Complete Dentures

The shape and amount ofthe distobuccal extension of a complete mandibular

edentulous impression is determined during border rnolding by the:

. Ramus of the mandible

. Position and action ofthe masseter muscle

. Lateral pterygoid muscle

. Tone ofthe buccinator muscle

Size and location

ofthe buccal frena

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When border molding a mandibular custom tray that will be used for a final dmture impression:
. The distobuccal extension is determined by the position and action ofthe masseter muscle.
. The distolingual extension is limited by the action ofthe superior constrictor muscle.
. The buccal vestibule: proper extension into this area provides the best support for the mandibular denture. This area is refened to as the buccal shelf.
. Lingual frenum: the proper borders must be established with movements ofthe tongue when border molding. The genioglossus muscle influencs the lengdr ofthe flange during normal movements
of the tongue.
. The mentalis muscle will elevate the mandibular antrior labial arer unless this border is established by accurate border molding.
. The retromol.r pad: marks the distal termination ofedentulous ddge. This structure needs to be covered for support and retention.
. The mylohyoid area: the flange in this ara must accommodate the movemnt ofthe mylohyoid
muscle in swallowing.
. The retromylohyoid area: this area is limited posteriorly by the action ofthe palatoglossus muscle
and inferiorly by the lingual slip ofthe superior constrictor muscle.

Remember: The palatoglossus, superior pharlalgeal constrictor, mylohyoid, and genioglossus muscles
are influential in molding the lingual border ofthe mandibular impression for an edentulous patient.

Import.nt:

The most important consideration in checking custom trays for accurate border molding is

stability and lack of displacement.

Note: The custom tray for a final mandibular or maxillary complete denture impression should have a
sprcer with stops to insule that th tray will be seated in proper relationship to the arch and that there
will be adequate room for the impression material. The space is created with wax covered by aluminum

foil over the master

cast pdor to forming the tray.

The primary difference between border molding with a ZOE impression matcrial and border molding
with modeling plastic is that the zoE impression material must be border molded during one inseropposed to two insertions with modeling comtion and within the setting time of the mate al
oound.

-as

. To increase the capacity of underlying

struchrres to withstand the stress due to biting

force and to improve appearance

To provide balanced occlusion and to increase tongue space

To increase the capacity of the underlying structures to withstand the stress due to
biting force and to increase the effectiveness ofthe seal

. To improve retention and to increase tongue space

Copyrighr O 201 I ,2012 , Dental Decks

. I month and 3 months post extraction

. 4 months and 7 months post extraction

. 5 months and l0 months post extraction

. I year and 2 years post exhaction

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***

Key point
undcrcxtcnsion ofthc pcriphcral bordcr ofa complctc mandibular dcntrrrc dccrcascs tissuc-bear- affccting dcnturc stability. Merked ridge resorption will occur ifa mandibular complctc dcning surfaccs, lhcrcby
turc base terminates short ofthc rctromolar padThc underlying basal bote (be eath lhe retromoldrpdd) is rcsistant lo rcsorption. Covemge ofthis arca will also
provide some bordcr seal- An overload ofthe mucosa will occur iflhc bascs covcring thc area are too smali in oulRemember: Mandibular denn[cs do not rely on suction from a pcriphcral scal for retention /ds do marillary den|r,"es, but rather on dcnturc stabiljty in covcring as much basal bonc as possiblc $ithout i'rpinging on thc musclc
attachmcnts. Thc active bordrmolding perfonned bythc lips, chccks, and tonguc determines the peripheral areas
ofa mandibular arch, thus establishirg ma{imal basc bonc covcrage.
Limiting structurcs ofthc mrndibular dcnturc:
. Mandibular lnterior labial area: thc action of the mentalis musclc and the mucolabial fold dctcrmincs thc cxtcnsion ofthe denture flangc jn lhis arca.
. Mandibular labial frenum: lhis band offib.ous conncctive tissue hclDs attach thc orbicularis oris musclc. Thc
sizc ofthis s(ructurc limits thc cxtcnsion ofthc dcnturc bordcr. thc thickncss oflhc dcnturc basc, and aflects thc
position olthc mandibular tccth.
. Buccal vestibule: is infiucnccd by the buccinator musclc which has musclc fibcrs that run in an obliquc dircction and thcrcforc bave littlc displacing aclion- Propcr cxtcnsion into this arca provides the best support for thc
mandibular dcnturc. Tlis arca is rcfcrred to as thc buccrl shelf.
. :|Iasscter area: thc dcnturc is limited in a latcral dircction by lbc action ofthc massctcr musclc.
. Retromolar padi marks thc distal termination ofcdcntulous ridgc. This structurc nccds to bc covcrcd fbr suppon and rctcntion. By doing lhis thc intcgrity ofbonc in lhis arca is maintaincd and allows for support.
' Lingurl frenum: thc proper bordcrs must bc cstablished with movemcnts ofthc longuc whcn bordcr molding.
Thc gcnioglossus musclc inlluenccs lhe length ofthc flangc during normal movcmcnts ofthe tongue.
. Sublingual gland sreai maximum cxtcnsion dcsircd without ovcrcxtcnsion.
' \ll lohtoid area: thc flangc in this arca must accommodatc the movcmcnt ofthc mylohyoid musclc in swallowing
. Retromllohloid area: this area is limitcd posteriorlyby thc action ofthc palatoglossus musclc and inferiorly by
rhr lingual slip ofthc superior constrictor musclc. Ifthcsc musclcs arc impingcd upon, thc paticnt may dcvclop a
sora throat. Notei This is often ahc most diflicult are to manaqc.

Recontouring of the healing ridge progresses rapidly for four to six months and does
not become stable in fonn until l0 -12 months post extraction. Due to this, immediate
dentures become progressively more ill-fitting. They should be relined five months and
ten months after delivery in order to compensate for contour changes. Note: This is a general timeline; each case needs to be evaluated monthly and, if necessary, relines
performed.

A reline is indicated on any denture when the diagnostic information indicates that a re-

when the denture base

line rvill effectively solve the patient's chief complaint
adaptation is the major defect in the prosthesis. A reline is contraindicated when there is
a large decrease in veftical
excessive overclosure of the vertical dimension
dimension. In this case, new dentures are indicated -at the proper vertical dimension.
patient wears a complete maxillary denture against the six urandibular anterior teeth, it is very common to have to do a reline every so often due to the loss of
by a flabby maxillary anterior
bone structure in the anterior maxillary arch
-evidenced
ridge.

Note: When

. 3 hours aiier delivery

12 hours after delivery

. 24 hours afier delivery

. 48 hours after delivery

Coplrishr O 20ll-2012 - Denral Deck

. Gagging
. Cheek biting
. Reduced taste

Speech aberrations

Copright O20ll-2012, Dental Decks

This is done for the purpose of correcting undetected enors. Tissue trauna attributed to
denture function manifests as h)?eremia, inflammation, ulceration, and pain.
The basic sequence ofthe clinical procedure for a 24 hour recall appointment is:
l. Remove the dentures from the mouth.
2. Thoroughly examine the mouth.
3. Ask the patient about the areas oftissue trauma which have been obseryed.
4. Pemit the patient to describe additional complaints.

*** After collecting all ofthe

diagnostic information, the dentist can determine the source

ofthe problem and the cure.

Remember: During the first few days following the insertion of complete dentures, the
patient should expect some difficulty in masticating most foods and excessive saliva
*hich is due to reflex parasympathetic stimulation ofthe salivnry glands. Over time this
u

ill

subside and become normal.

Important: Occlusal disharmony can be most accurately corrected on the articulator

after patient remounting procedures.

Posterior teeth edge to edg

Reduce the facial surfaces olmandibular molars to

create proper horizontal overlap

Inadequate vertical dimension

Reline at corrected VDO, patient remount, fabricate

new denture

ofocclusion
Biting comers of the mouth

\otes

l. Lip biting may be due to reduced muscle tone and/or a large anterior horizontal overlap.
2. Tongue biting may be caused by having posterior teeth too far lingually.

. Facial to the ridge

. Lingual to the ridge

. Exactly over the ridge

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A patient who wears a complete msxillary denture complains of a burning

sensation in the palatal area of his/her mouth. This is Indicativ oftoo much
pressure bcing exerted by the denture on the:

. lncisive foramen
. Palatal mucosa

. Hamular notch
. Posterior palatal seal

7
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Setting anterior teeth directly over the ridge usually causes poor esthetics of dentures.
Also, it is important to have accurate adaptation ofthe border seal and adequate bulk of
the maxillary facial flange for good esthetics. Vertical dimension ofocclusion affects the
lip support as well.
For most patients, the labial surface ofthe central incisor should be approximately 8 mm
anterior to the center ofthe incisive papilla. The labioincisal onethird ofthe maxillary
central incisors should support the lower lip when the teeth are in occlusion.

Important: The long ares of the maxillary central incisors should be perpendicular to
the occlusal plane; the long axes of the maxillary lateral incisors should have an asyrnmetric mesiodistal inclination.

Remember: Maxillary central incisors are the most important teeth when esthetics is
under consideration. Their placement controls the midline, speaking line, lip support and
srniling line composition. Note: Placement of maxillary anterior teeth in complete dentures too far superiorly and anteriorly might result in difficulty in pronouncing "f'and "v"
sounds.

ofthe common errors in the arrangement ofteeth include:

. Setting mandibular anterior teeth too far forward to meet the maxillary teeth
. Failure to make canines the tuming point ofthe arch
. Setting the mandibular first premolars buccal to the canines
. Establishing the occlusal plane by an arbiirary line on the face

Some

. Not rotating anterior teeth enough to give an adequately narrower effect

1.

,,Note{,

A burning sensation in the mandibular anterior area is caused by pressure

on the mental foramen.

2. A patient having trouble swallowing may have insufficient interocclusal

freeway space caused by excessive vertical dirrension olocspace
-decreased
clusion.
3. The best dietary advice for an elderly denture patient is to eat foods rich in
protein and vitamins A, C, D, and B complex.
Important: Leaming to chew satisfactorily with new dentures requires at least 6-8 weeks.
This time is spent on establishing new memory patterns for both facial and masticatory
muscles.

Residual ridges can be ruined by the use of denture adhesives and home-reliners.
Therefore. patients should be specifically warned about their uses. These agents can modifl the position ofthe denture on the ridge and result in change ofboth vertical and centric relations.

The trNtment plan for a patient indicates thst both manilibular and maxi.llary
immediate dentures are to be fabricated. The ideal wav to do this is:

. Fabricate the maxillary immediate denture first

. Fabricate the mandibular immediate denture first
. Fabricate the maxillary and mandibular imrnediate dentues

at the same time

8
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The first step in the treatment of abuseat tissues

in a patient with existing dentures is to!

. Fabricate

a new set ofdentures

. Reline the dentures

. Educate the patient

. Excise the abused

tissues

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The main reason for this is to avoid setting the maxillary teeth to the likely malpositions

of the remaining mandibular teeth

Important: Ifthe master casts are altered in an immediate denture procedure (e.g., elimination ofgt"oss undercuts), it is advisable to construct a second denture base that is transparent (called a surgicol stent or template). This surgical stent is placed over the ridge after
the teeth are exhacted. Pressure points and undercuts are readily visible and surgical ridge
conection can be performed.

Remember: The duplication ofthe master cast used for the construction ofthe surgical
template to be used at the time of immediate denture insertion is best rnade after wax
elimination and after the cast is trimmed.

Note: A major advantage with immediate dentures is being able to duplicate the
position of the natural teeth.

Important: The patient should understand both the cause ofthe tissue deterioration and
the eventual outcome ifthe process is not arrested.
Treatment plan for tissue rcovry from abused tissues:

. Educat the patient

. Remove the dentures: at least for 24 hours or until the tissues retum to normal size,
shape, color, consistency, and texture. Note: Ifthe constant wear ofunacceptable dentures is the cause of the tissue abuse, the most efficient preliminary treatment is removal ofthe dentures. However, business and social commitments may not permit
removal for extended periods. In such patients, resilient tissue conditioning materials may be used to assist in the tissue recovery program.
the patient clean the dentures: with a sofi brush and no abrasive agents. They
should be instructed to soak the dentures for at least 30 minutes in a commercially
available denture disinfectant solution.
. Ifpatient has a Candida albicans infection (either generalized or angular cheilitis):
should be treated by using nystatin oral rinses for generalized infection and nystatin
h|ith tridmcinolone acetonide) cream for angular cheilitis.
. Resilient tissue conditioning materials may be needed to assist in the tissue recovery program.

. Have

Other procedures recommended as aids in the treatment ofabused tissues include massage and warm saline rinses.

. The psychological comfort ofavoiding the loss ofall teeth

The continuous functional feedback for the neuromuscular system from proprioceptors
in the periodontal membrane

. The preservation ofthe alveolar ridge

. The improved support and stability for the denture
. The increased retention ofthe denture

10

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. Linguoalveolar sounds or sibilants (such as s, z, sh, and ch)

. Fricatives or labiodental sounds (such

. B, P, and M

as

f,

v, or ph)

sounds

. Linguodental sounds (such as this, that, or those)

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The overdenture is a denture whose base is constructed to cover all ofthe existing residual ridge and selected roots. Retained roots help to prevent resorption of the alveolar
ridges. These roots also improve retention and afford the patient some proprioceptive
sense

of "natufalness" in function ofthe dentures.

It is not always necessary to cover a root beneath an overdenture, however, ifa root is
not covered, the exposed surfaces are highly susceptible to decay, The oral hygiene of
the patient must be impeccable to prevent the decay ofthese roots.

Note: Retained roots are the most common findings when taking routine panoramic
radiographs of patients who wear complete dentures (rol necessarily overdentures).
Important: The general rule for retained root tips with no radiolucency and the cortical margin ofbone intact is that they can remain in place; however, the patient should
be informed oftheir presence. They should be removed if the cortical plate is perforated
and/or the PDL or radiolucent area is getting larger

Speech sounds in the complet denture patlent:

. Frictative or labiodental sounds (f, v, and ph): are formed between the maxillary incisors contacting the weVdry lip line of the mandibular lip. Note: These sounds help deter-

mine the position ofthe incisal edges ofthe maxillary anterior teeth.
. Linguoalyeolar sounds or sibilants (s, z, sh, ch, and j): arc made with the tip of the
tongue and the most anterior part ofthe palate or lingual surface ofthe teeth. Note: These
sounds help determine the vertical length and overlap ofthe antedor teeth. Important: A
whistling sound with dentures is indicative ofhaving a posterior dental arch form that is too
narrow or high.
. Linguodental sou nds (this, that, and those,),' the tip of the tongue should protrude slightly
between the maxillary and mandibular anterior teeth. Note: These sounds help determine
the labiolingual position ofthe anterior teeth.
. The b, p, and m solnds: are made by contact of the lips. Not: Insuficient lip support
by the teeth or the labial flange can affect the production ofthese sounds.

Note: The two most probable causes of a patient complaining that whenever he/she tries to
make an "s" sound. it sounds like "th" are:

. lncisor teeth are set too far palatally

. Palate is made too thick

Important: To evaluate vertical dimension,

terincisal sepantion should be

have the patient pronounced the s sound; the inas the closest spaking space.

to 1.5 mm. This is known

Remember:
. Ifthe teeth are positioned too far lingually, the "t" will tend to sound like a "d." Ifthe teeth
are positioned too far labially, the "d" will sound more like a "t."
. An increased occlusal vertical dimension can result in clicking ofteeth.

The

primrry role ofanterior leeth on a denture is:

. To incise food
. Occlusion

. Esthetics

. Stability of the denture

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Coplright O 201l-2012, Denral Decks

. Fibrous tuberosities
. Too great a vertical dimension ofocclusion
. A lack ofposterior occlusion

. The maxillary denture teeth that were

used are too short

13

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Spaces, lapping, rotation, and color changes can bejudiciously used to create a natural

appearance. Note: Proper

lip support is provided by

the facial surfaces of teeth and

sirnulated attached gingiva.

Setting the anterior teeth either too far lingually or facially to satisfy esthetic concems
should not be done. When selecting teeth, pre-extraction records are very valuable.
Maxillary and mandibular anterior teeth should not contact in centric relation.
The outline ofanterior teeth should harmonize with the form ofthe face:
. Convex profile faces should have a similarly convex labial surface ofanterior teeth
. Broader contact areas ofteeth look more natural on dentures as they seem more compatible with advanced age

with dentures (complete or partial wltich replaces the

incisors) may be caused by any ofthe following:
. Vertical overlap is not enough
. Horizontal overlap is too much
. The area palatal to the incisors is improperly contoured (too high or too narroh,)

Whistling when

a patient speaks

Note: In general, functional needs overshadow those ofesthetics when selecting posterior teeth. Do not set mandibular molars over the ascending area ofthc mandible
because the occlusal forces in the area will dislodse the mandibular denture.

The patient's chiefcomplaint will be looseness ofthe maxillary denture. Thcy will also state thal they
can no longer see their upper teeth on the denture. These signs and symptoms are caused by a lack of
postcrior occlusion.

Important: A patient wearing a maxillary complete denture and a mandibular bilateral distal-extension removable partial may show:
. Decreased vertical dimension ofocclusion
. A prognathic facial appearance

\ote: \\ftcn

a complete

maxillary dcnture opposes natural mandibular anterior tecth. the marillary tn-

terior ridge often becomes very flabby.

Rememberi The best impression technique for an edentulous patient with loose, h)?erplastic tissue in
rhe maxillary anterior region is to register the tissue in its passive position.

.
)-oter,.

*'

1. Denture support refe$ to rcsistance to vertical seating forces.

2. Denture stability is necessary to resist dislodgement of a dcnture in the horizontal direc-

tion.

l. D"ntu." ."tertion

is the ability ofthe denture to withstand dislodging forces exerted in the

venical plane. Surfaces of a denture that play a part jn retention:
. Intimate contact ofthe denture base and its basal seat
. Teeth: no occlusal prematurities to break rctention
. Dsign of the labial, buccal, and lingual polished surfices: configuration harmonious
with forces generated by thc tongue and musculature

4. Factors that influence denture sudace:

. Adherion: saliva to denture and to tissues
retentive force
. cohesion (the attraction ofmolecules lot -primary
each other) depends onr the area covc.cd and
thin, \,atery
better retention)
the type of saliva /i.e. , thick, ropy
-unfavorable;
. Atmosphric pressure: prcportionate
to area covercd and depends on pe pheral seal
. Mechanical: ridge size, shape, and inter-ridge distance

. Adequate coverage of tray borders with the material used for border molding

. Contours ofthe periphery similar to the final form of the denture

. Stability and lack ofdisplacement ofthe tray in the mouth
. Uniformly thick borders of the periphery

14
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. Residual ridges
. Palatal rugae

. Incisive papilla
. Maxillary tuberosity
. Buccal vestibule

15
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The ease and accuracy ofthe border molding depends upon:

l. An accurately fitting cuslom tray
2. Control of bulk and temperature ofthe modeling compound
3. A thoroughly dried tray
The custom tray fabricated on the preliminary cast is trimmed approximately 2 rnm short
of the mucosal reflection and frenae. This is done by first checking the borders in the
mouth and then trimmed down. This will allow a uniform thickness of 2 mm of modeling compound when borders are molded. Proper border molding results in contours resembling the final form ofthe denture. However, the primary indicator ofthe accuracy
of border molding is the stability and lack ofdisplacement oftray in the mouth.

Border molding is completed in two stages. In the lirst stage the molding should approximate the borders but should be slightly overextended. Excess compound is trimmed
from inside and outside ofthe tray. The remaining modeling compound is then refined by
repeating the process. The final form ofthe border molding should represent an accurate
impression ofthe peripheral tissues. The modeling compound should have a smooth, almost polished appearance.

After border molding is cornpleted, some areas ofthe modeling compound should be relieved because the tissues are extremely displaceable and have probably been distorted
during the border molding process. These areas include around the maxillary labial
frenum and over the retromolar pad areas.

Remember: Modeling compound (plastic) has a relatively low thermal conductivity.

***

The primary support areas of the maxillary complete denture are thc residual ridges (the

ntatillan

and

palatine bones),

the primary support area is the buccal shelf because of its

to the occlusal plane. Proper extension into this area
right
anglc
relationship
bone structurc and its
is necessary- to more widely distribute the load ofmastication. The residual ridges iflarge and broad
can also be considered as lhe primary suppofl areas.

lmportant: In the mandibular arch,

Limiting structures oflhe maxillary denture:

. ln the anterior region: the labial vestibule, which cxtcnds from the right buccal frenum to the
leil laterally, from the right and lcft buccal vestibules extending in the posterior aspect on each
side to the right and left hamular notches, respectively.
. The posterior limit: extends to junctions of moveable and immovable tissue. This coincides
'$'ith a line drawn through the hamular notches and approximately 2 mm posterior to the foveae

palatiJle (vibrating I ine).

Remember:
. The secondary peripheral seal arca for a mandibular complete denture is thc anterior lingual border
. Ifyou are labricating a mandibular complete denture for a patient with a knife-edge ridge,
you need maximal extension of the denturc to help distribute the forces of occlusion over a
Iarger arca

Important: The most important factor for providing retention for complctc
ripheral seal.

dentures is the pe-

An overertended distobuccal corner of a mandibulrr denture

will push agrinst which muscle during function?

