Cuspid Eminence Hence, the impression will be the narrowest in It is a bony elevation on the residual alveolar ridge the anterior labial region. It is located between the canine and first premolar region Fig. Labial Vestibule portion of the lingual flange.
This anterior portion of the lingual flange is called sub-lingual crescent This is the space between the residual alveolar area.
A high-lingual frenum is called a Tongue Tie. It ridge and the lips. The length and thickness of should be corrected if it affects the stability of the the labial flange of the denture occupying this denture. It is considered in three It overlies the depressor anguli oris. The fibers of regions namely: the buccinator are attached to the frenum.
The flange will be. It is bound by the residual alveolar ridge on one side and buccinator on the Middle region It extends from the pre-mylohyoid other side.
This space is influenced by the action of mas- This region is shallower than other parts of the r. When the masseter contracts, it pushes sulcus. This is due to the prominence of the ra. This bulge can be recorded only muscle Fig. It is reproduced as llib. The height and width of the frenum varies consi- derably. Relief should be provided in the anterior Fig. Note that it is shallower than the anterior portion.
The lingual flange should slope medially de. It is a non-keratinized pad of tissue seen 5 function. The pear-shaped pad is a triangular keratini- Posterior region The retro-mylohyoid fossa is zed soft pad of tissue at the distal end of the ridge. The denture flange in this region Sicher described retromolar pad as a triangular should turn laterally towards the ramus of the soft elevation of mucosa that lies distal to the third mandible to fill up the fossa and complete the.
It is nothing but a collection of loose con- typical S-form of the lingual flange of the lower nective tissues with an aggregate of mucosal denture Fig. This is also called lateral throat glands. It is bounded posteriorly by the tendons. These muscles limit the denture extent and prevent the placement of extra pressure during. Hence, the denture base should extend only one half to two third over the retromolar pad Fig.
Retro-mylohyoid Fossa lo It belongs to the posterior part of the alveolo- lingual sulcus. It lies posterior to the mylohyoid muscle Fig. Craddock coined this term and described it as a small elevation. It is nothing but llib. It lies along the line of the ridge. The denture should terminate at the distal end of the pear-shaped papilla. Beading this area improves a. Green: Mylohyoid muscle; Blue: Submandibular salivary gland.
Retromolar Pad The retromolar pad is an important structure, which forms the posterior seal of the mandibular Fig. The retromolar pad has a stippled and kera- Most patients do not require any clearance. A sim- tinized mucosa. Pterygomandibular Raphe Supporting Structures Pterygomandibular raphe arises from the hamu- lar process of the medial pterygoid plate and gets The mandibular denture poses a great technical.
A raphe is a challenge. The support for a mandibular denture tendinous insertion of two muscles. In this case, comes from the body of the mandible. Hence, the mandible is less capable of resisting occlusal forces. Buccal Shelf Area Fig. It has a thick submucosa overlying a cortical plate.
As it lies at right angles to the occlusal forces, it serves as a y. Residual Alveolar Ridge Fig. The edentulous mandible may become flat with a concave denture-bearing surface. In such cases Fig. Note: The buccinator ridge attach over the ridge. Due to resorption, the is lateral to the ramus and the superior constrictor is medial mandible inclines outward and becomes to the ramus progressively wider.
The maxillae resorb upward and inward making it smaller. This gives the It is very prominent in some patients where a prognathic appearance in long-term edentulous 58 notch-like relief may be required on the denture. Genial Tubercles Fig. Due to resorption, it may become increasingly prominent making denture usage difficult.
The superior one gives Mylohyoid Ridge Fig. Anteriorly the ridge lies close to the inferior Torus Mandibularis Fig. The thin mucosa over the It is an abnormal bony prominence found. The area under this ridge is an region.
It is covered by a thin mucosa. It has to be undercut. Mental Foramen Fig. Due to ridge resorption, it may lie close Principles of Impression Making to the ridge.
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