\-

. Zygomaticus
. Orbicularis oris
. Temporalis
. Masseter

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After border molding the mandibuhr custom tray, it is important

to check for dislodgement in order to detect areas of:

. Underextension ofthe tray

. Overextension ofthe tray

. Thickness ofthe tray
. None ofthe above

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very common area ofoverextension and should be checked very well when delivering the mandibular denture.

This is

The buccinator muscle lies under the denture flange in this area but the fibers run anteroposterior in a horizontal plane and their action is weak; the anterior fibers of the
masseter muscl pass outside the buccinator at the distobuccal comer ofthe mandibular
denture and will push against the buccinator during function causing dislodgement.

Important: When the posterior maxillary buccal space is entirely filled with the denture flange, the coronoid process may interfere with the denture upon opening of the
rrouth. This will cause dislodgement olthe maxillary denture.

L The superficial layer ofthe masseter muscle originates from the zygomatic
process of the maxilla and inserts at the angle and lower lateral side of the
ramus of the mandible.
2. The pterygomandibular raphe lies between the buccinator and superior
constdctor muscles.

Check for dislodgement using the following techniques:

. Pull gently upward on the patient's cheek
. Pull the lower lip gently forward in a horizontal direction
. Have the patient open widely
. Have the patient move the tongue into the right and leit buccal vestibules
. Have the patient protrude the tongue to touch the lower lip. Have the patient move the
tip ofthe tongue from one corner olthe mouth to the other

Dislodgement indicates overextnsion and the border molding process should be refined
in the offending area. Common areas ofoverextension ofthe mandibular impression are
the labial and the truccal. This is suspected when the impression raises as the mouth is
opened.

The most critical area in the border-molding procedure for a maxillary denture is the
mucogingival fold above the maxillary tuberosity area. This area is extremely important
for maximal retention. Other critical areas are the labial frena in the midline and the
frena in the bicuspid area. Overextension in these areas often leads to decreased reten-

tion and tissue irritation.

Pressure areas on the impression surface ofdentures is checked with PlP. Use digital pressure only, one denture at a time. Special attention should be given to the hard
palate and the mylohyoid ridge areas.

\ote:

. The inclination ofeach condyle

. Vertical dimension ofocclusion

. Centric relation
. Location ofthe hinge axis point

t8
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. Maintain the vertical dimension of occlusion

. Maintain bite registration

. Preserve the face-bow transfer
. All ofthe above

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A face-bow is a caliper-like device used to record the patient's maxilla / hinge axis relationship (opening and closing axis).It is also used to transfer this relationship to the articulator during the mounting of the maxillary cast. Ifthe face-bow tratsfer procedure is
properly done, the arc ofclosure on the articulator should duplicate that exhibited by the
patient. This hinge-axis face-bow transfer enables alteration in vertical dirnension on
the articulator
Note: When altering vertical dimension (either through restorations or with dentures),
casts should be mounted on the hinge axis.
When the maxilla,4ringe axis relation is transfened to the fully adjustable articulator, it
may be necessary to obtain the precise tracing of the paths followed by the condyles. A
pantograph is an instrument which carries out this task with the help of two face-bows.
One is attached to the maxilla and the other to the mandible using a clutch that attaches
the teeth in their resDeclive arches

When fabricating dentures, there are two methods used to preserve the face-bow
transfer:

l.Taking a plaster index ofthe occlusal surfaces of a maxillary denture before removing the denture from the articulator and cast (see picture below).
2. Placing a piece of 10x wax on the occlusal surfaces of the mandibular teeth and
closing the articulator in centric relation. Chill the wa.x, drop the incisal guide pin to
touch the incisal guide table (do not change).

Important: The plaster index method is the preferred method due to possible distortion
ofwax.

[tlaxillary Oenture
Plastor lndex Cast

. Faulty tooth position

Excess vertical dimension ofocclusion

. Faulty palatal contours

. Faulty occlusion

20
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201 I -20 12 - Dental Decks

ofthe denture

. Defective tissue registration

. Premature occlusal contacts
. lncornplete polymerization of the denture

base

21

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Spcech problcms due to faulty tooth position can be avoided by placing thc dcnturc tccth as close as possible to thc
position ofthc natural tccth. Note: Thc most cffcctivc timc to lcst for phonctics is at thc timc oflhc wax try-in oithc
t.ial dcrture frlrr rs l/s!d f thefourth appointmett). Faulty palatal contours can bc co.rcctcd by trial and crror Add
wax to incrcasc contours and rcducc as nccdcd to improvc articulation ofsounds. Note: Paticnts who have becn edentulous for many years oficn havc more distorted spccch than thosc \r'ho havc bccn cdcntulous lbra shorllimc. This
is usually duc to a loss oftonus ofthc tonguc musculaturc.

An sbcam passcs unimpcdcd

or with inadequate impcdancc
bclwcen lhe dorsal surface of
maxillary ccntral incisors to
thc torgrc and lhc ani,crior pal- irnpcde $e ail stream parsing
btwen ilE tonge aDd palate. Crcat rugae ifnecs3sry
The an strcam passing bctwccn Rcduco occlusal verlical
tle tongue and intc.iorpalalc is dimension
il prcmolars
cxccssivcly impcdcd. usually
no louer con&ct during
by njgae or xcessiv resin

Reduce oc.iussl vrlical

Maxillary & Mandibular

ircisots or p.emohrs conta.t
during sibilsnl /r s/,, z cr)

dineDsion unril premolas

ro longer contacl during
Maxillary teetl mal be sct loo
far labially

Cliniciar obs'ves that incisal

dg6 of naxillart incisors
co act lhe lower lip I mm or
moE labial to lhe wet/dry
of lower lip when "F

& "1f'lomds

are

'

nade

Eval a& Iip suppod and

overall apperance of anterior
terh as dley ar positiood.
Reset to a more lingual posrtion as need.d- Incisal edge of
maxillary incisors lhould conracl thr wat/dfy junciion Just
lingual to it during producrion
olthe

"F'& "V" sounds

At the first appointment after insertion ofcomplete dentures, the presence olgeneralized
soreness on the crest of the mandibular ridge is most likely due to improper occlusion
(premature occlusdl contqcts). To identify these, the best method in the mouth is to use
disclosing wax that is slightly warmed. Insert the wax bilaterally and bave the patient
close into centric. The prematurities will show up as windows in the wax' Once centric
is complete, be sure to check eccentric movements.

Important: Acrylic spicules, inaccurate denture bases and trapped food can all cause ulcers as rvell. Ifan acrylic spicule is found, it should be reduced. Ifan inaccurate denture
base is suspected, it should be relined.

-.;:.iot{]
r

'@f

1.

After relining dentures, ifa patient constantly retums for adjustments due to

sore spots on the ridge, check the occlusion. The relining procedure may have

changed the centric relation contacts.

2. Errors in occlusion may be checked most accurately by remounting the dentures on the articulator using remount casts and new interocclusal records.

Remember: Casts mounted with an interocclusal record are mounted more accurately if the material used is selected according to the accuracy of the casts
bing articulated (casts produced with iteversihle hydocolloid are more accurateb) mounted with wtu records, and casts obtained with elastomeric materi'
sls are more accurately mounted with elsstomeric registration materials or
zinc and eugenol paste).

. Frankfort's plane
. Camper's line
. Fox plane
. Horizontal condylar inclination

22
Copright O 20l l-2012 - Dntal D4ks

. Insufficient

pressure on the flask during processing

. Insumcient material in the mold

. A rapid elevation in temperature to 212' F causing vaporization ofthe liquid

. insufficient time for processing

23
Coplrighr O20ll-2012 - Dental Dcts

Occlusion rims are the resultant product after adding base plate wax to a record base
in order to approximate the tooth position and arch form expected in the completed denture,

Occlusion rims are used to:

. Determine and establish the vertical dimension ofocclusion

. Make maxillo-mandibular jaw records
. Establish and locate the future oosition ofthe artificial teeth
l. A good slarting point for determining the vertical length ofthe maxillary occlusion rim is a point approximately 2 mm below the upper lip when it is relared.
2. When recording centric relation for a removable partial denture, the occlu-

sion rirn should be attached to the completed partial denture framework in-

ofa record base as used with a complete dentue.

3. Ifat the tooth try-in appointment the teeth need to be adjusted to correct the
centric occlusion, the best way to do this is to take a new centric relation record
and remount.
stead

Acrylic resin used for denture repairs should be under 20-30 psi air pressure while being
processed to help eliminate porosities. These porosities, ifpresent, will usually occur in
the thickest part ofthe denture. Self-cured resins are generally used for repairs instead
ofheat-cured resins because the risk of distorting the denture is less.

l. When there is a rapid elevation in temperature causing vaporization ofthe liquid, the vapor is then trapped as gas bubbles.
2. Porosities will also occur if the packing and processing ofthe powder and
liquid resin is too pllstic (stringl or sandy/. This permits the liquid to vaporize
and, at the same time, does not allow sufficient pressure during closure of the
flask.

. Increased post-insertion

care

. Increased post-insertion

soreness

. Not being able to have an anterior tooth try-in to evaluate esthetics

. Greater complexity ofclinical procedures

. A higher cost oftreatment

21
Cop).righr O 201 l-2012 - Denlal Decks

The face-bow is a caliper-like device used to record the patient's maxilla,/hinge axis
relationship (opening and closing axis)

. If

the transfer is done properly, the arc of closure on the articulator should duplicate
that exhibited by the patient

The face-bow transfer is a maxillo-mandibular record

. The face-bow transfer is used to transfer the maxilla/hinge axls relationship to the
articulator during the mounting ofthe maxillary cast

25

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Other drawbNcks of immediate dentures:

.Increased post-insrtion care, including relining or remaking the denturcs. Contour changes occur in
the healing residual ridge for 8-12 months.
.Incrersed post-delivery soreness. The combination of post-extraction pain and denture related trauma
often produces greater discomfoit during the first few days following insertion.
. Greater complxity ofclinical procedures. Forexample, bordermolding and final impressions are more
difficult when natural teeth remain.
. Higher total cost of treatment Ther is an increased expense due to the need for relines and repeated equilibration of the occlusion.
Advanlags of immediate dentures:
. Continuously acceptable esthetics. Immediate dentures are esthetically advantageous in that the palient
is never without either natural or artificial teeth.
. Improved speech adrption. Immediate dentures rcquire only one period ofspeech adaptation, whereas
conventional denture trcatment requircs two; one afierthe teeth are extracted and anothcr after thc dentures
are delivered.

'

Protection of the extraction sites frcm trauma, Denhrres act

as a typ

ofbandage over the clot filled sock-

ets.

. Continuously acceptabl masticatory function. The patient retains some semblance ofchewing ability
during the healing process.

. Prevention oftongue enlirgement. When naiural teeth are lost and not replaced, the tongue tends to expand into the available space.
To help the patient get through the fiIst day ofwearing immediate dentures, instruct him to do the following:

. Do not remove the

. Eal soft foods

dentures

. Retum in 24 hours

Recommended trvo-step schedule ottooth rcmoval;

. First stepi extract all posterior teeth except a ma-rillary first prcmolar and its opposing tooth. This leaves
a posrerior "stop" in order to maintain the vertical dimension ofocclusion.
. Second step: after the posterior rcsidual ridges exiibit accptable clinical healing, the second phase of
rreament, that ofdenture fabrication, can begin. The anterior teeth will be extracted at the time ofdcnnrrc
lnsertlon.

***

This is false; it is a record used to orient the maxillary cast to the hinge axis on the

articulator.

"",f

{.

;
"t
T = Tragus

ofear

OC = Outer canthus of the eyes

Several varieties of arbitrary face-t ows are available. All are based on an average location ofthe hinge axis and will yield an enor of2 mm or less in the majority ofpatients.
Arbitrary rotational centers are generally located over measured points on the face or by
some type of earpiece. One average measurement (above picture) places the rotational
point 13 rnm anterior to the distal edge of the tragus of the ear' along a line from the
superior-inferior center ofthe tragus to the outer canthus of the eye. The condylar styli
of the face-bow are then placed directly over the dots.

. Is placed 3 mm posterior to the vibrating line

. Is not necessary when fabricating

. Is not

necessary

ifa

a complete denture on a patient

with a flat palate

metal base is used

. Will vary in outline and depth according to the palatal form ofthe patient

26
CopriShr C

201 I

'l0l:

- Dental Decks

. Pterygomaxillary notch
. Vibrating line
. Hamular

process

. Fovea palatinae

27
CopFighr O 201l-2012 - Dnlal Deks

Posterior Palatal Seal

The dcnture cnds on thc cast at A. the bcad (B), locatcd 2

Ttre poslcrior line (A) indicatcs th cnd of thc
denture posteriorly across the palate. The anterior
linc (B) marks thc location of the posterior palatal
scal that will b caRed intothe cast and transfcrcd
as a bead onto the denture.

mm in front of the vibrating line, is extcndcd latcrally

through thc ccntcr of thc hamular notchcsBolh phoros m Fprcduced wnh pmission, fiom zdb GA,and Bolender
CL.. Ptosthodontic Tredhent lot Edertulow Potients- Mosby,20,.J6.

The posterior palatal se|l is completed before the final arangement ofthe posterior teeth because this firal
arrangement is a laboratory procedure and is done in the absence of the patient. The anterior lilre that indi_
cates the location ofthe poste or palatal sealis drawn on the cast in fiont ofthe line indicating the end ofthe
denture. The width ofthe posteriorpalatal sealitselfis limited to a bead on the denture that is I to 1.5 mm high
and 1.5 mm broad rt its base. A greater width creates an area oftissue placement that will have a tendency
ro push the denture downward gradually and to defeat the purpose ofthe posterior palatal seal ln other words,
rhe posterior palatal seal should not be made too wide.
A !'-sh|ped grcove I to 1.5 mm deep is carved into the cast at the location ofthe bead. A large, sharp scmper
is used to carve it, passing through the hrmuler notches and across the palate ofthe cast. The $oove will form
a bead on the denture that prcvides the posterior palatal seal. The bad will be I to 1.5 mm high, 1.5 mm
wide at its base, and sh|rp tt its apex. The depth ofthe grooves will be determined by the thickness ofthe
soft tissue against which it is placed and will establish $e height of the bead.

Landmarks for Posterior Palatal Seal

. The posterior outline is formed by the "ah" line or vibrating line and passes
though the two pterygom xillary (hamrlay' notches and is close to the fovea palatini.
. The anterior outline is formed by the "trlow" line and is located at the distal extent
of the hard palate.
Note: Excessive depth ofthe posterior palatal seal will usually result in unseating ofthe
denture.

Remember: The posterior palatal seal will vary in outline and depth according to the
palatal form of the patient.
Functions of the Posterior Palatal Seal:
. Completes the border seal ofthe maxillary denture
. Prevents impaction of food beneath the tissue surface of the denture
. Improves the physiologic retention of the denture
. Compensates for shrinkage of the denture resin during processing

. Deepening ofnasolabial groove

. Loss oflabiodental angle
. Retrognathic appeaxance
. Decrease in horizontal labial angle
. Narrowing of lips
. Increase in columella-philtral angle

2A
Cop}Tighr O 201 1,2012 - Dertal Decks

r ln rhc nnraaloin

. At the porcelain-metal interface

. In the metal

29
Copyrighl O 20ll-2012, Dent.l Decks

It must bc emphasized that one or more of these items are also frcquently encountered in persons with intact dentitions because the compromised facial support of the edentulous state is
not the cxclusive cause of thc morphological changes. Patient's weight loss, age, and hcavy
tooth attrition manifest orcfacial changes suggestive ofcompromised, or absent, dental support
for the overlying tissues.

Pre-extraction guides for selecting afiificial teeth from edentulous patients include:

. Photographs: provide general information about width

and possibly outline fonn.

judged from previous diagnostic
very
well
casts: the form of the teeth can be
patient's
prerious
(check
dentist).
if
available
with
the
casts ofnatural teeth ,
. Intra-oral radiographs: the size and form can be dtermined but beware because radiogmphs can be distorted and usually are larger images ofthe tccth.
. The teeth of close relatives: when no other means are available to get an idea about the
form, size and shade of teeth to be used for thc denture of an edentulous patient, records of
son's or daughter's teeth can give a clue. lt may also help in the arangement ofteeth as well
. Extracted teeth: sometimes patients keep their cxtracted teeth, which could be an excellent
source and aid to delineatc the form ofthe teeth, thus helping in the selection process.

. Diagnostic

1. Degenerative joint disease is frequently scen in denture wearen but this may be
age related rather than the state ofthe dentition.
2. The recording of centric relation is considered as an essential starting point in
the design ofthe artificial denture.

3. ln complete denture prosthodontics the position ofthe maximum planned intercuspation of teeth or centric occlusion, is established to coincide with the pa-

tient's centric relation.

One of the major reasons for the acceptance ofporcelain fused to metal restorations is
its greater strength and resistance to fracture. The combination of porcelain and metal,
fused together, is stronger than porcelain alone. Because true adhesion occurs, the bond
strength is such that failure or fracture will occur in the porcelain farther than at the
porcelain-metal interface.

Important points conceming the metal-ceramic crown:

. The necessary thickness ofthe metal substructue is 0.5 mm
. The minimal porcelain thickness is 1.0-1.5 mm
. Based on the above points, the tooth reduction necessary for the metal-ceramtc crown
is approximately 1.5-2.0 mm. The labial shoulder width is ideally 1.5 mm.
. The most frequent cause ofporosity in the porcelain is inadequate condensation of
the porcelain
. The effectiveness ofcondensing porcelain powder to reduce shrinkage is determined
by the shape and size ofthe particle

Remembr: Porcelain is much stronger under compressive forces than it is when subjected to tensile forces by the opposing teeth. Porcelain fracture in all-ceratnic restorations
can be avoided by keeping the angles ofthe prparation rounded.

. Porosity

. Thickness

Surface area

. All of the above

CopFight C

201

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l-2012 - Dental Decks

Which of the following are indications tbr lixed bridgework or important

considerations to think about when contemplating the fabrication of lixed
bridgework for a patient?

. A limited number ofedentulous areas which would not otherwise be more satisfactorily restored with a removable partial denture

The need to prevent the over-eruption ofopposing teeth and the ddft of teeth neighboring
the edentulous space

. The presence of suitable abutment teeth

support, absence ofapical pathology, etc.

favorable crowr/root ratio, adequate alveolar

. Esthetics
. Patient motivation, including time availability
. Clinical
.

and technical ability

All ofthe

above
31

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Soldering is used in dentistry to connect bridgework and in fabricating orthodontic appliances. Gold solders are generally used for fixed bridgework and silver solders for orthodontic appliances. It is important that the solder melt at least 150oF below the fusion
temperatures ofthe metals or alloys being solders (for obvious reasons).
A good solderjoint between 2 castings requires clean surfaces and fre electrons present on the surfaces.

Commonly used dental solders include:

Note: The bonding ofthe solder is contingent upon wetting ofthejoined surfaces by the
solder, and not upon melting ofthe metal components.
Cleanliness is the most important prerequisite ofsoldering, since the soldering process
depends upon wetting ofthe surfaces to achieve bonding. Fluxing is the oxidative cleaning ofthe area to be soldered. Fluxes are used to dissolve surface impurities and to protect the surface from oxidation while heating. Note: Fluxing is also performed on molten
metal alloys during the casting ofa crown or partial denture framework.

Contraindications for fi xed bridgework:

. Poor oral hygiene
. High caries rate
. Multiple spaces in the arch or teeth likely to be lost in the near future
. Space not detrimental to the maintenance of arch stability or dental health

. Unacceptable occlusion
. Bruxism

\ote+
'.;** .

l. If the clinical and technical skills ofthe dentist do not match the demands
ofthe case, fixed bridgework should not be undertaken because a failed bridge
is likely to be more detrimental to dental health than a failed removable partial
dnture.
2.Unless specifrcally contraindicated, fixed restorations are always the treatment of choice.
3. Fixed bridgework can be used in conjunction with removable partials. Example: A patient with a couple ofmissing anterior teeth and no posterior teeth.
Treatment could be fixed bridgework in the anterior and a partial denture replacing posterior teeth.
4. Although somewhat controversial, the literature recommends that you should
not splint natural teeth and implants in a fixed partial denture. Implants
have no periodontal ligament and so do not have the same capacity to ab-

sorb shocks as do natural teeth (they have dffirent mobilityb). When this
bridge is subject to occlusal loading, the difference has been shown to be
detrimental to the natural teeth as well as cause bone loss around the imDlants.

. Periodontal disease
. Recunent caries
. Vertical root fracture
. The need for an apicoectomy

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Coplrigh O

201 l-2012 - Dental Decks

All of the following are indications for porcelain veneers EXCEPT one,
Whieh one is the -EXCEPZOfr?

. Coverage of labial surface defects

.Masking of discolored teeth

vitality

-hypoplasia

-tetracycline

of the enamel

staining, discoloration following loss

. The severe imbrication ofteeth

. Repair of structural damage

fractured incisal edges

. Improvement of tooth contour *peg-shaped lateral incisors

. Reduction of spacing in cases when orthodontics would

Cop),right O 20ll-2012 - Dental Drcks

be inappropriate

of

***

The main symptom will almost always be pain when biting. The radiograph usu-

ally appears normal.

Advantages of using a post and core as opposed to a post crown when restoring endodontically treated teeth:
. The marginal adaption and fit ofthe restoration is independent on the fit ofthe post
. The restoration can be replaced at some time in the future, ifnecessary without disturbing the post and core

. Ifthe endodontically treated tooth is to serve as a bridge abutment, it is not necessary to make the root canal preparation parallel with the line of draw ofother preparations
it can be treated as an independent abutment

The post and core, when used, is made separate from the final restoration. The crown is
then fabricated and cemented over the core just as a restoration would be placed over a
preparation done in tooth structure.
For teeth with little or no clinical crown that have roots with adequate length, bulk, and
straightness, a post and core can be utilized. For posterior teeth with less extensive destruction ofcoronal tooth structure, or for those possessing less favorable root conhgurations. a pin retained amalgam or composite core can be used.

***

Other contraindications to porcelain veneers include: traumatic occlusal contacts, unfavorable morphology, insufficient tooth structure, and insumcient enamel.

Technique for Insertion of Porcelain Veneers

. The veneer should be tried in wet with either a drop of water or glycerine to check
for fit. A reliable estimate for the possible post-cementation appearance with try-in
pastes can also be performed.
. The veneer fit surface should be cleaned to rernove any saliva contamination or try-

in composite

. Ifthe fit surface has not previously been treated with silane and protected with lightcured unfilled resin, this should be done at this stage
. The enamel surface should be cleaned with pumice and water
. While protecting adjacent teeth with matrix strips, the enamel is acid-etched with di-

luted hydrofluoric acid. Note: The etched surface is washed and dried and a layer of
unfilled bond resin is applied and thinned with oil-free air
. An appropriate shade oflight-cured composite is applied to the fit surface ofthe veneer which is "puddled" into place on the tooth surface
. Gross excess of composite should be removed and light-curing completed
. Remaining excess composite is removed with finishing diamond burs, discs, strips,
etc., and the margins finely polished
. The patient should be seen in approximately one week

. One
. Two

. Thiee

. Four

34
Cop,.righl O2011,2012 - Denral Decks

. Maxillary premolar
. Mandibular premolar
. Mandibular molar
. Maxillary molar

35
Coplright

@ 201 I -20 12

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Important: One factor that limits th length ofthe pontic span is the abutmnt teeth's ability to accept the additional occlusal load while providing adequatc support to the cemented fixed partial denturc. Ant's law stales
that the root surface arca ofthe abutment tcelh supported by bone must equal or surpass the root surface area
ofthe teeth being replaced with pontics.

An edentulous spacc involving four adjacent teth otherthan four incisors is usually best treated lvith a removable partial denlure. [f more than one edentulous space exists in the same arch, even though each of
thcm could be individually rcstorcd with a bridge, it may be dcsirable to restore them with a removabie partial denture. This is especially true ifthe spaccs arc bilateral and each one involves two or more missing teeth
be used as abutments, sinc they fiequently display incomplete eruption; shon, fused
roots; and a marked mesial inclination in the absence ofa second molar Note: Diverging multirooled, curvd,
and broad labiolinglal roots are prefened over fused, single, conical, and round circumferential roots.

Third molars can rarely

Remember:
. Splinling adjacent abumlent teeth in a fixed bridge is primarily done to improve the distrit ution ofthe
occlusal load,
. In order to maintain and protect the health ofthe gingival tissues and prcvent recession, lhe correct contour of the cro$n's gingival one-third to one-fifth and interproximal areas are most impofiant in the final
restoratioD,

.An anterior fixed bridge

is contraindicated when there is considerable resorption ofthe rsidual bridge.

A removable panial denrure would be indicated in this case.
. Horizontal loads 1ol &,c"t on natural or abutmcnt teeth are most deslructive to the pcriodontium.
. Abuimenls with hatfor lss ofbone support and loss ofattachment have a poor prognosis.
. \\'hen replacing the maxillary or mandibular canine, the central and lateral should be splinled to prcvent
lateral drifting oflhe fixed bridge.
. Aburment teeth must align to a common path of insertion (/o/ orvious reasons when lryng lo seat lhe

hrklge).

. Short root-to-crown r^lio

(less lhan./:21 with conical roots should be avoided as abutmenls.

. \atural reeth exert more force than an RPD or complete denture when opposing a fixed bridge
. Ideaff)--, rhe supportive surface area (peiodontium) of lhe abutment teeth should be equal to but not
leis than !ha! ofthe teeth to be replaced

This design preserves the lingual surface and is indicated for restoring mandibular molars with damaged buccal surfaces and intact lingual surfaces. It is also useful on teeth with
severe lingual inclinations where large quantities oftooth structure would be destroyed if
a full veneer crown were to be used.
The standard thre-quarter crown is a partial veneer crown in which the buccal surface is left uncovered. It is the most commonly used form ofthe partial veneer crowns.
A patient with a high caris index, short clinical crowns, and minimal horizontal overlap would not be a candidate for partial veneer crowns. The restoration ofchoice would
be a

full metal-ceramic crown,

Note: Rtention and resistance forms in full coverage preparations on short molai:s can
be enhanced by placing several vertical grooves or boxes.

According to the ADA classification for alloy systems used

for metal-ceramic restorations. noble allovs:

. Have

a noble metal content

of

2 600lo

. Have

a noble metal content

of

> 45%

. Have a noble metal content of > 25o%

. Have

a noble metal content

of )

[ 50%

36
Copyright O 201l-2012 - Dental Decks

Periodontal health of the gingival tissues is a major concern when phnning

any fixed prosthodontic treatment. For optimum periodontal health,
restoration linish lines should be:

. \\'ithin

the sulcus at least 1.0 mm and away from the free gingival margin without
encroaching on the biologic width

. Terminated at the free gingival margin

Supragingival whenever possible (at least 0.5 mm from the free gingival ntargin) to

allow for hygienic cleansing

. As far

as possible subgingivally into the attachment apparatus

37
Cop)righr O

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ADA classification for alloy systcms uscd for metal-ccrumic rcstontions

. High noble alloys (old tem was pre.ious netal)t > 60o/n noblc rr'ctal contcnt (gold > 40%)
. Nobfe alloys (o// ter"r, tr^r senripreciout metal): > 2570 noblc mclal contcnt ( o gold rcquircd)
. Base metaf affoys foll term was nonptecious metal): < 25y. notle fielzl conlent (tro god requile,l)
Remember: Noble alloys (gold, plaainuD\ and po adium) do not oxidize on casting. This featurc is important in a
mctal substmte so that oxidation althc metel-porcehin interface can be controlledby thc addition oftracc clcmcnts
to thc metal (silicon, ituiiun, and iridiunl

Desirable properties of alloys for metrl-cerrmic restorations:

. High yield strength: minimizcs pcrmancnt dcformation und$ occlusal forcc and porcclain fracture duc to fmmcwork deformation
. High modulus of elasti cilf (snfness)| minimizes flexure of long-span fixed bridgcs and porcelain fracturc duc
to framcwork dcformation.
. Casting Nccuncy: basc mctal alloys arc lcss accuratc lban gold
. Biofogical compatibililf (for patient, dentist and lab technician): cat be a problcm with Nickcl and Bcryllium
in base mctal alloys (a/&/gler/
. Corrosion resistanc
. The metal coeflicient ofthermrl expansion should bc highcr than thc porcciain to lcavc thc porcclain in comprcsslon rn a stronSer statc

)letal based based on color or composition:

. \'ello* gold: > 60% gold content.
.

$hite gold: > 50% gold

content.

. Lo\n (econom\,) gold (usualr te ow): < 600/0 gold (42yFs59/o)

. Higb prll.diurn whitc, mainly palladium, Gold (22,/, littlc coppcr or cobalt
. Sifler-pa lladi u m: whi te, silvet (5 5a/F7 I %o) , palladium for nobi lity and control ling tamish (2J%- 27/o) , may or
ma) not contain a little gold or copper
. Pelladium-silver: whitc, mainly palladium, silvcr up to 40%,

Porcclain adhercs to mctal primarily by a chemical bond, A covalent bond is cstablished by sha;ng 02 with thc clcmcnts prcscnt in thc porcelain and the mctal alloy. These clemcnts includcsilicon dioxidc (SlO, in lheporcclain and
oxidizing clcmcnts such as indium, tin, and gallium in thc mctal alloy.

***

There is general agreement among dentists and researchers that optimum fixed prosthetic restorations will display supragingival finish lines.
Such positioning is quite often not possible because ofesthetic or caries considerations.
Subsequently. the margin must be placed subgingivally. Ifa margin needs to be placed sub-

gingivally, the major concem is not to extend the preparation into the attachment apparatus. Ifthe margin does extend into the attachment apparatus, a constant gingival irritant
has been constructed and ultimatety the crown will fail. In this case, the tooth should
have had crown lengthening performed on it prior to final crown preparation.

Remembr: It is important to maintain the biological width (the combined width of the
connective tissue attachment and thejunctional epithelium, which averages approximately
2 mm).

The most important criterion for a gingival margin on a crown preparation is that its
position is easily discemible
be able to recognize it easily. Note: The most com-must
regarding a PFM prosthesis is improper margins in the
mon complaint oflab technicians
impression.

Remembr: The optimum margin for

a casting is an acute edge

with

a nearby

bulk of

metal. This acute edge or angle can be easily bumished to improve its fit.

Note: A butt joint,

as

gpified by a shoulder, is the poorest type offinish line that can be

used with cast metal restorations.

When casting conventional gold rlloys, which type

of investment matrial is used?

Silica-bonded investments

. Phosphate-bonded investments

. Gypsum-bonded investments

Coplriglit e 201I ?012 Denral Decks

The metal and porcelain must have compatible melting temperatures as well as compalible coe{ficient of thermal expansions

. The metal's melting

temperature should be at least 300-500"F higher than the fusing

temperature of the porcelain

. The metal coping should preferably have sharp surfaces to prevent shrinkage of the
porcelain

. In function,

glazed porcelain on the occlusal surface removes 40 times as much ofthe

opposing tooth structure than gold

39
Coplright O 201 l-2012, Denral Decks

A dental inyestment is a refractory material that is used to surround the wax pattern during the
procedure of fabricating thc metallic prmanent restoration. It forms the mold into which the
alloy is cast after the wax has been eliminated.

An investment material to be used for

a casting

mold should expand on setting and heating to

compensate for the shrinkage of molten metal as it solidifies. Metal casting alloys have diffcrpure metals and alloys of eutectic composition have a melting point.
ent melting ranges

The melting range-only

of gold casting alloys (aprox. 900'Q is lower than that of Co-Cr alloys
(aprox. 1350'C), Therefore, investment materials used for gold casting alloys arc sometimes
different from those used for Co-Cr alloys. The investment material should be ofa suitable consistency for adaptation to the wax model and have a reasonable setting time. To withstand the
temperatures required for the casfing process there should be no distortion, no decomposition;
thc investment should not fragment or disintegrate under the impact ofthe molten metal: the material should be porous to allow the escape ofair and gases and the investment should be easily

removed from the casting after cooling.

Classification of Dental Investment Materials

. GJ-psum-bonded investments: binder is gypsum (calcium sulfate hemihydrate). Used'
when casting conyentional gold alloys containing 65yo to 75y. gold at temperahrres near
1.100'c.

. Phosphate-bonded investments: binder is a metallic oxide

and a phosphate. Two lypes

Ti pe I is used when casting base metal alloys for rnetal-ceramic crowns and Type II is used
for removable partial denhrre frameworks. Are capable of withstanding high temperatures
/abote 1,100"C).
. Silica-bonded investments: binder is ethyl silicate. Not used much today.
The refractory material for thcse invcstments is either quartz or cristobalite. This material prolides the thermal expansion for the investment. Note: The expansion of the investment provides a larger mold to compensate for the subsequent contraction ofthe alloy.

***

This is fals; the metal coping must have all of its surfaces smooth and rounded to prevent porcelain shrinkage.
Note: The purpos ofthe metal coping is to ensure the
strength ofthe porcelain veneer.

fit ofthe crown and to maximize the

Important points to remember conceming the metal coping or substructure ofa metal-ceramic ctown:

l. The metal must have proper thickness (0.5 mn)

very important
2. The outerjunction ofporcelain to metal should be- at a right angle (to avoid burnishing
oJ the metal and subsequent f-acture of the porcelain).
3. All ofthe porcelain should be supported by metal.
When delivry cast restorations, the following sequence should be used: (l) check the intemal surface fit (2) adjust the proximal contacts and pontic-ridge relationship (3) check the
maryinal integ ty (4 )check the stability (ifit is a bridge) (5) check the axial contours and last
but not feast, (6) check the occlusion (centric qnd eccentrtic contacts).

Important: If your margins were all closed at the metal try-in appointment and when the
crown came back from the lab they are all open, check the contacts. They are probably too
ttght (over-bulked porcelain).

' ' . -.

;'Note{

I . Porcelain that is baked onto a high-fusing gold alloy may exhibit a green discoloration due most likely to contamination of the metal by copper traces.
2. The best measure ofthe potential clinical performance ofa casting alloy is its

ADA crtification.

. Eniances resistarce form when buccal-tolingual forces

.

Serves as a positive stop when the casting is seated during cementation

. Relieves the functional cusp from additional

the long axis ofthe tooth

are applied

Provides space
occlusal contact

stresses when the restoration is loaded in

for restorative material of adequate thickness in an area of heavy

40
Copynghr O 201

l':012

- Detual

Deks

The preparation for a full veneer crown is begun with occlusal reduction. There
should be
clearance on the functional cusps and rbout _
on the non-functional cusps.

. 0.5 mm;

1.0 mm

. L5 mm;

1.0 mm

.2.0 mm;

1.5 mm

. 2.5 mm; 2.0 mm

41

CoplriSht O 201 1,2012, Denial Decks

The functional cusp bevel is an area ofreduction over the functional cusps that allows for cxtm
thickness ofmetal in this area ofhealy occlusal contact in centric occlusion as well as in lateral
movcments. The functional cusps are those that oppose thc ccntral fossae ofthe teth in the oppostte arch (buccal cusps on mandibular teeth, lingual cusps on ma-tilldry teetu.
Thc primary reason for choosing a r/4 crown over

full

cast crown is

tooth structure is spared.

Other advantages to the use of partial veneer restorations (three-quarter

&

seven-eighths

crowns).

. A great deal ofthc margin is in an area accessible to the dentist for finishing and to the patient for cleaning.
. Less ofthe restoration margin is in close proximity to the gingival crevice, thus lessening
the opportunities for periodontal irritation.
. Can be more easily seated completely during cementation.
. with at least part ofthe margin visible, complete seating ofa partial veneer crown is more
easily verificd by direct vision.
. Ifit is evernecessary to conduct an electric pulp test on the tooth, a portion ofenamel is unvcneered and accessible.
..

,\orec

,"-;*

The path ofinsertion ofan anterior three-quarter cro*'n parallels the incisal l/2
to 2/3 of the labial surface, not the long axis of the tooth. For a posterior threequarter crown it parallels the long axis ofthe tooth.
2. A pin modified three-quarter crown can preserve the facial surface and one proximal surface. This is preferred in cases which require repairing of severe lingual
abrasion on incisors and canines, avoiding other more destructive options like full
veneer metal-ceramic restorations.
1.

Thjs reduction is done to eliminate undercuts and create space for suffcient metal to ensure adequate
strength ofthe crown.

Remember: In preparing a tooth for a metal-ceramic crown, it is necessary to create space for 0.5 mm
ofmetalpfus at lcast 1.0 mm ofporcelain lpreferably 1.5 mu) to cnsure adequate strength and optimum
esthetics of the ceramic material. Snpporling (fuhctiotlal) cusps require 2 mm of the reduction The
opposing walfs should convcrge no more than lO degtecs (6 degree tapet is reconmended). A chamfer
finish line /0.i

l?r,

and a1l maryins should be placed supragingivally when possible.

The same amount ofoverall tooth reduction is needed for a metal-ceramic crown as for an all-cerarnic
cro*n / L 5-2.0 nn). Howevet for all-cersmic restorations, the preparation needs to be well-rounded
\\ irh no

shrrp angles to avoid porcelain liacture.

The most frequent causc of failure of a crown (reganlless ofa,hich ,*pe) is the lack of attention
Important: For gingival health, the conect contour ofinterproximal gingival areas and the gingival third are most important.

\ote:

ro rooth shape, position, and contacts.

is regarded as a more favorable material for the occlusal surface as its wear characreristics are more in harmony with enamel; porcelain is considered to bc the cause ofaccelerated wear
of the opposing dentition. Gold would certainly be preferred for the restoration ofocclusal surfaces in
rhe presence ofa tooth-grinding h.bit.

Important: Gold

..
:{oteCl

ja*

l. Axial contours should correspond to the emergence prolile (usually flat or concave) of
the tooth.
2. The buccolingual dimension of a cast restoration is usually determined by the occlusal
morphology oflhe opposing tooth.
3. Occlusal point contacts between opposing teeth arc preferred to broad, flat occlusal contacts to Dlevent weaf.
4. Type I and II gold alloys are uscd for inlays.
5. The most commonly used type ofgold for all-metal crowns and bridges is TyPe III.

Which ofthe following best describes 'rstrain hardening't

or 'rwork hardeningrt?

. Hardening (or deformation) ofa metal

at room temperature

. Hwdening (or deformotion) of a metal at a very high temperature

. Softening

a metal by controlled heating and cooling

Softening a metal at room temperature

42
Coplright O

. A metal is elevated to

20ll

2012 - Denral Decks

a temperature above room temperature and held there for a

length of time

. A metal is rapidly cooled frorn an elevated temperature to room temperature or below

Softening a metal by controlled heating and cooling

. None ofthe above

43
Coplrishr O 20ll'2012 - Dental Decks

In polycrystalline metal, dislocations (defects) tend to build up at the grain boundaries. Also, the banier action to slip at the grain boundaries causes the "slip" to occur
on other intersecting slip planes. Point defects increase and the entire grain may
eventually become distorted. Greater stress is required to produce further "slip" and
the metal becomes stronger and harder. The process is known as strain hardening
or work hardening. The latter term is derived from the fact that the process is a result ofcold work ( i.e., deformation at room temperature, in contrast to the effect of
working at a higher temperature, such as in forging). The ultimate result ofstrain
hardening, with further increase in cold work, is fracture.
The phenomenon ofcold work and strain hardening is familiar to everyone. For example, one way to cut a wire is to bend it back and forth rapidly between the fingers.
When all the slip possible has occurred, the wire fractures.
and proportional limit of the metal are
increased with strain hardening, whereas the ductility and resistance to corrosion are

Important: The surface hardness, strength,

decreased. However, the elastic modulus is not changed appreciably.

..

elongated grains in the microstructure of a wrought

indicate that the wire has been cold worked or strain hardened.
2. A slip is a deformation process requiring the simultaneous displacement
ofan entire plane ofatom A, relative to the plane B, below it'
l.Under

'rote*. wire

'*-i.".

a microscope,

complete gold crown is cast and immediately quenched in

u ater. This softens the alloy, making it more malleable for frnishing procedures.

It is usually performed when

a softened condition for a Type III dental gold alloy, the casting
should be quenched in water immediately or within 30-40 seconds ofbeing made.

Important: To achieve

. l
}-oa3'.

'.9."

Hert treatment is the subjection of metals and alloys to controlled heating

and cooling afier fabrication to relieve intemal stresses and improve their phys-

ical properties. Methods include annealing, quenching, and tempering.

2. Annealing is controlled cooling of a material to increase ductility and
strength. The process involves first h eaing a mateial (usually glass or metal)
for a given time at a given temperature, followed by slow cooling.
3. Fritting is a process ofmanufacturing low and medium fusing porcelains. It
involves raw constituents ofporcelain to be fused, quenched, and ground back
to an extremely fine powder This "frit" can be added over by other metallic
substances to produce color in porcelain.

. Dowel crowns to be cast in silver-palladium alloys

. Titanium crowns and copings

. The substrucfure for metal ceramlc crowns

. Type IV gold alloys
. None ofthe above
. All ofthe above

44
Cop)righr O 20ll-2012 - Dental Decks

. Be perpendicular to the incisal one-half

of the labial surface rather than the long axis

of the tooth

. Be parallel to the incisal one-halfto two-thirds ofthe labial sudace rather than the long
axis ofthe tooth

. Be parallel to the long axis ofthe tooth

. Be parallel to the cervical one-third ofthe labial surface rather than the long axis of the
tooth

45
Cop)'righr C 201 l'2012 - Dental Dcks

Dowel cores do not require

as much expansion as do crowns. So even though they are

(alloys
that require a high temperature for expansion) , a gypsum
cast with Ag-Pd alloys
bonded mold is used and heated to only 1200'F. Type I, II, and III Gold alloys can also
be cast in g]?sum bonded investmen! material.

The substructures for metal ceramic crowns ard Type IV Gold requires heating above
2100'F. These are invested in phosphate bonded material. Any alloy with a casting
temperature in excess of 2100'F (115f" C) shouldbe cast in an invesfinent with a binder
other than gypsum. High temperatures cause decomposition of calciurn sulfate in the
gypsum binder with the resultant release ofcontaminating sulfur into the mold.

Magnesium phosphcte reacts with primary ammonium phosphate to produce magnesium ammonium phosphate which gives the investment its strength at room temperature.

At higher temperatures, silicophosphates are formed which give the investment its great
strength.
The metal-ceramic alloys must have a high melting range so that the metal is solid well
above the porcelain baking temperatures to minimize distortion (sag) ofthe casting during porcelain procedures. A high sag factor will lead to distortion of bridge spans when
the porcelain is fired. Remember: When casting a cedain alloy, make sure you use a crucible that has not been used for other allovs.

*** Important: If the path of insertion is made parallel to the long axis ofthe tooth, the
labio-incisal comer will be sacrificed and an unnecessary display of gold will result.

Two factors that must be dealt with successfully to produce an anterior % crown with a minimat display ofgold:

l. Path of insertion and groove placemnt

2. Placement and instrumentation of extensions

Proximal extensions must be done with thin diamonds and hand instruments from a
lingual approach to minimize the display ofgold. They should be extended facially to a
cleansable area without destroying the facial contour ofthe tootlt.

Note: The anterior three-quarter crown is not used as fiequently today as it once was. Unsightly and unnecessary displays of gold in poor examples of this restoration have made it
less popular with the public and dentists alike. However, the standard three-quarter crown
on a maxillary anterior tooth need not show large quantities ofgold ifprepared correctly.

. The length ofthe abutment teeth can be accurately gauged

. The true inclination ofthe abutment teeth will be evident
. The presence

ofperiodontal pockets and the crown-to-root ratio of potential abutment

leeth

. Mesial,Distal drifting, rotation, and faciolingual displacement of potential abutment

teeth can be clearlv seen

46
CopFight O

20ll 2012, DentalDecks

All of the following statements concerning pontics are

trae EXCEPT one. Which one is the EXCEPTIOM

. With regard to the ease of cleaning and good tissue health; proper pontic design is
more important than the choice of material used in fabricating the pontic

. The contour and nature ofthe pontic contact with the ridge is very important
. The area ofcontact between the pontic and the ridge should be small
. The portion ofthe pontic approximating the ridge should be

as concave as possible

.The pontic should exert no pressure on the ridge (pdssive contact with no blanching
ofthe tissue)

17
Cop)righr (, 201I -2012 - Dental Decks

*** Important:

The presence ofperiodontal pockets and the crown-to-root ratio ofpotential abutment teeth cannot be determined by studying diagnostic casts. You need to do an exam and have
x-rays in order to obtain this information.

More information that can be obtained by studying the diagnostic casts:

. It allows an unobstructed view ofthe edentulous areas and an acaurate assessment ofthe span
length, as well as its occlusogingival dimension.
. The curvature ofthe arch in the edentulous region can be determined, so that it will be possible to predict whether the pontic(s) will act as a lever arm on the abutment teeth.
. A thorough evaluation ofwear facets, their number, size, and location is possible when they
are viewed on casts. Excessive wear on occluding surfaces ofteeth usually results from a dishar-

mony between centric occlusion and cenhic relation.

1.

lrreversible hydrmolloid or alginate is the material ofchoice to produce diagnos-

tic casts.
2. Tray adhesive should always be used to prevent distortion at the time ofremoval.
3. The greater the bulk that the alginate has, the more favorable the surface area:volume ratio and the lower the susceptibility to water loss or gain and, thercfore, unwanted
dimensional change.
4. The tlay should be removed 2 to 3 minutes after gelation.
5. The irnpression should be rinsed and disinfected with glutaraldehyde oriodophorbefore pouring.
6. Pouring with ADA type IV or V stone is recommended.
7. Do not disturb poured impressions until they are set, the time varies between 30 and
60 minutes depending on which type ofstone is used.

***

This is false; the portion ofthe pontic approximating the ridge should be as convx as possible.
Pontic design and selection directly impact periodontal health. Pontics should contact keratinized attached tissue and rest passively, free ofpressure, to prevent ulcerations and plaque
buildup. Pontic designs with concayities (such as the saddle-shaped pontic), are difiicult to
clean because oftbe depression on their inner surface is inaccessible to conventional methods
oforal hygiene. Egg- or bullet-shaped pontics are the easiest to clean because they are convex in all aspects and contact the residual ridge at a single point.

Most important: Whatever pontic is used, it must be properly designed to prevnt an unhealthy response to the underlying ridge mucosa. The pontic must:

.
.
.
.
.

Be nonporous, smooth, and have a polished surface

Make passive pinpoint contact with the gingival tissue
Not be concave in two directions
Be readily cleanable by the patient
Be narrowr at the expense of the lingual aspect of the ridge
. Be on as straight a line as possible between the retainers to prevent any torquing ofretainers or abutnents.

Important: Excessive tissue contact

has been cited as one

ofthe major

causes of failure

of

fixed bridges.

Glazed porcelain, polished gold, unglazed porcelain, and polished acrylic are prefened in
that order for their acceptability to the soft tissue.

. J:

.l:l

1:2

.l:l

a8
Cop)nght

@ 201 1,201 2

, Dntal Decks

Sodium pyroborate

. Alum

. BoraK
. Silica

49
Coplright O 2011,2012, Dental Deck

This high a ratio is rarely achieved, however, and a ratio of 2:3 is a more realistic
optimum. A ratio of l:1 is the minimum ratio that is acceptable for a prospective abutment
under normal circumstances.
The crown-to-root ratio alone is not adequate criteria for evaluating a prospective abu!
ment tooth. Root configuration is an important point in the assessment ofan abutment's
suitability from a periodontal standpoint. Roots that are broader labiolingually than they
are mesiodistally are preferable to roots which are round in cross section. Multi-rooted
posterior teeth with widely separated roots will offer better periodontal support than
roots which converge, fuse, or generally present a conical conhguration. Single-rooted
teeth with an irregular configuration or with some curvature in the apical third ofthe root
are preferable to the tooth which has a nearly perfect taper. Root surface area of the
prospective abutments should also be evaluated.

All ofthe following

are factors in fixed bridgework design:

. Root configuration

. Crown-to-root ratio
. Axial alignment of teeth
. Length ofthe lever arm (span) Note: Rplacing three teeth is maximum!l!
Remember: Parallelism ofabutment preparations is best determined by the long axis

of

the DreDarations.

Soldering flux dissolves surface oxides and allows the melted solder to wet and flow onto the
adjoining allow surfaces. It is composed of sodium pyroborate (5 5%.), borax (35%.), and silrca ( 10%)

In addition to the usual reducing and cleaning agents incorporated in a flur, a flux used for
soldering stainless steel or cobalFchromium alloys also contains a fluoride to dissolve the
passivating film supplied by the chromivm (chromium osidey'lz). The solder will not wet the
metal $ hen such a film is present. Potassium fluoride is the most common agent.

Soldering is thejoining ofmetal components by a filler metal, or solder, which is fused to each
ofthe pans beingjoined. To be biologically and mechanically acceptable, a solderjoint should
be circular in form and occupy the region ofthe contact area. The strength ofthe solderjoint
is increased by increasing the height ofit (as opposed to the wldlr. Not: The recommended
distance /i|ldrlr/ between the parts to be joined should be 0.25 mm.
Cleanliness is the prime prerequisite ofsoldering. Corrosion products, such as oxides and sultides that are present as a result ofthe casting process, interfere with bonding. Flux is placed
on the surfaces to be soldered before they are heated. When it melts, the flux displaces gases
and removes conosion products by either combining with them or reducing them. The flux
in tum is displaced by the solder, which can now form an interface with and bond to the surface being soldered.

Note: Antiflux is

material used to outline the area to be soldered in order to restrict the flow

of solder. The most common antiflux is a soft graphite pencil. Iron oxide (rouge) may also
be used.

. The saddle-ridgeJap pontic

. The sanitary ftygienic) pontic
. The modified ridge-lap pontic
. An ovate pontic

. A conical pontic

50

Cop}tghr O 20ll-2012 - Denlal Deck

. The first statement is true; the second statement is false

. The first statement

is false; the second statement is true

. Both statements are true

. Both stalements are false

Coplright O

5t
20ll 2012,

Dental Decks

ofa fixed bridge that replaces a missing tooth. This

tooth substitute must provide patient comfort, convenient contours for hygiene, and be
The pontic is the suspended member

esthetic,

if indicated.

Most Common Pontic Designs:

. The sanitary @1,glenic) pontic design leaves

pontic and the ridge.

(nonqppearance
zone, posIs most commonly used where esthetics are not important
a space between the

terior mqndible). Convex in all areas.

. The saddle-ridge-lap pontic design looks most like a tooth. Covers the ridge labiolingually with a large concave contact. Impossible to clean, should not b used.
. The modified ridgeJap pontic design uses a ridge lap for minimal ridge contact.
Gives the illusion ofbeing a tooth, but possesses all convex surfaces for ease ofcleaning. This design is the one of choice for pontics in the appearance zone (where esthetics are important) for both maxillary and mandibular bridges.
Conical pontic: rounded (rop) and conical (bottom). Suited for molars without esthetic requirements (in non-appearance zone).

Olat pontic:

a sanitary substitute for saddle-ridge-lap design. Set in the concavity

ofthe

ridge hllicl is eilher ptesent or surgically made)that gives the appearance that it is growing from the tooth.

Remember: The faciolingual dimension ofthe occlusal portion ofpontics is determined

b1 the faciolingual position ofthe opposing centric holding contact areas

"t

li.rcasins

a cement's

po$dcr,lo,liquid ratio decrcases thc solubility ofrhe ccmcnr.

Lutins agents /.prrdrrt:

. Zinc phosphaae cement: onc ofthc oldesr and most widcly uscd ccmcnts, zinc phosphatc ccmcnt is thc stanJrd rlirinst $hich nc$ ccmcnts arc mcasulcd. Advantages: Iong rccord ofclinical acceprability, high compres-

.:':

strcngth. acccptably thin film thickncss. Disadvantages: low initial pH which may lcad to poslccmentation
rtr'. lack ofan abilily to bond chcmically to tooth structure and lack ofan anlicariogenic cflcct.lmportant:
Z:n. phosfhatc ccmcnt is mixcd using thc "frozen slab" rcchniquc which grcarly cxtcnds thc working timc fb.t,
J ' .ak h as 340'i;). Note: Tlc pH of ncwly mixcd zinc phospharc ccmcnt is |ndcf 2 ( tbo lalers ol vtnish m sl

.:rr:trr

;.)ep!ieloraftlertoprotectthepulp)blJtnscslo5.9within24boursandisncarlyneutralat.l8hours.Thcfilm

ra:.kn.ss ofzinc pbosphatc is about

25 !rm-

. Zinc pohcarbor]late cement: also known

as zinc polyacrylarc ccmcnq was one of the first chemically adhesite denial mate.ials. Thc adhcsivc bond is primarily to cnamcl although a wcakcrbond io dcntin aiso forms. This
:. Ju. ro rhe faci that bonding appcars lo be the rcsult ofa chelation rcaction bcrwccn the carboxyl groups of rhc
.J:x.nt and calcium in thc tooth structure; hencc, tlrc more highly mincmlizcd Ihc tooth structure, rhe sronger the

:{nd.\drsntsges:kindlothepulp,chcmicallybondslotoorhstrxchrre.Disadvantagestshortworkingtimc,rc,
;urrss scparalc tooth conditioning stcp prior to ccmcnlation. Note: il is more viscous whcn mixed and has a shorle.
\rrking timc than docs zinc phosphate cement.
. Class ionomercement: Advantages: chemical bond ro cnamcl and dentin, anticariogenic cflcctlrcleases
Iu,
,rr,1r. cocllicicnt oftbcrmal cxpansion similar to that oftooth structurc, high comprcssivc strcngth, low solubil:n Disadvantages: low initial pH which may lead to postccmentation scnsiriviry. scnsirivity ro both moisturc
.onramination and dcsiccation. Notet Its mcchanical propcrties arc supcrior to zinc phosphatc and polycarboxy. Resin-modified glass ionomerluting agents; have propcnics similarto glass ionomcrccmcnts. but have higher
5trenglh and lower solubility. Note: Thcy should not bc uscd wilh all-ccramic rcstorations dues to rcports ofccr3nlic fracturc, most likcly thc rcsult ofcxpansion from watc. absorprion.
. Resin luting agentsr arc unfillcd resins that bond to dentin, which is achicved with organophosphonatcs,
/2-1,)dro]reth\ I ttrcthacrylate IHEMAII, or 4-mcthacryloyloxycthyl trimellirarc anhydridc (4-Mf,TA). Advanrrges:
hr!h comprcssivc strcnSth, low solubility. Disadvant.ges: irritating cfl'ects on thc pulp, high film thichcss p -?J
1]r'l. Note: As a gcncml nrlc, rcsin cements are thc bcst choice for luting ccramic rcstorarions_
Important: Thc film thickncss at thc margins shouid be minimizcd to rcduce the solubility of the luting agenr.
Tl.ough c|rcful tcchnique, a marginal adaptation below l0 pm can bc obrained consistcntly. Noter Factors that in,
.r.asc the cement spacc for crowns include (l) thc usc ofdic spacers (2.)incrcased expansion ofthc investmcnt mold.

. Zinc phosphate
. Zinc polycarboxylate
. Glass ionomer

. Resin-modified

glass ionomer

Coplrighr O 201 l-2012 - Dental Decks

. Shoulder
. Shoulder with a bevel
. Chamfer
. Bevel or feathered edge

Coplright O 201 I -20

12 -

Ddtal

Decks

Ide.l

Zinc

Glasr

Resin-

Resin

Material

Poly-

Iotromer

modified

luting

Glass

rgents

crrboxylete

Ionomer

<25

<25

<25

>25

>25

Long

1.5-5

L75-2.5

2.3-5

2-4

3-10

Setting time
(nt r)

Short

5-14

6-9

G9

Pulp irriration

Low

Modelate

Low

Hieh

Iligh

High

High

Low

Film thickness Low

(rn)

Solubility

Hich
Iligh to very
high

Microleakage

Very low
High

Retenlion

High
Modrate

High to very
high

Low to very low

Low to moder-

Moderate to high

lligh to very
high
High

Moderate

ate

l.

Cemenrs do not rdd to the retentive chamcteristics ofa crown. Ccmcnts act by increasing the frictional rcsistance between tooth and restoration. Thc ccmcnt prcvcnts two surfaccs from sliding. Although they do not prcvcnl onc surtacc from bcing liftcd from another
2. A toolh should bc wiped dry before cementation ofa crown as opposcd to drying the tooth with alcohol and warm airto dccrease the possibility ofpulp damagc.
3. Always apply cement to both the rcstoration and tooth.
4. One way to rcducc thc potential for post-cementation sensitivity with zinc phosphate and Slassionomcrccmcnts is to use a resin based descnsitizeron thc prcparcd tooth p.ior to luting.
5. Cement film thickncss is dependent upon powder-to-liquid ratio, powdcrparticle sizc, and pressure

gencratcd dunng seating of the casting.

However, in practice this finishing line is difficult to read on both the impression and die and may lead
to inaccurate extension and also distortion ofthe wax pattem, and subsequent casting, as a result ofthe
thin wax. It also offcrs the least margid.l strength to the castingThe chamfer prepamtion is the preferred linishing line for cast gold restorations. The resultant casting has sufficient marginal strength; at the same time it allows the slidingjoint at its periphery to minimize the gap between the tooth and preparation, thus rcducing the thickness of the cement. A
well-prepared chamfer margin combines the advantage of an easily definable margin, on both the impression and die, with minimal tooth prcparation.
The shoulder preparation is the finishing line of choice for porcelain jacket and tll-ceramic crown
preparations, The edge strength of porcelain is low; therefore, a butt joint is required. The shoulder
provides resistancc to occlusal forccs and minimizes stresses in the porcelain. The margin can be easily
read on both the impression and die. The main disadvantage is that any inaccuracies in the fit ofthe
cro$n Nill be reproduced at thc margin, resulting in an increased thickness ofcement.

Tle shouldr with a bevel allows

sliding fit to occur at the margin and therefore may be used on thc

proximalbox ofinlays and the occlusal shoulder ofthe mandibular three-quarter crowns ltmayalsobe
used for the labial margins ofmetal-ceramic crowns. Providing these margins are placedjust in the gingival crevice, little display ofmetal will be noted.
Four Tlpes of High-Gold Alloys:
l. ADA t-ype I highest gotd content, 83o/o noble metals. Intended for small inlays. Easily bumished
due to high ductility.
2. ADAtype II: $eatcrthan 78olo noble metals. Intended for larger inlays and onlays. Can also be burnished.

3. ADA type UI: greater than

75o%

noble mctals. Intended for onlays and crowns Capable ofbeing

heaFtreated.

Iv: greatcr than 7570 noble metals. Intended for bridges and removabJe partial dentAlso capable ofbeing heat-treated. Hardest ofhigh-gold alloys.

4. ADA type
ures

. The diameter of the sprue pin should be equal to or greater than the thickest portion
of the pattem

. The diameter of the sprue pin should be equal to or smaller thar the thickest portion

ofthe pattem

. The diameter of the sprue pin

should be equal to or greater than the thinnest portion

ofthe pattem

. The diameter of

the sprue pin should be equal to or smaller than the thinnest portion

ofthe pattem

54
Cop'.righr O 2011-2012, Dental Decks

.Akey
. A keyway

. A kev and a keyrvay

Copltigh

O 201 l'2012 - Dental Decks

The sprue is a small diameter (10-12 gauge) pin made ofwax or plastic.

A 10 gauge sprue pin can be used on most patterns, while the l2 gauge is used on small
premolar pattems. The sprue should be attached to the wax pattem at its point ofgreatest
bulk and at an angle (45) that will allow the incoming gold to flow freely to all portions
of the mold. Spruing at a thin area of the pattem can produce the same result as using a
back porosity. This is caused by turbulence in the flow
sprue that is too small
-shrink
in tum creates a shrinkage void, or suck-back porosity.
ofthe molten metal which

Note: Low investment permeability and insullicient wind-up of the casting machine
may also cause this shrink back porosity.

A nonrigid connector is

broken-stress mechanical union ofretainer and pontic, instead

ofthe usual rigid, solderjoint.

The most commonly used nonrigid design consists ofa T-shaped key that is attached to
the pontic and a dovetail keyway placed within the retainer. The path ofinsertion ofthe
key into the keyway should be parallel to the pathway of the retainer not involved with
the keyway.

Its use is restricted to a short span bridge, replacing one tooth. It is indicated when retainers cannot be prepard to draw together without excessive tooth reduction. Prostheses rvith nonrigid connectors should not be used ifprospective abutment teeth exhibit
significant mobility.

Important: When abutment teeth are in normal alignment and have good bone support
tcanine and /irst molar.r), the connectors of choice are solder joints.

. 90 degree,

1.0 mm shoulder

. Bevel
. Chamfer
. 45 degree, .25 mm shoulder with

bevel

56
Copraight

e 20ll-2012

- Dental Decks

. To remove hyperplastic gingival tissue where it has proliferated into preparations or

over crown margins

. In place of gingival retraction cord where substantial attached gingiva

is present

. Where attached gingival tissues are thin, or where an underlying dehiscence is

suspected

. For crown-lengthening procedures prior to fabricating

57
CopFiglu O

201 I

-2012 - Dental Dcks

provisional crown

Unlike thc metal-ceramic .estoration, which will accept any marginal design (a bevel, chamfer, or
shoulder), marginal tooth prepamtion for the all-ceramic crown or porcelainjacket crown must
be a shoulder foptrn ally 90 degrees and 1.0 mm).
There are indications and contraindications for all-ceramic crowns, and violating these will compromise the success of a restoration. All-ceramic crowns generally are accepted to be superior
esthetically, but their lack ofa metal substructure makes them inherently weak, As a result, they
are rarely indicated for use on posterior teeth, and are not indicated at all for anterior teeth in a
Class III edge-to-edge relationship, where the occlusal forces can subject them to fracture. There
are few acceptable instances where all-ceramic crowns may fuuction as irxed partial denture abutments, such as during the replacement ofanterior teeth when a favorable anterior guidance occlusal
scheme exists.

The main reason for the use of porcelain jacket crowns and all-ceramic crowns is superior esthetics. These tlpes of crowns have the capability to mimic the optical properties ofthe natural
tooth. However, the guidelines for usage, such as tooth preparation, are more critical and in general more complicated than for the metal-ceramic restorations. ln general, it is advisable to use
these more esthetic crowns only in the anterior segment, where esthetics is the dominant factor.

Dilferent materials used in the fabrication ofa full crown require dilferent marginal designs:
. All-ceramic or porcelain jacket crowns
. \Ietal ceramic with porcelain extended -shoulder
to maryinal edge
. Vetal ceramic with metal collars shoulder with beYel-shoulder
or chamfer
. Full gold crown
bevel (feather edge) or chamfer

*** This is a contradiction to electrosurgery

this p.ocedure.

-gingival

rcession may be marked following the use

of

Objectives of electrosurgery:

. Coagulation
. Hemostasis
. Access to cavosurface margin
.Reduction ofthe inner wall ofthe gingival sjulcts (removal ofa thin layer ofcrevicular gingiwl tissue)

Electrosurgery, although considered by many to be a more radical means ofrefiaction ofgingival tissues. is an acceptable method. It functions by passing small curents ofelectricity through the gingival
rissue, causing the cells to desiccate, or scorch. Electrosurgery usually results in sorne delayed healing
because ofthe lack of proper clot formation. It is very good at stopping hemorrhage. Note: Too low a
current in an electrosurgical electrode can be detected by tissue drag.

Important points about elechosurgery:

. Use pfastic instruments (nirror explorer, erc)

instead of metal to prevent buming and tissue destruction of the surface contacted.
. Rapid, single, light strokes should be used with the electrode
. 5 secotrd intervlls should be used when cutting
. The electrode should not contact metallic restorations or tooth skucture (may cause ineversible

pulp damage).

Great care must be employed when performing electrosurgery as the potential exists for
serious damage to the PDL and surrounding bone, resulting in loss ofattachment ofthe tooth.

Note: elechosurgery

is not recommended for thin attached gingiva.

Important: Electrosurgery is contrai[dicated in patients using medical devices such

as cardiac pace-

make$, a trancutaneous electrical nerve stimulation (TENS) :urit, or an insulin pump, and in patients
with delayed healing.

if you look at bfue color obiects (drupes, charts, wall-color or any

othet object arcund,) while selecting the shade, it will help to
accentuate tbe ability to discriminate yellow shrdes.

. The first statement is true; the second statement is false

. The first statement is false; the second statement is true

. Both statements are true
. Both statements are false
58
Coplright O 201 l-2012' Dntal Dech

. Equate
. Contract
. Expand
. None ofthe above

59
Cop)'right O 201

2012 - Denial Decks

Shade selection sequence:

.
.
.
.
.

Use the same shade guide as given by the manufacturer

Match the shade before you do any preparation ofthe tooth
Remove all distractions (e.g., Iipstick, dark glasses, heavy make-up, etc.)
Quick rubber cup and paste prophylaxis can make shade selection more accurate
Position yourselfbetween the patient and the light source
. When observing, do not gaze for greater than 5 seconds at a time. Prolonged gazing
decreases the ability to discriminate colors and shades
. Proceed by process of elimination. Exclude first, shades which are too light or dark
. Half-closed eyes can increase the sensitivity of retinal rods to better choose the

"value" ofthe color

Remember: "Blue" fatigue accenhrates "yellow" sensitivity. This means that ifyou look
at blue color objects (drapes, charts, wall-color or any other object around) while selecting the shade, it will help to accentuate the ability to discriminate yellow shades.

role in producing an expanded mold and thus compensating for

the solidification shrinkage ofthe alloy.

Four mechanisms play

l.

Setting expansion: results from normal crystal growth. In air, it is about 0.4% but

it

is partially restricted by the metal investment ring.

2. Hygroscopic xpansion: employed to augment normal expansion by allowing the

investment to set in the presence of water. It is said that this water will replace the
water used by the hydration process and thus maintain the space between the growing

crystals. Allows continued expansion outward rather than restricting them. This
expansion ranges from

1.2%o

to 2.2o/o.

3. Wax pattern expansion: the wax pattem is warmed while the investment is still
fluid. The heat may come from the chemical reaction of the investment itselfor the
s'ater bath in which the casting ring is immersed.
4. Thermal expansion: occurs when the investment is heated in the bum out oven. It
also serves to eliminate the wax pattem and to prevent the alloy from solidifing before it comoletelv fills the mold.

. Mesiobuccal margin is positioned slightly distal to the middle ofthe buccal surface
. Distobuccal margin is positioned slightly mesial to the middle ofthe buccal surface

. Mesiolingual margin

is positioned slightly distal to the middle

ofthe lingual surface

. Distolingual margin is positioned slightly mesial to the middle ofthe lingual surface

60
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201l-2012 - Dnbl Decks

coplrishr

@ 201

. Predominantly glass

. Particle filled

glass

. Polycrystalline

61

l-2012 - Dertal Decks

A partial crown is a cast restoration made entirely from metal and covers more than half
but not all ofthe tooth's clinical crown. A partial crown is named according to the fractional amount ofthe clinical crown it covers. Examples are the half, three-quarters, foulfifths, and seven-eighths crowns. In most instances, the facial surface ofthe tooth is not
disturbed for esthetic reasons.
The seven-eighths crown design is especially effective either as a single tooth or an abutment restoration on maxillary molar teeth where both proximal surlaces are involved as
well as the distal buccal suface ofthe tooth. In many instances, the mesio-buccal cusps
of maxillary first and second molars can be preserved for esthetics and still provide adequate extension to include extensive areas ofdestruction.

Seven-eighths crown:

. It can be used on any posterior tooth

.Esthetics is good since the veneered distobuccal cusp is obscured by the mesiobuccal
cusp

. Distobuccal finish line is easy to access, which makes preparation easier to do. It also
makes cleaning ofthe margins easier for the patient
. \4ore coverage than the standard 3/4 crown which improves its resistance
. Especially useful when the distal surface has caries or decalcification
. Serves as an excellent abutment for a bridse

Metal ccramic restorations have been available for more than three decades. This type ofrestoration has gained popularity from its predictable perlomance and reasonable esthetics. Despite its
success, the demand for improved esthetics and the concems regarding the biocompatibility ofthe
metal has lead to the introduction ofall-ceramic restorations.
Two concepts help in simplifying the understanding of dental ceramics: First, ceramics fall into
three main composition categoriesl
. Predominantly glass

. Particle filled glass

. Polycrystalline
Second, ce.amics can be considered as a composite material, in which the matrix is a glass that is
lightly or heavily filled with crystalline or glass particles.

Predominantly glass: have a high content ofglass making this type of dental ceramic highly esthetic. This type is the best ir mimicking the optical properties ofenamel and dentin. Optical effects are controlled by manufactures by adding small amount of liller paniclcs.
Particle-filled glass; filler particles are added to the glass matrix to improve the mechanical propenics. Fillcrs can be crystalline particles ofhigh-melting glasses.
Polycrystalline: this type ofce.amic contains no glass. Atoms are packed into regular crystalline
arrangement making it toughcr and less susceptible to crack propagation. lt is important to understand the lact that highly esthetic ceramics are predominately glass, and ceramics that exhibit high
strength are generally crystalline.

Note: It is important to understand the fact that highly esthetic ceramics are predominately glass,
and ceramics that exhibit high strength are generally crystalline.

. Nickel
. Cobalt

. Chromium
. Silver

62
Cop).righl O 20ll-2012 - Dental Decks

tr'irrad Drtrs*lr,

CS

AII of the following are resins used for fabricating provisional

restorations .EXClgPl one. Which one is the EXCEPTIOM

. Polymethyl methacrylate
. Polyethyl methacrylate
. Pol)'vinyl methacrylate
. Polyacryl methacrylate
. Bis-acryl composite resin
. Msible light-cured (ltLC) urethane dimethacrylate

CoplriShr q

20ll'?012 Dfrtal Decls

***

Silver is a precious metal.

Metals are classified as noble elements based on their lack of chemical reactivity. The
noble metals include gold, platinum, palladium, and other inert metals. Alloys with less
than 25olo noble elements are called base metals. Note: Silver is not considered noble;
it is reactive and improves castability but can cause porcelain "greening."

Remember: Noble metals are precious, but not all precious metals

re

noble (i.e., sil-

ver).
Base metal (nickel, chromium and cobalt) alloy advartages are principally found only
in their strength and low density.

As compared to T)?e IV gold alloys, base metal alloys have:

. A higher resistance to deflection in thin segments
. A lower yield strength
. A higher modulus ofelasticity
. A lower specific gravity
. A much higher melting temperature (230CF to 260CF)

Remember: The nickel in the composition ofbase metal alloys is responsible for ductiliq of the alloy. It is also measured as a percentage of elongation and determines how
much margins can be closed by bumishing. Chromium produces a passivating film for
conosion resistance and cobalt increases the rigidity ofthe alloy.

Provisional restorations:
Requirements:
. Provide pulpal protection
. Positional stability
. Occlusal function

. Easily clcancd margins

. Strength and retention
. Esthetics
Resins for prorisional restorations:
. polvmelhvl methacrylatc
. Polvcthyl mclhacrylatc
' Pollinyl mcthacrylatc
. Bis-acryl composite rcsin

. \'isiblc lighccurcd /,/ZC) urethane dimethacrylatc

\lthods of fabric.tion:
. Prefabricated: Uscd for single tooth restoration (e.g., anatonic netal crown fon,$, deu celuloid shells and

ol orcd polr@rbonate crovns).

. Custom-made: uscd for single and multi -unit lixed b.idges-There are a variety of tcchniqucs for f'abricating thc
mould used to form the outcr surface ofthc custom provisional rcstoraljon /i.e., take an inpression prior to prcparing teth fiIh algilnte. elastomenc i tpression material or use tle .liagnostic &st ond clear lhetmoplastic resi
natrix [wcuunt fon'ing machineJ).The innc' s[rface will be providcd by the preparation.
t.roth

Provisional restorations can be classified by the tchnique olfabrication used:

. Direct technique: is done on the actual prepared leeth in the mouth. Disadvantagcs includc: potcntial tissuc
trarma, poor marginal fit, and prolonged chairside time.
.Indirecttechnique: is done on the cast outside thepatient's mouth. Advantages include: no tissuc fauma, good
marginal fit, and minimum chairsidc timc.
. Combination techniqte (inrlirect-direct): advzntages include: reduced tissue trauma, rcasonablc marginal fit,
and reduced chairside timc.

Note: Thc provisional rcstoration is cemcntcd in with Temp Bond.

. Type I
. Type II
. Type

III

. Type IV

54
Copyn8hr O 20ll-2012 - Denkl Decks

In mixing dental stone, why should the powder

be sprinkled onto the water in ths bowl?

. The addition ofpowder prevents the mix fiom becoming exothermic

. This is not recommended; the water should be added to the powder

. This process results in better powder mixing and reduced chance for air bubbles
. The powder is added to the water to avoid using more than one bowl

Cop)riglr

2011-2012 - Dental Decks

Type I Gypsum: 'lmprcssion Plastca'

. Comprcssion strcnglh: 580 psi
. Pcrccntagc ofcxpansion: 0.15%
. Uscsi not uscd much tod^y li.e., solderillg it leres)

llTe lf Gyps[rn:

"Modeling Plastca'
. Comprcssion strength: 1300 psi
' Pcrccntagc of cxpansion: 0.307;
. Uses: orthodontics diagnostic casts

lll Gypsum: "Dcntal Stone"

. Compression strcngihr 3000 psi
. Pcrccntagc ofcxpansion: 0.20%

Type

. Uscs: diagnostic casts, opposing arch casts, and removable prosthodontics

. Also called: "Ycllow Stone", or "Microslonc"
Ttpe IY Glpsum: Dic stonc. Low Expans;on"
. Conprcssion srcngth: 5000 psi
. Pcrccntagc ofexpansioni 0.10%

. Lscs: dics for crown, bridg, and implants

{1so

callcd: Dcnsitc or lmprovcd Dcntal Stonc"

Ttpe \. Gtprum: Dic Slonc, Hjgh Expansion"

. f..mpressron strcngth; 7000 psi
. P.rc.nlagc ofexpansion: 0.10%

. LiJs: di.s for crown and bridgc

. \1io callcd: "DieKccn"

Dental gypsum products are made up of hemihydrate particles whose size' shape, and
porosity differ for each material. These gypsum-based powders require different
amounts ofwater for mixing because the different particle shapes produce different packing efficiencies that affect the amount ofexcess water required for making a suitable mixture.

llixing:
. lVater/powder ratio:

the water/powder ratio is an important factor in detennining

physical properties. When a high proportion ofwater is used, the powder particles are
farther apart. This results in less expansion with a retarded setting time and a weaker
product. Dental plasters generally require about twice as much water compared to
stones. Plaster has a higher setting expansion thar does stone.
. \\'ater temperature: generally, the coldr the water, the longer the setting time
. Spatulation: rapid spatulation for a time equal to normal hand mixing for 1 minute
accelerates setting time and produces greatest strength. Do not spatulate to the point
$ here the mixture starts to harden. This will produce a cast that is much weaker.

. Accelerators and retarders (modifiers):

- Retarder: borax. sodium citrate
- Accelerators: gypsum, potassium sulfate, NaCl 28%
Remember: The setting expansion ofany gypsum product is

a function

fate dihydrate cystal growth. Some is the result of thermal expansion.

ofcalcium sul-

. Beta-hemihy&ate and dental stone has gamma-hemihydrate

. Alpha-hemihydrate and dental stone has beta-hemihydrate

. Gamma-hemihydrate

and dental stone has beta-hemihydrate

. Beta-hemihydrate and dental stone has alpha-hemihydrate

66

Cop"iSh O20ll-2012

- Dental Decks

Dental plaster rnd stone lre vibrated after mlxlng to:

. Minimize distortion
. Reduce setting time

. Eliminate air bubbles

. Increase the setting time

67
Cop)'righr O

20ll'2012, Dertal

Decks

The principal constituent of the dental plasters and stones is the calcium sulfate
hemihydrate. Depending upon the method of calcination, different forms of the
hemihydrate can be obtained
alpha or beta hemihy&ate. The beta-hemihydrate

-eitherofParis, and these crystals are characterized by their

is more popularly known as plaster
sponginess and irregular shape in contrast to the alpha-hemihydrate f.r/one) crystals!
which are more dense and have a prismatic shape. When the alpha-hemihydrate is mixed
with water, the pro dtrct obtained (dental stone or die stone) is much stronger and harder
than that resulting from beta-hemihydrate (plaster). The chiefreason for this difference
is that the afpha-hemihydrate powder (stone) reqrires much less gauging water when it
is mixed than does the beta-hemihydrate. The beta-hemihydr^te Q)lqster) requires more
water to float its powder particles so that they can be stirred, because the crystals are
more irregular in shape and are porous in character.

Note:

All glpsum products

that are reacted with water form calcium sulfate dihydrate

as a reaction Droduct.

vibrator when pouring models helps to eliminate ar bubbles (trapped air).This

produces a more accurate, usable model. Another way ofpreventing entrapment ofair is
to place the proper amount of water in the mixing bowl first and then sift the model
plaster or stone into the bowl. When mixing dental plaster or stone, any ofthe following
spatulation, a lower water-pow$,ill cause the gypsum product to set faster
-incrased
der ratio, and using a mixture of water and ground-up set g'?sum particles to mix with
Using

the plaster or stone.

Once the impression is poured, it should be allowed to harden for 45 minutes to
(or until cool to the touch) before removing the cast from the impression.
Casts can be disinfected by immersion in a

I hour

l:10 dilution of sodium hypochlorite for 30

minutes or with iodophor spray.

If nodules of stone appear in the occlusal pits ofa stone cast, it is most likely
entrapment ofair during the insertion and seating ofthe tray.

due to the

lrJote: All types of gypsum products are weaker in tensile strength than compressive
strength.

. Heating g)?sum in an open vessel at 150'C

-160'C
. Heating gypsum under steam pressure in an autoclave at 120'C
-150.C
. By boiling gypsum in a 30olo aqueous solution ofcalcium chloride and magnesium
chloride

68
Copr.right C 201 l-?012 - Dental Decks

'

Dr. Lozier rquested that you mix alginat and take an imprcssion,
Whil measuring the water, you got involved in a conversation with
your patient and did not notice how cold it was. This oversight will:

Shorten the gelation time

. Make the mix unusable

. Lengthen the gelation time

. Not affect the gelation time

69
Cop)'right O 201l-2012 - Dental Decks

*** This process produces particles that are porous and

the weakst gypsum product.

inegularly

shaped. Note:

It

is

Heating gypsum under steam pressure in an autoclave at 120'C - 150'C produces dental
stone. This process produces particles that are uniformly shaped and less porous.

Boiling glpsum in a 30o% aqueous solution olcalcium chloride and magnesium chloride
produces high strength (improved) die stone. This process produces the least porous
and strongest particles.

All gypsum products come ftom the mineral gypsum, which is the dihydrate form of
calcium sulfate. During heating, (the manulircturing process), water is lost and g)?sum
is converted to the hemihydrate form of calcium sulfate (p owder). When water is added
to the powder, a chemical reaction takes place and the hemihydrate is converted back to
the dihydrate form of calcium sulfate.

liotel

l. When mixing gypsum products always sprinkle the powder into the water.
This results in better powder mixing and reduces the chance for air bubbles.
2.When gypsum products are mixed with water, heat is given ofl This is called
an exothermic reaction.
3. Exposure ofa stone cast to tap water should be minimized because eroding

ofthe cast will result.

***The best method to control the gelation time ofalginate impression materials is to alter the tempemture ofthe water used in thc mix. The higher the tempemture, the shorter lhe gelation timc,
the lower the temperature, the longer the gelation time. The mix is usable regardless ofwater tempenture as long as there is adequate ['orking tim.
Changing thc water/powder ratio and the mixing time will alter the gelation time, but thesc mcthods also impair ce ain properties ofthe matcrial. Too little ortoo nuch waterwill weaken the gel.
Undermixing may prcvent the chemical action from occurring evenly; overmixing Inay break up
the gcl.

Calcium sulfate (/re reactol in alginate), is not so soluble in watcr that is entircly consumed before gelation is con'lpleted. Therefore, the set mass becomes an entanglcment of calcium alginate

fibrils around residual sodium alginate sol, filler and water. The residual sodium alginate has thc
nasty habit ofreadily giving up water /.t),reresis) or gaining water (imbibitiotl). For accurate results,
thc cast should be poured imrnediately.

.
\ores

'

L When taking an alginate impression fo. a partial denture, it is best to apply somc alginate directly on the teeth to eliminate bubbles and saliva from the rest seat prcparations.
2.lnaccuracies in imprcssions can be caused by fracture ofthe fibrils during gelation.
.3. Tray adhesivc should ahvays be used to prcvent distortion at the time ofremoval.
4. The greater the bulk lhat the alginatc has, the more favorable the surface area:volume ratio and the lower the susceptibility to water loss or gain and, therefore, unwanted
dimensional change.
5. The tray sltould be removed 2 to 3 minutes after Selation.
6. The impression should be rinscd and disinfected with glutaraldehyde or iodophor
befbre pounng.
7. Pouring with ADA type lV or V stone is recommended.

. Irreversible hydrocolloids
. Polysulfides
. Polyethers
. Condensation silicones

70
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201

,201? - Dertal Dcks

. Polysulfides
. Condensation silicones
. Polyvinyl siloxanes
. Polyethers

71

Coplright O 20ll-2012 - Denial Deckr

Polyether materials are dimensionally unstable in the presence of moisture. These materials are the most
rigid frt,r?s, and most dillicult to remove fiom the mouth. Note: Whcn removing the impression, break the
seal and rock slightly to prevent tearing.

Composition of polyether impression materials:

. Base: amiDe teminated polyether polymer

. Cross-linking agent: an alkyl-aromatic sulfonate

. Catalysrs: glycol-based plasticizers
. Filler: colloidal silica

*** Polyeth$ are two-component materials. The base includes apolyether, silica filler and a plasticizer The
accelerator contains a crossJinking agent. When mixed, a nrbber is formed by a cationic polymerization
process. Cationic polymerization is very similar to addition polymerization, except that instead ofa free radical, a cation fporirlyc ior, is the reactive molecule. \o reaction by-product is produced. Polyethers have excellent dimensional stability. They ar also t.uly hydrophilic, resulting in superior wettability.

.
.
.
.
.

.
.

Excellentdimedsiolal
stability whell dry
Short settirg tirne
Dimensionally stable
more lhan one cas! is poured
Slable evn ifpoured 24
hours after taking impresaion
Automix available

if

.
.
.
.
.
.

Set material very stiff

Difficult to remove

Most imprssion6

from mouth

Take care not to

break teeth when
separating casls

Tears easily

Limited shelflife
May adhere to teeth
Demonstmtes imbibi-

tions
Unpleasant taste
Short working time

Important regarding polyethr imprssion materials:

. \\'arer, saliva, and blood affect polyether matenal
. Added moistur will increase the impression's marginal discrepancy

These materials record surlace detail well and have excellent elastic propenies but a low tear strength. They
arc less expensive ihan polyvinyl siloxanes fdddition silicones) ard polyethers.

Composition of condensation silicones:

. Base: poly dimethyl siloxane
. Cross-linking agent: alkyl ortho silicate or organo hydrogen siloxane
. Catalyst: organo tin compott ds (e.g., titl octoate)

. Fillers: silica

or calcium carbonate

\\'hv poor dimensional strbitity?

The principal reaction, which takes place during setting

ofthis material, is

condensation reaction and hence called condensation silicone. It occurs by elimin tior (evaporation) of
eth) l or methyl alcohol. This is also responsiblc for shrinkage ofthe material and resultant poor dimcnsional
a

itabilit\'.

Plea-sant to use

Shon stting time

.
.
r
.
.
.

Hydtophobic
Poor wetting
Low stability
Limited sbelflife

Wait 20 to 30
minutes before
pouring lbr sbess
relaxauon to occur

Tray requires special

adbesive

The material is more

flexible, so there is
more chance ofdistortion during removal

l. Reaclion is sensitive to heat and moisture f'eill reduce working snd setting times).
2. Do not mix initially by haod (allergic rcaction to catalyst may occur).

. Dimensionally unstable

Sets quickly

. Excellent detailed reproduction

Sets hard

. No shrinkage even ifstore for many days

72
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The popularity of agar impression m

'\

the:

^teriz.l

is timited by

Oevercible hyfuocalloid)

. Difficulty in pouring the impressron

. Poor reproduction ofdetail
. Need for special equipment
. High cost

73
Cop).riglft C2011,2012 - Dmtal Dcks

*** This is fals; ZOE impression

paste is dimensionally stable

ZOE impression materials were once very popular. Today, however, ZOE materials have been
replaced by newer materials, such as polywinyl siloxanes, condensation silicones and polyethers.

Components of ZOE impression paste:

. Calcium chloride (CaCI): ftncttons as an accelerator ofthe setting time

. Oil ofcloves: contains 70-850/o eugenol. It is sometimes used in preference to
eugenol because it reduces the buming sensation in the soft tissues ofthe mouth.
. Mineral or {ixed vgetable oil: plasticizer, aids in masking the action of eugenol as an

irritant

. Resinous balsam: often

used to increase flow and improve mixing properties

facilitates the speed of the reaction which results in a smoother, more homoge-

. Rosin:

nous mix
The setting reaction that occurs is a typical acid-base reaction to form a chelate. This reaction
can take place either in solution or at the surface of the zinc oxide particles. The chelate is
thought to form as an amorphous gel that tends to crystallize, imparting increased strength to
the set mass.

'

. --.... 1. The dimensional stability ofa zinc oxide-eugenol impressionis most likely tobe
..'Note{,; affected by failure to use a custom-made impression tray.
',i*tl: 2 . The setting time of a zinc oxide-eugenol impression paste may be acclrated by
adding a drop ofwater to the mix.
3. The setting time of a zinc oxide-eugenol impression paste may be rtardd by
adding inert oils (olive or mineral oils) during mixing.
4. Ifthe paste is too thin or lacks body before it sets, a filler----such as a wax or an
inen powder (lanolin, kaolin, etc.) may be added to one or both of the original
pastes

The use of agar impression material does require special equipment. The rcproduction is excellent, and the im-

pression is easy to pour compared to elastome c imprcssion matrial.

Reversible hydocoltoid is an impression material that changes its physical state ftom a sol to a gel and then
back to a sol.

Composition of reversible hydrocolloids:

85% water

. l2'.I5r/.
***

agar (agar is an organic substance deri|ed

from seaweed)

ofbomx fbr rtrerglr), potassium snlfate (improves gvsum r&r/dce/ and sodium tetrabomte
Conditioning bath for reversible hydrocolloid:
Traces

. Three compartments:
. The first bath is for liquefying the semisolid material. A specialwater bath called a "hydrocolloid conditioner" at212"F (100'C) liq\refies the material. After Iiquerying, the preset thermostat cools the tempcrature to 150oF /65.5"C/ automatically.
. The second bath becomes a storage bath that cools the matedal, readying it for the impression.
At this temperature, the tubes are waiting for use.
. A third bath is kept at 110" F (43.3'C) for tempering the material aller it has been placed in the

trav

. Zinc oxide

. Calcium sulfate
. Potassium titanium fluoride
. Diatomaceous earth fsilrca)

. Potassium alginate
. Tri-sodium phosphate

Coplright O 201 I -20 l2 - Denral Decks

. lt will

be grainy

. It will tear easily

. There will be irregularly shaped voids

. It will

be distorted

75
Coplrighr O 2011,2012 - Dntal Decls

Alginate materials (incversible h,vdt'ocolloid) are the most widely used impression materials. They are termed irreversible impression materials because they will not reverse
to a sol once they react and become a gel. Indications: diagnostic casts, not suitable for
final impressions. Examplcs: Ieltrate (Dentsply / Caulk), COE Alginare (GC Americal

.
.
.
.
.
.

.
.
.

.
.
.
.
.
.

DiatomaceousfsrTical
Potassium alginate
Calcium sulfate

Zinc oxide
Potassium fluoride
Sodium phosphate

.
.
.
.

Low cost
Straight forward technique
Rapid set

Tearing

Inegularly shaped voids

Rough or chalky stone

Distortion

(fillcr)

16o/a

7rA

(reactot)

lpla.ttici:er)

(inpror,es gJpsum sutJace)

|V. (tetarder)

60A

Unstablc

---)

immediate pour, single cast

Tears casily

Poor accuracy and surfacc detail

High permanent defbrmation

Cause

Problem
Grainy material

50%

20nh (dissolres in u,alet ./brming the sol)

r
.
.
.
.
.
r
.

o
.
.
.
.
.
.
.
o
.
.

Improper mixing
Prolonged mixing
Undue gelation
Water/powder ratio too low
Inadequate bulk

Moisturecontamination
Premature remoratfrom mouth
Prolonged mixing

Moisture or debris on tissue

Inadcquate cleaning of impresston
Exccss water left in impression
Premature removal of cast
Leaving cast in impression too long

lmproper

man

ipulation ofstonc

Imprcssion not poured immediate ly

Movcment oftray during gelation
Premature removal lrom moult

Improper removal from mouth

Tray held in mouth too long fort with certain brantls)

. Polyether

. Polysulfide
. Reversible hydrocolloid
. Vinyl polysiloxane

76
Coplrighr O 201l-2012 - Dental Decks

. Polyether
. Polysulfide
. Hydrocolloids (reversible and irreversible)

. Polyvinyl siloxane

77
copyright o 201 l -20 l2 - Denral Deck

Polyvinyl sifoxanes (addition silicohes.) are the most widely used and are the most accurate of the
elastic impression materials. They have less polymerization shrinkage, low distortion, fast recovery from
deformation and a moderately high tear strenglh. Most ofthe pol;vinyl siloxanes can be pourcd up to
one week after impression making and are stable in most sterilizing solutions. Important; Tle sulfur
in latcx glovcs and in ferric and aluminum sulfate retraction solution will retard the setting ofaddition
in temperature will
silicone materials. Also, addition silicones are temperature sensitive
-increases
shorten the working and sefting times.

Composition of polyvinyl siloxanes /addition si[icones):

. Base: silicone polymer

. Catalyst: chloroplatinic acid

. Filler: colloidal silica

.
.
.
.

Scavengers: platinum or palladium /acr as scavengers

Dimensional stabilig
Pleasant to use

Short setting time

Automix available

.
.
.

Hydrophobic
Poorwetting

Hydrcphilic formula-

Some materials release

hydrogen gas

for

the hydrogen gas releosed)

Delay pouring of
some materials to
allow thc release

ofhydrcgen gas

tions imbibe moisture

\otes,
:

1. The addition reaction that occurs with pol''vinyl siloxanes is terminated with a vinyl group
and crosslinked with hydride groups activated by a platinum salt catalyst No reaction byproducts are developed, but hydrogen gas release may occur ifa reaction betwem moisture
and rcsidual hydrides ofthe base polymer occurs. The result is a cast with small voids ifthe
impression is poured too soon after removal from the mouth.
2- Stiffness ofthc matcrial makes removal ofthe trav difficult.

- lowest to highest
. alginate, agar, polysulfide, condensation silicone, poly'vinyl siloxanes,
polyether
- best to worst

polyvinyl siloxanes, polyether, polysulfide, condensation silicone,

hydrocolloids

- best to worst
. hydrocolloids, polyether, hydrophilic pollnr'inyl siloxanes, polysulfi de,
hydrophobic pol)'vinyl siloxanes, condensation silicone
- best to worst
hydrocolloids, hydrophilic polyvinyl siloxanes, polyether, polysulfide,
hydrophobic pol)'vinyl siloxanes, condensation silicone

- most to least
polyether, polyvinyl siloxanes, condensation silicone, polysulfide,
hydrocolloids

- greatest to least
polysulfide, polyvinyl siloxanes, polyether, condensation silicone
hydrocolloids

. Polyether
. Polysulfide
. Reversible hydocolloid
. Pol)'vinyl siloxane

7a
Cop)righr O 201l-2012 - Dental

Dek

. Polyethers
. Polysulfides

. Silicones
. Irreversible hydrocolloids

79
Coplright C 201l-2012 - Denial Decks

Reversible
Irreversible
Hydrocolloid Ilydrocolloid
Boil, temper,

Polysulfide

Pourder, urater

2 pastes

Pollainyl

Silicor.

Siloxane

Polyether

2 pastes

2 pastes

2 pastes

or

paste/liquid

slore

Conderrsador!

Technique
sensitive

Good

Fair

Fair

Excellent

Good

Pstient
Reactlon

Thermal
shock

Pleasant

Unpleasant,
slarns

PIeasant,

Pleasant

Unpleasant

cleln

Erse of
Removal

Very easy

Very easy

Easy

Moderate

Modrate

Difficult

se

of use

cleat

clea1r

to

Working

2.5

-15

difficult
2.5

Time (min")

Settirg

8-

l2

6-E

4.5

3-7

Time (min.)

Stability

I hour

Immediate

100% RH

pollr

I hour

lmmediate

I week

Poured

r/ithin

pour

few

hours

Weftebility

Excellent

Excellerlt

Fair

Fair

Fair to
good

Good

Low

Very low

Low

Moderate

High to
very high

Very high

& Castlbility
Cost

\ote:

Reversible and irreversible hydrocolloids have the advantage of wetting oral surfaces
limited dimensional stability because they include as much as 85%

\\ ell. but they have very

$ater in their composition.

Irreversible hydrocolloids (alginate) is most accurate when at least 3 mm ofspace exists

befween the impression tray and the tissue. The other impression t)?es are most accurate
when a small but definite space exists between the impression tray and the tissue.
Remember: The setting time ofalginate is controlled by the amount of sodium phosphate
that is present. Sodium phosphate serves a retardr in this reaction, which means it
slows down the process. As long as sodium phosphate is present, it will react with soluble calcium ions. Once all the sodium phosphate has reacted, then the sodium alginate reacts with the remainins calcium ions and calcium alginate is formed.

EN;"po;-l +

F""r-t."d

Ec,sql-

+ lZaso;l

Ia",Go;l + l3-N"-sql

-sg l?;"r*;;l * lN;q

1. Fast removal ofimpression from the mouth increases both the compresstve

Iotn''

and tear strength of the impression.

2. All impressions must be rinsed and disinfected

prior to pouring or sending

to the laboratory. Soak or spray for a minimum of 10 minutes. Important:
Always follow the manufacturer's recommendation for the specific product!!

,\

Today wae a very busy day for Ashley, the dental hygienist in our olllce. Ashley
took alginate impressions on her lirst patient in the morning, who needed a
nightguard. Since she was so busy, Ashley left the alginate impressions in the
lab most ofths morning. Ashley decided to place the impressions in a bowl
of water so that they would not dry up before she had a cbance to pour
them up in dental stone. Which ofthe following was the result ofAshly
Ieaving these inpressions immersed in water for a few hours?
.

. Gelation
. Hysteresis
. Syneresis
. Imbibition

80
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l-2012 - Dental Decks

If your patient indicrtes r tendency to gag while taking elginNte impressions,

afl of the following manuvers can h elp EXCEPT one.
Which one is the EXCCPZOIW

. Lessening the time to take an impresslon

. Using cold water to mix the alginate
. Having the patient breathe through his / her nose

Seating the patient in an upright position

Seating the posterior portion ofthe tray first

81

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l-2012 - Dental Decks

Imbibition occurs when the impression absorbs water, which expands the dimensions of
the impression. When this occurs, the impression is no longer accurate. Shrinkage will
occur in alginate impressions, even when they are placed under 100% relative humidity.
The shrinkage and exudation of water is called syneresis.
Since shrinkage is undesirable (causes distortion ofimpressions), alginate impressions
should not be left either inwater (v,ill expard) or exposed to air 6vill shink). They should
be poured in.rmediately after they are taken to ensure accuracy. When immediate
pouring is not possible, they may be stored briefly in a rnoist paper towel.

Important: While taking an impression with alginate, it is advisable that the tray be
placed in the mouth after all critical areas are wiped with alginate. Critical areas are
buccal to the maxillary tuberosities and retromylohyoid space. Rest seats and guide planes
should be covered with alginate as well as any other soft tissue undercuts.

Gefation is the term given to the setting process (c/rrrglng afrom sol to a gel)
of hydrocolloid material.
2. Hysteresis refers to a material's characteristic ofhaving a melting temperature different from its gelling temperature.
1.

Iotes

Cold water will make the alginate take longer to

set.

Mixing the alginate material rapidly will cause setting to occur more rapidly.
Decreasing the water to powder ratio will cause alginate to set up more rapidly (affects
is much thicker v'hen less v'ater is used).
consistenc.,^ of the mit

-mix

Note: The mandibular alginate impression is taken first since gagging is more likely to
occur when taking the ma"xillary impression. For the maxillary impression, the posterior
portion of the tray is seated first, then the anterior portion. This helps to prevent the
alginate material from being squeezed out of the tray, back torvard the patient's throat
hrhich may cause gagging).
Alrvays remove alginate impressions in one quick movement, with a snap. This helps to
decrease permanent deformation.

l. The setting reaction of alginate is a "double decomposition" reaction be.\-ores tween potassiurn alginate and calcium sulfate. Also remember that casts must
damp.
. , - -,,,. be poued within 24 hours and the impression must be kept
impressionofthe
can
reduce
the
strength
2. Both under and over-mixing
(minimum)
of alginate should remain
0.25 inch
3. Do not over-seat the tray
over all critical strucl]tj'es (especially occlusal surfaces).

Elastomers are rubbery polymrs that are capable of elastic deformation from
undercut arcas to produce a complete impression for dentate situations.

fmpression materials must hrve some strength, but generally

their design is focused more on accuracy, dimensional stability,
and flexibility (rr tear rcsistance),

. The first statement is true; the second statement is false

. The first statement is false; the second statement

is true

. Both statements are true

. Both

statements are false

a2
Copyrighr O 201 1,201 2 - Dental Decks

Custom trays arc an important part of rubber base

impression tschniques, since elastomers are:

. More accurate in uniform, thin layers 0.5 to

1.0 mm

. More accurate in uniform, thin layers 1.0 to

1.5 mm thick

thick

. More accurate in uniform, thin layers 2.0 to 4.0 mm thick

. \{ore accurate in uniform, thin layers 5.0 to 6.0 mm thick

83
Copltighr O 20ll-2012 - Dental Decl6

The simplest method ofclassifoing impression materials is by key properties: rigid' water-basd, and elastomeric. Of the rigid rlpes, impression plaster was the first material usd for both edentulous and denolous
imprcssions, it is no longer used for impressions. Impression compound is used for single tooth impressions
where there are no undercuts. zinc oxid eugenol (ZOE) is used for edentulous impressions.

Water-brsed systems include alginate fil,"e1,ersible lrydrocolloid) and ag^r-^g r (reversible hydrocolloid).
Both types ofmatrials are inherently unstable because watr is 85oZ ofthe composition. They are vry easily distortd during syn eresis (loss of$'ater to lhe air or surrounding envirokmenl) or ifibibition (ahsorption

ofwaterfron

the air).

Elastomrs are rubbery polymers that are capable ofclastic deformation fiom undcrcut areas to produce a
complet impression for dentate situations. There are four major types (pollsullide, condensation silicone,
pol),ethe\ and pol\'ri nll si loxane).
Characteristics of elastomeric impression malerials:

. Bas: packaged as a paste in a tube, as a cartridge, or as putty in ajar

. Catalyst: also kno$.n as lhe acceleratot is packaged as a paste in a tube,

as a

cartridge, or

as a

liquid

Forms of elastomeric imprcssion materials:

. Light-bodid:

also referred to as syringe q!e, or wash O?e. This material is used because ofits ability
to flow in and about the details ofthe prepared tooth.Aspecial slringe, or extnrder, is used to place the lightbodied material on and immediately around the preparcd tecth.
. Regular and heavy-bodied: often referred to as tray-typc matcrials, they are much thicker As the names
imply, they are used to fill the tray. Their stiffness helps to force the light-bodied material into close contact 1\ ith rhe prepared teeth and surrounding tissues to ensure a more accurate impression ofthc details of
a prepamdon.

Curing stages of elastomeric impression materials:

. Initial set the first stage results in stiffening ofthe paste without the appeannce oflastic prcperties. The
marerial may be manipulatcd only during this first stage.
. Final set: the second stage begins with the appearance ofelasticity and proceeds through a gradual change
.o a solid rubberlike mass. The matedal must be in place in the mouth before the elastic properties
llnal set begin to develop.
. Final curi the last stase occu$ from I to 24 hours.

ofihe

With all elastomers, a custom tray should be fabricated with a plastic material. This tray
should be rigid, have occlusal stops to avoid permanent distortion during polyrrerization
and be coated with an adhesive. With hydrocolloid impre ssiors (ctlginate),a greater bulk
of material produces greater accuracy, however, the thickness of rubberlike materials
should not only be less, but should be evenly distributed. lmportant: Let adhesive that
is applied to the tray dry completely. If it is wet, impression material may pull away.

Custom trays are recommended for the following reasons:

. They require less impression materials
. They facilitate uniform concentration ofthe impression materials

. Stock trays usually are short in the llange area

. with stock trays, the uneven bulk of the impression material is conducive to distortion
The accuracy and reliability of an elastic impression is controlled by the tray in which
it is taken. The best tray is one that is custom-made for each patient. In most cases, it is
best to take a complete arch impression, which will provide maximum reliability.

. Poured immediately
. Poured within

15 minutes

. Poured within 30 minutes

. Poured within t hour

84
CoplriSh O

201 1,2012 - Dmtal Decks

The powdel used in mixing acrylic resin is referred to ar the:

. Dimer

.Initiator
. Polymer

. Monomer

85
Coptrighr O 20ll-2012, Dnral Decks

Polysulfides have good flow properties and high nexibility and tear strngth. These materials show the
strongest resislance to tearing, but as a result, impressions can distort when removed from areas where deep
undercuts are prcsent. They have a long working time and a relatively long polymerization time, which may
add to patient discomfort. Their rcsistance to deformation is low. Generally, the use ofthis material demands
the construction ofa specialllray (custom tray) in order to control polymerization shrinkage by thc use ofa uniform thickness ofimpression matrial. Note: The polymerization ofpolysulfides is exothermic and is accclerated by an increase in the temperature or humidity.

Composition of polysulfide impression material:

. Base: mercaplan firnctional polysulfide
. Cross-linking agent /dccelerator): stJlfur andlor lead peroxide
. Plasticizer: dibutyl phthalate
. Catalyst: lead dioxide, copper hydroxides, zinc percxide or organic hydroperoxide
. Fille(to add strength): titanium dioxide or zinc sulfate
. Retardei oleic or steric acid
Notes: (l) Tle lead dioxide is responsible for the broum color and difficulty in cleaning clothes that come
in contact with this impression matrial(2) On polymerization water is releasd as a b)?roduct causingdi_
mensional contmction. The cast must be poured within I hour fdt rre lalest, some literature sals 45 min'

Components of Acrylic Resins:

.Powder: Pofymethyl meth,,cryl^te (PMMA) polymer, benzoyl peroxide initiator, and pigments.
. Liquid: Pure methyl methg,cryl^te (MMA) monome., hydroquinone inhibitor, crosslinking agents, and
chmical activator fdi methrl-ploluidine). Not: This activator is only present in self_cured resins to bring
about polymerization.

Remember: mechanical propertis of resins are influenced by the following:

. Molecufar weight of the polymer (the grealer the molecularweigllt, the betler

the

pollmerization and the

harder the resin)

Degree of cross-linking (need difunctional monomers which contain tu)o areas for reaction) is direclly
proportional to lhe degree ofpol)rnerization. A polymer with a greatcr molecular weighl is formed if more

crosslinking occurs.
. Tle composition ofthe mororner ( prepares lhe polymer)
: '. - - .. . 1. Acrylic resins will expand when immersed in water and become distorted when dried out
:NoteJ;2.shrinkageofanacrylicrsinoccu$butxcessiveshrinkagemayoccuriftoomuchmonomer
i tliqurll is added to the polymer lpov'derJ. The volumetric monomer-to-polymer ratio is l:3.
,

..&1

out heat
3. The polynrerization reaction of methyl methacrylate is xothermic
-gives
4. Inhibitors are added to the monomen to aid in preventing polymerization during storage.
5. Cross-linking contributes greatly to the strength ofthe polymer
6. Hal-cured materials: heat is used as an accelemtor to decompose benzoyl peroxide frre
t alol) into fre radicals, These fiee radicals initiate the polymerization ofMMA into PMMA Th
pol]'rnerization process continues as new PMMA is formed as a matrix around residual PMMA
powder particles.
7. Self-cured (auto-cured, cold cureA materials: a chemical activator such as dimethyl-p_
tofuidine flvri., is a lertiory amine) is ?dded to the monomer fMM,'r' This chemical activator
causes decomposilion of the bnzoyl peroxide (lhe initiator) into free mdicals. These f.ee radi_
cals initiate the polymerization ofMMA and PMMA. Tle polymerization process continues the
same as in heat-curing materials.
8- The pofymerization range is the temperaturc mnge, approximately 60"C (l1f F) to 77"C
f17rP-F), at which the major part ofpollmerization occurs in a heat-cured resin.
9.The heat-cured resins have less residual monomer and a higher molecular weight than the selfcured resins; therefore, they are stronger. They also have superior color stability.

,ri

Z\

An edentulous patient has slight undercuts on both tuberosities and also on the
faclal ofthe &nterior maxilla. To construct a satisfactory maxillary complete
denture, you should reduce which ofthe following?

. All undercuts

. The anterior undercut only

. Both tuberosity undercuts

. None ofthem

CoplYigh O

201

86
1,201: - Denlal Decks

. Upper (mandibular.fossa - articular disc) compartment

. Lover (condyle - anicular disc)

. Both

the upper and lower compartments

a7
CoplriShr O 201l-2012, Derral Decks

Undercut tuberosities will interfere with the seating ofthe denture.

Explanation of answer: Maxillary anterior undercuts are very cornmon and present no
special problems unless accompanied by large bilateral posterior undercuts. Even this situation can usually be managed by reducing the inner surlace ofthe denture lateral to the

tuberosities.

The maxillary sinus appears to enlarge throughout life if it is not restricted by natural
teeth or dentures. As the sinus enlarges, the tuberosity moves downward. Ifthere is no contact with the retromolar pad at the vertical dimension ofocclusion, the tuberosity must be
reduced.

If a fow tuberosity is not removed before constructing new dentures (C/C), an accidentally underextended mandibular denture will probably be made and limited space to position posterior teeth will occur.
A submucosal vestibuloplasty is usually performed on the maxillary arch to improve
the available denture base area. This procedure is favored because no raw tissue
surface remains to granulate and re-epithelialize.

The temporomandibularjoints are considered to be the most complex joints in the human
body because they must provide for rotational movements, sliding movements (trqnskrto\) motion) and an infrnite range ofcombined movements and functions, unlike any other
joint in the body.
When the mouth opens, two distinct motions occur at thejoint. The first motion is rotation around a horizontal axis through the condylar heads. The second motion is translation. The condyle and meniscus move together anteriorly beneath the articular eminence.

ln the lower (condyle - articular disc) compartment, only a hinge-type or rotary motion can occur. This rotational or terminal hinge-axis opening oflhe mandible is possible only when the mandible is retruded in centric relation with a conscious effort by the
patient or by the dentist's control. Note: A pure hinging movement is possible only in the
terminal hinge position.

ln the upper (mandibular./bssa - articulqr disc) compa'rtment, only sliding movements

or translatory motion can occur. When the lateral pterygoid muscles contract simultaneously, the discs and condyles slide forward down over the articular eminence (prctru-

sion), or can move backwards together (retrusion) during opening and closing of the
mouth, respectively.

Remember: The TMJ is a ginglymoarthrodial joint fn eaning that it glides and rotates),
permitting both hinge-like rotation and sliding (gliding) movements. Ginglymus means
rotation, and arthrodial means freely movable.

. Arcon articulator

. Nonarcon articulator

88
Copyrighr O 20ll-2012 - Denral Decks

. Epinephrine
. .Llurn (aluminum potassium sufatu)

. Zinc chloride
. Any ofthe above

Copright

89
20ll-2012 - Denhl Decks

Thc capability of the articulator to closcly simulatc the movcments ofthc mandiblc is dcpcndcnt upon thc ajustability ofthc articulator elemcnts.

f,lements of an articular;
. Horizontal axis of rot|tion: variability ofthc position ofthc horizontal a\is ofrotation in rclationship to thc max-

illary dental cast

. Condylar incliration/fossa components: variability ofthc anglc ofthc cmincntia, dircctionaL guidance of thc
supcrior, postcrior. and medial walls ofthc fossa, and ability to simulatc lalcrotmsive
'novemcnt
. Inter Condyl|r distance: adjustability ofthe distancc bctwccn ihc vcrlical axcs ofrotation
. Bennett , ngle/Bennett movement:adjustability ofthc anglc and capability ofsimulating sidcshift movcmcnt
. Incisal guidance: adjustability and ability lo simulatc the aoterior guidancc ofthc natural dcntilion
Types ofArticulators:
. Cl^ss | sinple hi ge).-The movcmcnt ofthese articulators is limitcd to inaccuratc hinge opcning and closing
arcs about a fixcd axis. The maximum intercuspation position is the only position that can be reproduced. Casts
are arbitrarily mounted without use ofa facebow
. Cl^ss ll (rlrbitrary nllrc -Plane line): Evolvcd from the Class I articulator dcsign, thesc aniculators arc capable oflatcral movement. Some are capablc ofvariablc location oflhc horizontal a{is ofrotalion //, et, arc li.tl si:e
and capable o.f acceptitg a facebo\,), but a1l of this tlpe have fixed, arbitrary condylar inclination scllirrgs. vertical axcs ofrotation settings, and Bcnnctt Anglc. No adjustment ofthcsc posterior elcmcnts is availablc. Some
havc a provision for incisal guidance.
. Cl^.s lll (Seni-adiusta6le): These a(iculators can simulate lateral, protrusivc a d llcnnett movcnents to varying degrces. By utilizing a facebow and intraoral maxillo-mandibular records, thesc articulators can bc programmed to sinrulate thc curvi linear anatomical movcmcnts. Thcrc are cssentialiy two designs ofscmi-adjustablc
articulators. Onc which has thc guidance ofcondylar movcmcnt in thc maxillary menbcr and the centers ofaxial
roration in thc mandibular member This dcsign is termed arlon articulators. Thc ton-arcon arliculator dcsign has
lower members arc rigidly attachcd. Theocclusal planc is relatively fixed
rhcsc elements reversed
the nrandibular casl. Note: Arcon arc more accurate fbr fabricating fixed rcstorations,
lo rhc occlusal planc of -lhcuppcrand
Nhile nonarcon providc casicr control in sctting tceth for complet 8nd partial dentures.
'Cl^ssly (filh adjustarle/: This class ofarticulatom accepls registration ofall anatomic dctcrminant ofocclusal
morphology, and mosrcloscly simulates the movement dircctcd by thcsc controls. Thc postcrior clcmcnts ofthcsc
controls are dircclcd and adjusted by an cxtm-oral tcchnjque called a p.ntogr{phic rcgistration. This class tvill
accept a "hinge axis. kinemstic transfer bow. The incisal guidancc cl]n closely simulatc thc paths ofthe natural dcntirion. This class is fully utilizcd in cxtcDsivc rcstorative procedures, as rvcll as adjunct to diagnostic dctcr_
minations of lcmporomardibular joint dysfunction f?iMJr.

Epinephrine causes local vasoconstriction, which in nrm results in transitory gingival shrinkage Epincphrine
impregnatd cord has been shown to produce minimal physiologic changes uhen placed in an intact gingival
sulcus. Howeve( there is evidence ofincreased heart rate and elevated blood pressure when the cord is applied
ro the severely lacerated gingival sulcus. For those patients with medical conditions such as certain tlpes of
cardiovascular disease or hyperthy'roidism, or a kno\r'n hyPersensitivity to epinephrine, a cord impregnatcd

with alum should be substituted.

Note: Zinc chforide is caustic and causes delayd healiDg lcdute.t ,?ecrosis ofthe sulcular ePitheliu and the
adjacenl lq:er ofconnecliv? lissre). Therefore, it should not be used in impregnatcd cordTissue retraciion is necessrry to:

. Control bleeding
. Refiact the gingival tissues slightly away from the margins
. Allow imDression material to flow into the sulcus
. Expose all gingival margins
Modes to achieve tissue displacement whn taking impressions:

. Mechanical modes
- Cords: which stretch the circumferential periodontal fibers. They can be rwisled, braided, or knitted
These cords can be impregnaled with chemicals such as aluminum, iron salts or epinephrine which
cause transient ischemia and shrinkage ofthe gingival tissue, and absorb seepage ofgingival fluid They
are supplied in different diametcrs.

. Surgical modes:
- Elctrosurgery: when cord will not produced the desired gingival displacement, this method can be
used.

Fluid control when taking impressions:

. Mchanical means:

saliva ejectors, cotton rolls, cotton sponges

. Medications: anticholinergic drugs such as atropine. dicyclomine, glycopyrrolate, and methantheline act
as anti-siafogogues f/educe salivary secrctiont. Notei Anticholinergic drugs should not be given to paiients with narrow-angl glaucoma. They should be used wilh caution in patients with heart disease.

. Hamulus
. Hamular notch

. Maxillary tuberosity
. Fovea palatini

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2olo

ofthe population

. 20% ofthe population

50olo

ofthe population

.75% of the population

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*** It is a thin,

curved process that serves as the superior attachment of the pterygomandibular raphe. This raphe is a tendon between the buccinator and superior
constrictor rnuscles.
The hamular notch is a thin cleft between the maxillary tuberosity and the hamulus. The
vibrating line is an imaginary line drawn across the palate that marks the begiming of motion in the soft palate when an individual says "ah". It extends from one hamular notch to
the other. At the midline, it usually passes about 2 mm in front ofthe fovea palatinae.

Remember: The distal end ofthe maxillary denture must cover the tuberosities and extend into the hamular notches. Overextension at the hamular notches will not be tolerated
because of pressure on the pterygoid hamulus and interferences with the pterygomandibular raphe. When the mouth is opened wide, the pterygomandibular raphe is pulled
forward. Ifthe denture extends too fff into the hamular notch. the mucous membrane covering the raphe will be traumatized.

The fovea palatinae are indentations near the midline ofthe palate formed by a coalescence of several mucous gland ducts. They are always in soft tissue, which makes them
an ideal guide for the location ofthe posterior border ofthe denture.

Palatal tori are bony enlargements located at the midline ofthe hard palate. They occur
in approximately 20% ofthe population and are more prevalent in women than men. They
usually reach maximum size in the third or fouth decade. Because the torus is usually covered by thinner and less resilient mucosa than the residual ridge, it may act as a fulcrum
and cause rocking ofthe ma"rillary denture.
Because the soft tissues over the torus are generally thin and have a poor blood supply,
post-operative healing is slow. It is best to cover the opemted site with a surgical stent lined
with a sedative dressing. Ifa patient is having all oftheir maxillary teeth out at one time,
it is best to also remove the tod at the same time.

Note: Palatal tori are usually not removed for denture fabrication whereas mandibular
tori are usually removed prior to denture fabrication. The following conditions warrart removal ofpalatal tori, ifit: (1) impinges on the soft palate (2) is so large that it fills the vault
and prevents the formation ofan adequate dentue base (3) is undercut (4) extends so far
posteriorly interfering with the posterior palatal seal (5) is psychologically disturbing to
the patient (cancetphobia)

. It will make the patient feel better

. It will make the face-bow lransfer easier to perform
. To provide a firm, stable base for the denture
. The final impression material will flow better

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When

inflannatory papillary hyperplasia

is seen on the palate of a patient

wearing a maxillary complete denture, the condidon

likely going to be associated with:

. A vitamin B deficiency
. A sudden increase in body weight

. A hypersensitivity ofthe patient to the acrylic denture

base

. Ill-fitting dentures and a poor state oforal hygiene

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fu

most

Treatment may include:

. Tissue rest
. Soft reline ofexisting dentures

. Change in denture habrts (not wearing them 24 hours a dav)

. Surgical removal oftissue (y'ti.rsaes changes are extensive)
Note: Mandibular tori, sharp pron.rinent mylohyoid ridges, and epulis fissuratum should
also be evaluated for surgical removal trefore the iabrication ofnew dentures is begun.

Curent concepts of impression making for complete dentures recommend using

technique that:
. Affords placement and control ofthe impression material in recording border tissues

(bonler molding)
Results in minimal displacement oftissues under the dentLre (registers the tissue in

Its passive

position)

[s dependent on the oral conditions present.

\ote: The best impression technique for a patient with loose hyperplastic tissue is to register the tissue in its passive position. There must be intimate contact of the
impression material with the tissue.

The hyperplasia is produced in respons to ifiitation from movement ofthe denture and from accumulating food debris. The masses prescnt as painless,Iirm, pink, or red nodular pmliferations ofthl] mucosa. Candida albicans may contribute to the inflammation.
Conditions that compromise the optimal function ofcomplete dentures:
. Frenectomy; common for labial, less for buccal, rare for lingual. Surgery is usually Z-plasfy which
must include fibrous attachment to bone.
. H;-permobile ridge: ifinflamed. trcat with a tissue conditioner. Lascr suryery may bc needcd
. Epulis Iissuratum: a hyperplastic tissue reaction caused by an ill-fitting or overextended flange in
a denture.

Fibrous maxillary tuberosity: common occurrence when largc maxillary tuberosities contact

mandibular retromolar pads.

. Combination syndrome: refers

to $hat is believed to be a specific pattem ofbone resorption in the

anterior ponion ofan edenfulous maxilla, caused by wearing a complete denture opposing natural anterior teeth.
. Papillarl' h!perplasia: found in the palatal vault. Caused by local irritation, poor-fitting denture,
poor oral hygiene, and leaving the denture dentures in all day and night. Candidiasis is the primary
cause.

. Paget's

disease of bone: a denture or RPD in a patient with this disorder may have to be remade
periodically due to bone expansion

1.

Alveoloplasty is the improvement ofthe alveolar bone by surgical reshaping or rcmoval.

Noled,2.Palataltorishouldberemovedonlyif(l)itissolargcthatitfillsthevaultandprcvents

,....,
:.
r&a;-

the formation of an adcquf,te denture base when it is undercut, (2) it interferes with the placement ofthe posterior palaral seal, or (3) ifthe patient is canccr phobic.
3. Vestibuloplasty: this tcchnique increases the relative height ofthe alveolar process by api.
cally repositioning the alveolar mucosa and the buccinator mentalis, and mylohyoid muscles as they insert into the mandible.
4. Augmentation: (l) Bone gmfts l'rources include anleior iliac crest ofthe hip or the rib)
(2) Hy&oxyapatite (3) Freeze-dried bone

. Agrng
. Alcoholism
. Vitamin A or Vitamin B deficiency
. The use ofdrugs to manage chronic diseases
. Diabetes

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. Vemrcous lulgaris
. Inflammatory papillary hyperplasia
. Stomatitis nicotina
. Epulis fissuratum

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Xerostomia is a possible side effect associated with more than 400 drugs including antihlpertensives, antidepressants, antihistamines, bronchodilators, anticholinergics, and
sedatives. Mouthwashes, alcohol, tobacco, and caffeine may alter salivary flow or cause
dryness ofthe oral mucosa.
Even though xerostomia is not a disease, it can be a symptom ofcertain diseases. It can
cause health problems by affecting nutrition as well as psychological health. It can contribute to and increase the chances ofhaving tooth decay and mouth infections.

Temporary relief may be found from several sources:

. Saliva substitutes
. Sugarless hard candies
. Glycerine-based cough drops and lemon flavored glycerine mouthwash
. Medications may

be added, changed, or dosages altered to provide increased salivary

florv

Remember

saliva has several important functions:

. \vashes away food debris and plaque from the teeth to help prevent decay
. Limits the growth ofbacteria that cause tooth decay and other mouth infections
. Bathes the teeth and supplies minerals that allow remineralization ofearly cavities

. Lubricates foods so they may be swallowed more easily

. Provides enzymes that aid in digestion

. Helps us enjoy foods by aiding in the "tasting" process

. \'loistens the skin inside the mouth to make chewing and speaking

easier

The cleft-like lesions ofepulis fissuratum result primarily from overextension ofdenture flanges. The overextension may result from long-term neglect or settling subsequent
to residual ridge resorption. Trar.rmatic occlusion of natural teeth opposing an artificial
denture may also cause this condition.

Denture stomatitis is a localized or generalized chronic inflammation of the denture

bearing mucosa. Clinically, there is redness and a buming sensation. There may be or
mav not be discomfort. Trauma and secondary fungal infection appear to be the most

likeh

causes

of denture stomatitis.

The treatment generally consists of:

1. Improved oral hygiene
2. Tissue rest
-1.

Antifungal therapy (ny*atin)

Resilient tissue conditioners

5. New. well-fittins dentures
-+.

. Addison's

disease

. Paget's disease
. Hashimoto's disease
. Multiple sclerosis

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. Delayed healing
. Rapidly progressing periodontal disease with marked alveolar bone loss
. Mucosal bleeding
. Increased calculus formation
. A predilection for periapical abscesses

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Paget's disease (also called osteitis deformans) ofthebone is a chronic bone disorder in
which bones becorne enlarged and deformed. The exact cause is not known. It is
characterized by excessive breakdown of bone tissue, followed by abnormal bone
formation. The new bone is shucturally enlarged, but weakened with healy calcifications.

Important: Involvement of the skull may enlarge head size and cause hearing loss and
blindness if the cranial nerves are damaged by the bone growth.
the tissue surface of the dentures and relining with
-relieving
resilient materials can extend
the life of the dentures. However, remaking the dentures
freouentlv is unavoidable.

Dental Considerations

Children who wear dentures and patient's with acromegaly who wear dentures also often need to have their dentures relined or remade to allow for bone
growth.
2. Diseases ofbone growth or expansion are much rarer than those ofbone
1.

Not"* l

loss.

with systemic disease.

This condition is a generalized defect in which the quantity and quality ofbone
in the skeleton is reduced.
3. Osteoporosis is the most common change associated

your eyes, nerves, kidneys, heart,

Diabetes is a disease that can affect the whole body
and other important systems in the body. It can also affect your mouth. People with diabetes face a higher than normal risk of oral health problems. The link between diabetes
and the development of oral health problems is high blood sugar If the blood sugar is
poorly controlled, it is more likely that oral health problems will arise. This is because uncontrolled diabetes impairs white blood cells, which are the body's main defense against
bacterial infections that can occur in the mouth.

Just as studies have shown that controlling blood sugar levels lowers the risk of major
so too can
such as eye, heart, and nerve damage
organ complications of diabetes
good diabetes control protect against the development oforal health problems.

Even controlled diabetics present problems for the prosthodontist. The oral mucosa is
prone to the development of sore spots which heal poorly and often become secondarily
infected.

Principles to keep in mind when constructing denturs for patients with any debilitating
drsease:

.
.
.
.

Maximum extension
Narrow occlusal table

Non-pressure impression technique

Do not use porcelain teeth
. Establish a good occlusion
. Reinforce oral hygiene
. Place on 6-month recall (sooner ifnecessary to reinfor ce oral hygiene)

. Masseter muscles
. Medial pterygoid muscles
. Lateral pterygoid muscles
. Temporalis muscles

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Assume that a patient wearing complete dentures for a number ofyears is

given an oral exarnination and it is determined that the verticat dimension

ofocclusion has been decreased. This would cause:

. An increased vertical dimension that leaves the teeth in a clenched.

closed relation in

normal positions

. An occluding

vertical dimension that results in an excessive interocclusal distance

when the mandible is in the rest position

. An insufficient amount of interarch distance because ofhearry, bony ridges

. An inability to open the mandible because of temporomandibular joint pathosis

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Muscles acting on the TMJ:

. Opening (depress): lateral pterygoid, digastric (anterior belly) and the omohyoid
muscles.

. Closing

(elevate): masseter, medial pterygoid, and the temporalis (anterior fibers)

muscles.

. Protrude: laterals pterygoid muscles acting together

. Retract: posterior fibers ofthe temporalis muscle
. Lateral displacemnt: lateral pterygoid muscles acting individually.

Important:
. The lateral pterygoid muscles are mostly responsible for positioning and translating
the condyles.

. Ifthe mandible fractures, upward displacemnt ofthe fractured segment would

caused by the closing muscles (masseter medial pterygoid, a d temporqlis).

be

Interocclusal distance: also called "freeway space" is the vertical distance or space between the incisal
and occlusal surfaces ofthe maxillary and mandibular teeth with the mandible in the physiological rest
position. The average interocclusal distalce is about 3 mm. Too much interocclusal distance may result in muscuiar imbalance.
as measured between two arbitrarily
selected points, one above and one below the mouth, when the teeth or any substitute ma1e'rial (occluJiorl ,'rrril are in contact in centric relation. Excessive vertical dimension may result in trauma to thc
underlling supporting tissues (in a derlrtre patient) and strrir'jng ofthe closing muscles as well as
ad\erseft affecting the interocclusal distance (decreasedfreewal, space).

vertical dimension of occlusion is the vertical length ofthc face

\ertical dimension of rest

is the vertical length of the face as measured between two arbitrarily selecred points. one above and one below the mouth, when the mandible is in the rest position; in the
phlsiologicalJy healthy individual, there will always be a vertical space between the teeth (freewal' space)
\hen the mandible is in the rest position. This position is important in complete dentute fabrication because it p.ovides a guide to the vertical dimension ofthe occlusion.

l. Vertical Dimension ofOcclusion + Interccclusal Distance = VerticalDimellsion ofRest.

Notesi

**

Thc vcrtical dimension ofrest is always greater than the vertical dimcnsion ofocclusion.
A protrusive record registe$ the anterior-inferior condyle path at one particular point
in rhe translatory movement ofthe condyles. Some clinicians use this q?e ofrecord to detemine the amount of space between maxillary and mandibular teeth or occlusal rims in order
to maintain balanced occlusion throughout the mandibular functional range of movement
$'hen aniculating teeth.
4. Thc space that opens between the posteriorteeth during anterior movemcnt ofthe mandible
is called Christensen's PheDomenon. This posterior separation is increased if the incisal
guidance is increased. Tte amount of posterior separation is affccted by both the incisal
guidance and the horizontal condylar guidance. The separation is increased as both IG and
effect ofIC is greater anteriorly and the effect ofHCG is greater posHCG increase
-the
teriorly.
2.

l.

The anteroposteri or curvrtarc (in the median pltne)

the
mediolatrrl curv^tare (in thefrontal plane) in the ^nd
^lignment
of the occluding surfaces and incisal edges of artificial
teeti
that are uscd to develop balanced occlusion is called:

. Curve of

Spee

. Compensating Curve

. Curve of Wilson
. Curve of Pleasure

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. Tooth-to-tooth relation
. Occlusal relation
. Bone-to-bone relation

. Balanced relation

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The lorm ofthe compensating curve is entirely under the control ofthe dentist, For example, ifduring a try-in evaluation, a dentist notes that a protrusive excursion movement
results in the separation of posterior teeth, the problem can be corrected by simply increasing the compensating curve. The value of the compensating curve is that it allows
the dentist to alter the effective cusp angulation without changing the form of the manufactued denture teeth. The function ofthis curve is to help provide a balanced occlusion.
Not: As the condylar inclination increases, the compensating curve must increase to
keep a balanced occlusion. A prominent compensating curve is required when there is a
steep condylar path associated wilh a low degree of incisal guidance.

Orientation of the occlusal plane: The occlusal plane is an imaginary surface which is
related anatomically to the cranium and which theoretically touches the incisal edges of
the incisors and the tips ofthe occluding surfaces of the posterior teeth. lt is not a plane
in the true sense ofthe word, but represents the mean curvature ofthe surface. The anterior point of the occlusal plane is determined by the position of the anterior teeth. The
the height of the retroposterior determinants are anatomical lanalmarks
-two-thirds
ofcontrol the dentist may exercise
molar pads. Therefore, it is debatable as to the extent
over the orientation ofthe occlusal plane.
Cusp inclination is the angle made by the slopes ofa cusp with a perpendicular line bisectin-q the cusp, measured mesiodistally or buccolingually. This is under control of the
dentist (choosittg j0" degree teeth or cuspless teeth, etc.).

Remember: Anterior guidance in complete denture occlusion should be avoided to

Drevent dislodsement ofthe denture bases.

Centric refation (CR) (also called the retrudecl contact position) is considered a trminal
hinge position and is defined as "the maxillomandibular relation in which the condyles articulate with the thinnest avascular portion oftheir respective discs with the complex in the
anterior-superior position against the shapes ofthe anicular eminences". This position is independent of tooth contact. This position is clinically discemable when the mandible is directed superiorly and anteriorly. It is restdcted to a purely rotary moyement about the
trans\ierse horizontal axis. Important: This is a relationship of the bones of the upper and
loserjarvs without tooth contact.
lmportant points about centric relation:
. The mandible cannot be forced into centric relation fiom the rest Dosition because the

Da-

tient s reflex neuromuscular defense would resist the applied force

. The mandible should be relaxed and gently guided into centric relarion
. In fixed and removable prosthodontics, centric relation should be established prior to desi_uning the frameworks
. \\'hen a centric relation record is taken in the natual dentition, imprints ofthe teeth
should
be confined to cusp tips and the registration material should not be perfomted

Important point:

The current concept about centric relation: it occurs when the condyles are
in their most superoanterior position, resting on the posterior slopes of the articular eminences rvith the discs properly interposed.

Whl

do we ned to know this? This position is considered to be an optimum relative position between all ofthe anatomic components. And more importantly, it is a repeatable reference position to mount the casts on the articulator.

Helpful hint: Having the patient swallow, tuming the tongue upward towards the palate, relaxrng the jaw muscles, or protruding and retruding the mandible can be effective ways to
help in recording centric relation.

Which of the following stNtements concerning selective grinding in

complete dnture fabrication for centric relation is not true?

. Primary centric holding cusps are the maxillary lingual cusps

. Secondary centric holding

. Selective

cusps are the mandibular buccal cusps

grinding of the imer inclines of secondary holding cusps can be done

if

there is a working side interference

. Grind only the cusp tips of the upper buccal and the lower lingual
they are premature in centric, lateral or protrusive movements

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Brlancing side fn on-working side) interferencs

generally occur on th inner aspects ofthe:

. Facial cusps ofmandibular molars

. Facial cusps of ma"rillary premolars

. Lingual
. Facial

cusps ofmandibular molars

cusps of maxillary molars

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(8. U.Z.Z.) cusps

if

Selective grinding in centric rlation:

. Ideally selective grinding should result in harmonious cusp-fossa contacts olall upper and
lower fossa (and maryinal ridges of bicttspi"ds). Do not grind the upper lingual or lower
buccal cusps. A forward slide from centric can be corrected by grinding the mesial inclines
of maxillary teeth and distal inclines ofmandibular teeth
. Primary centdc holding cusps are the maxillary lingual cusps. Never grind these cusps.
See note below.
. Secondary cntric holding cusps are the mandibular buccal cusps. Grind these cusps
only ifthere is a balancing side interference
. Only grind cusp tips ifthey are premature in centric, lateral, and protrusrve movements.
Check before grinding.
Selective grinding in working-side relation: The rule ofselective grinding for interferences
in $orking -side movements is the &lgqlEIJ:LL!

. luccal cusp inner inclines ofupper teeth

non functional cusps
. lingual cusp inner inclines oflower teeth
Selective grinding in balancing side relation:

. Grind the inner inclines ofthe mandibular buccal cusps functional cusps
. \ever gind the maxillary lingual cusps (primary centric holding cusps)

\ote:

ifit

For the National Board Exam questions, you can reduce the maxillary lingual cusp
reality, you should not.
is high in centric as wll as othr occlusal positions

-in

Working side interferences generally occur on the innr aspects ofthe lingual cusps of
maxillary molars.
Protrusive interferences generally occur between the distal inclines of the facial cusps
of maxillary posterior teeth and mesiat inclines ofthe facial cusps ofmandibular posterior teeth. The proximity ofthe teeth to the muscles and the oblique vector ofthe forces
make contacts between opposing posterior teeth during protrusion potentially destructive.

The purpose of making a record ofprotrusive relation is to register the condylar path
and to adjust the condylar guides ofthe articulator so that they are equivalent to the condylar paths of the patient.

-{ centric interference (fot'wqrd slide) can be corrected by grinding the mesial inclines
of maxillarv teeth and distal inclines ofmandibular teeth.

qDn

(wwR
\C] IJ V
wk

. On the maxillary mesial inclines

and mandibular distal inclines

. On the maxillary mesial inclines and mandibular mesial inclines

. On the maxillary distal inclines and mandibular mesial inclines

. On the maxillary distal inclines

and mandibular distal inclines

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Which of the following best describes Camper'sline (plane)?

. It

is a line (plane) which is determined by the occlusal surfaces of the teeth

. It is a line (plane) which

extends from the outer canthus of the eye to the superior

border ofthe tragus ofthe ear

. It

is the hne (plane) running from the inferior border of the ala of the nose to the

superior border ofthe tragus of the ear

. None ofthe above

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Anteriorly the facial surface of the lower incisors will contact the guiding inclines /lzgual) of the tpper incisors and canrnes.

Protrusive movement is accomplished when the mandible is moved straight forward

until the maxillary and mandibular incisors contact edge.to-edge. This movement is bilaterally symmetrical in that both sides ofthe mandible move in the same direction.

In any restorative case involving all teeth in the mouth, the protrusive condylar path
inclination will have its primary influence on the same inclines (distal ofmaxillary and
mesial ofmandibular).

The pathway followed by the anterior teeth during protrusion may not be smooth or
straight because ofcontact between the anterior teeth and sometimes the posterior teeth.

The mandibular movements include movements:

. Approximately 9 - l0 mm anteriorly (protrusive movement)
. Approximately 50 - 60 mm inferiorly (opening)
. Approximately l0 mm laterally
. Approximately I mm posteriorly (retrusive movement)

Signilicance of the Camper's line: the plane of orientation for complete denture construction is established in the anteroposterior direction with the rnaxillary occlusal wax rim
parallel to Campers line, which is an imaginary line traced from the ala ofthe nose to the
tragus of the ear, and with the interpupitlary line in the transverse plane, which is an
imaginary line drawn between the eye pupils.

l{ote: The posterior determinants ofocclusion (two-thirds the height ofthe retromolar
pa&./ have the greatest effect on the setting ofthe mandibular second molars.
Remembr: The Frankfort horizontal plane extends from the outer canthus ofthe eye
to the tragus ofthe ear. It is commonly used in orthodontics for cephalometric analysis.

In the intercuspal position, the mesiolinguat cusp ofa permanent

maxillary lirst molar occludes where?

. Central fossa ofthe mandibular first molar

. Central fossa ofthe mandibular second molar
. The interproximal marginal ridge

areas between mandibular

. The interproximal marginal ridge

areas between mandibular second and third molars

first and second molars

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. The lingual groove ofthe mandibular first molar

. The mesiobuccal groove ofthe mandibular first molar
. The buccal groove ofthe mandibular second molar
. The distobuccal groove ofthe mandibular first molar
. The space between the mesiobuccal and distobuccal cusps of the mandibular first
molar

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Examples:

The mesiolingual cusp of the mandibular first molar opposes the lingual

embrasure between the maxillary first molar and second premolar

2. The mesiolingual cusp of the mandibular second molar opposes the lingual
embrasure between the maxillary second molar and first rnolar

\ote:

The distolingual cusp of the mandibular

lingual groove ofthe maxillary first molar.

first molar fits into fopposes) the

Remember: The lingual cusp ofpermanent mandibular first premolars does not occlude
* ith anlthing.

Important: During mandibular movements (working, non-working, e/c.) the outer aspects of the lingual cusps of the mandibular molars will not contact their maxillary anusonists. All other areas of buccal and lingual cusps may contact during mandibular
mo\ ements (this is assuming that all occlusal reletionships are normal).

\ote: In unilateral balanced occlusion, contact between mandibular buccal cusps and
maxillary buccal cusps, along with simultaneous contact between mandibular lingual
cusps and maxillary cusps will most likely occur in laterotrusive movements.

. Premolars
. First molars
. Incisors
. Canines

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. The central

fossae ofmandibular posterior teeth

. The lingual inclines of facial cusps ofmandibular posterior teeth

. The lingual inclines of lingual cusps ofmandibular posterior teeth
. The facial inclines oflingual cusps ofmandibular posterior teeth

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This is called canine or cuspid protected occlusion. It is an occlusal relationship in which the
vertical overlap ofthe maxillary and mandibular canines produces a disclusion (separation)
of all ofthe posterior teth when the mandible moves to either side. All other teeth, once they
move from centric relation, do not contact. If there is contact of other teeth. it is termed a
"working side" or "non-working side" interference depending on which side the mandible
moves towards. Note: When placing a crown on a maxillary canine, if you change a canine
protected occlusion to group function you increase the potntial for a "non-working side" interference.

Group function (sonetimes called unilqteral balanced occlusiotr) is an occlusal relationship

in which all posterior teeth on a side contact evenly as the jaw is moved toward that side
Irlorkitrg side). All teeth on the non-working side are free of any contact. The group function ofthe teeth on the working side distributes the occlusal load. The absence ofcontact on
tbe non-working side prevents those teeth from being subjected to the destructive, obliquely
directed forces found in non-working interferences. lt also saves the centric holding cusps,
i.e.. the mandibular buccal cusps and the maxillary cusps, from excessive wear. The obvious
adlantage is the maintenance of the occlusion.
l. Some relationships are not conducive to cuspid protected occlusion such as Class
relationships.
2. Some relationships are not amnable to group function such as Class II, deep
venical overlap.
3. Regardless ofwhat lateral concept is used. no non-working side contacts ar a
must because; (l) They are damaging (2) They are difficult to control due to
mandibular flexure and (3) They deliver more force to the teeth than other contacts.
.1. Horizontal forces on teeth are the most destructive to the periodontium.

-\otes II or end-to-end
^:.

_.

Remember:

Centric Occlusion Working

side

Balancing side

\otes on contacts in balancing occlusion (posterior teeth):

. Ideal Class I: cusp-fossa contact in centric occlusion
. Lateral excursion:
. \\rorking side: contact ofopposing cusps
. Balancing side (z on-vtorking): contact of maxillary lingtal atsps (lingual inclines)
and mandibular facial cusps (lingual inclines)

. The facial embrasure between their class counterpart and the tooth mesial to it
. The facial embrasure between their class counterpart and the tooth distal to it
. The opposing central fossae

. The opposing mesial marginal ridge

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Io tha ioturcusprl posltlon, the distobuccal cusp of o permanent

mandibular second molar occludes wbere?

. The interproximal marginal ridge area between the maxillary second bicuspid and first
molar

. Central

fossa of the rnaxillary first molar

. Cenfal

fossa

ofthe maxillary second molar

. The interproximal marginal ridge area between the maxillary first molar and second
rnolar

't'fi
Coplright O 201l-20t2 - Denral Dects

***

See picture below

Examples:
1. The facial cusp tip of a maxillary first premolar opposes the facial embrasure
between the mandibular first and second premolars (see note below).
2. The facial cusp tip of a maxillary second premolar opposes the facial embrasure
between the mandibular second oremolar and mandibular first molar.

\ote: During lateral excursive movements, the facial cusp ridge of the maxillary first
premolar on the working side opposes the distal cusp ridge ofthe first premolar and the
mesial cusp ridge of the second premolar.

. Backward and upward direction

. Downward and forward direction

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Coplright O 201 I -20 l2 ' Dental Decl!

.Pr

.E

.T
. RCP

.ICP

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Important:
. A protrusive movement requires the condyles to move downward and forward
direction.
. In latral movements, the working condyle moves down, forward, and laterally. condyle of working side
. In lateral movements, the non-working condyle moves down, forward, and medi- condyle of non working side
ally.
Remember: In complete dentures, the path ofthe condyle during free mandibular movements is governed primarily by the shape of the fossa and meniscus (articular disc) as
well as the muscular influence.
The inclination of th condylar path during protrusive movement can vary from steep
to shallow in different patients. It forms an average angle of about 3ff with the horizontal reference plane. Ifthe protrusive inclination is steep, the cusp height may be obviously
longer. Similarly, if the inclination is shallow, the cusp will be shorter. This factor is the
most important aspect of condylar guidance that affects the selection of posterior teeth
with appropriate cusp height.

Anterior guidance (vertical and horizontal overlap of anterior teeth) also affects the
surface morphology ofposterior teeth. The greater the overlap, the longer the cusp height.

Important: Anterior guidance must be preserved, especially when restorative procedures change the surfaces of aaterior or posterior teeth that guide the mandible in excursive (lateral, protrusiv) movements.

ICP

Intercuspal position (1P) or centric occlusion (CO)

RCP = retruded contact position or centric relation (CR)

PR = Maximum protrusion
E = Edge+o-edge position ofincisors

PR-T = the anterior border movement of the mandible

RCP-R = the rotational movement of the condyles retuming to centri c relation (tetmi'
nal hinge

ais

opening)

R-T = the translational moyement ofthe mandible retuming to where the condyles are
in centric relation
Togther these line segments (RCP-R and R-T) make up the posterior border movements of the mandible.

. Intercuspal position

f1P)

. Retruded contact position (RCP)

. Protruded contact position (PCPI

. Centric relation fCR)

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. Maximum
. Not present
. Premature

. qli ohr

1t5
Coptright O 201l-2012, Dental Decks

*** IP is also called centric

occlusion.

Remember: When the teeth are in centric occlusion, the position of the mandible in
relation to the maxilla is determined by the intercuspation ofthe teeth.

Empty mouth swallowing occurs frequently throughout the day and is an impofiant
function that rids the mouth ofsaliva and helps to moisten the oral structures. The hourly
rate of non-masticatory swallowing is apparently related to the amount olsalivary flow
and, in most instances, may be an involuntary reflex activity.

.,

l.

The masseter muscles contract and the tip ofthe tongue touches the

roofof

Note*: the mouth during normal swallowing.

\&|| 2. Tooth contacts are of longer duration in swallowing than in chewing, but

.r

there is wide variation in frequency and duration from one person to another.

This position results when the mandible and all of its supporting muscles (eight muscles
o-/'ntastication plus the supra - and inf'ahyoids) are intheir restingpostve (there is a rel-

atie

nruscular equilibrium). The term used to describe this absence ofcontact is

"free_
space" or "interocclusal distance". It usually averages between 2_6 mm. This
position is a 'rmuscle-guidedfi position. It is the beginning and end point of most
rr a'r'

mandibular movementsThe retruded contact position (also called centric relation) is a "ligament-guided"
position. It is the closing end point ofthe retruded border movement (the terminal hinge
nlol en1enu.

The intercuspal position (a/so called centric occlusion) is a "tooth-guided,' position.

\\-hen the teeth are in centric occlusion, the position of the mandible in relation to the
ma')rilla is determined by the intercuspation ofthe teeth.
The protruded contact position is s),rnnetrical, and the underside of the meniscus /ar_
ticular disc) moves distally relative to the superior surface of the mandibular condvle.
The condyle moves forward and canies the disc with it.

record should haye what important characteristic?

. Offer a maximum resistance to the patient's jaw closure and have high flow at
mixing

. Offer a marimum

resistance to the patient's jaw closure and have low flow at mixing

. Offer a minimum resistance to the patient's jaw closure and have low flow at mixing
. Offer a minimum resistance to the patient'sjaw closure

and have high flow at mixing

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Which of the following materials rvailable for recording centric relation

when frbricating a remov|ble partial denture is the least satisfsctory?

. Modeling plastic

. Wax
. Quick-setting impression plaster

. Metallic oxide bite registration paste

. Silicone impression materials

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In recent years, polyvinyl siloxane (addition silicones) impression materials have dominated the IOR (interocclusal record) market. These materials have very low flow when
mixed and become rigid after setting.
In the past, an interocclusal record was made by placing the IOR material into the mouth
usualla wax
and closing the patient's jaws into the material at the desired relationship. Although this
act of closing
may produce a relatively accurate IOR
concept is acceptable
-and of its lack of viscosity, often causes-the
a deviation of the
into any material, regardless
mandible away from the desired contact position.

A more desired method ofobtaining an accurate interocclusal record is as follows:

. Close jaws into centric occlusion (zost interdigitated position)
. With teeth occluded tightly, inject the addition-reaction silicone material in between
the marillary and mandibular teeth. Inject material only into areas where teeth have
been prepared and not around the entire arch.
. Advise patient to place tongue forward, short

ofgoing between teeth, thereby making

ofsilicone
. Let silicone set for about two minutes
. Remove IOR and him with a sharp knife
. Mount casts with IOR material present only in areas of tooth preparations
a matrix for the lingual aspect

Materials used to record jaw relationships have varied widely over the years An ideal
recording medium would be characterized as easy to handle, uniformly soft while the
record is being made, rapid setting, and totally rigid but not brittle when set. Rapid setting plastet zinc oxide and eugenol pastes, and modeling plastic all approach the ideal.
Avoid soft waxes as a recording material. They never become rigid and are likely to be
distorted during the cast mounting procedure.
exists, the mandibular cast may be mounted in
reinforced wax bite. In the case ofthe disa
zinc
oxide-eugenol
using
centric occlusion
plates
partial
base
and
occlusion rims should be placed on the
denture'
tal extension
framework ard the patient closed into softened recording wax or zinc oxide-eugenol
pxste (preferred). Whether this record will be in centric occlusion or centric relation will
depend upon the individual case and is dictated by the presence or absence of any natural posterior occlusion in the patient.

If sufficient natural posterior occlusion

A retiable method is to use a record ofall remaining occluding surfaces in a wax wafer
with the mandible in the terminal hinge position ard the teeth just out ofocclusion.
Primary requirements for making

centric relation record when fabricating a removable

dentue:

. To record the correct horizontal relation ofthe mandible to the maxilla

. To stabilize the lower record base with equalized vertical pressure
. To retain the record in an undistorted condition until the casts have been accurately
mounted on the articulator or until a previous record can be verified

. Non-supporting and working

Supporting and balancing

. Supporting and working

. Non-supporting and balancing

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. Horizontal overlap
. Vertical overlap
. Horizontal and vertical overlap

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Five Common Characteristics of Supporting Cusps

l. They contact the opposing tooth in the intercuspal position.
2. They support the vertical dimension ofthe face.
3. They are nearer the faciolingual center ofthe tooth than the non-supporting cusps.
4. Their outer incline has a potential for contact.
5. They have broader, more rounded cusp ridges than non-supponing cusps.
Remember: The supporting cusps are the maxillary lingual and the mandibular buccal. These cusps do grinding work because they occlude in a fossa or marginal ridge and
are also called working cusps. They are sometimes called centric cusps because they
hold the occlusion in a middle position (centric position).
The non-supporting cusps are the maxillary buccal and the mandibular lingual. These
reverse of supporting
cusps do not occlude or fit into fossa or marginal ridge areas and are called balancing or
non-cntric cusps. These cusps allow the dentition to move apart, out ofocclusion. They
allow teeth to "unlock" and move back and forth and side to side. These cusps have
sharper cusp ridges that serve to shear food as they pass close to the supporting cusp
ridges during chewing strokes
Supporting Cusps

Non-supporting Cusps

Supporting Cusps

Maxillary
Right
First Molar

Mandibular
Right
First Molar

Non-supporting Cusps

Anlerior guidance (sometimes called anterior coupllng) is a tightly overlapping relationship ofthe opposing maxillary and mandibular incisors and canines, which produces
disclusion of the posterior teeth when the mandible protrudes and moves to either side.

-{nterior teeth have a mechanical advantage over posterior teeth, due to the fact that they
are fanher away from the fulcrum (condyles), giving them better leverage to offset the
closing musculature. This apparent is apparent when one tries to occlude maximally with
anterior teeth as opposed to occluding maximally in the molar region. The further away
lrom the site of muscle action, the less force is exerted.

Important point ofall this: ifanterior guidance can be accomplished, the least amount
of tbrce u'ill be placed on the teeth during muscular contraction.
Incisal guidance is a measure of the amount of movement and the angle at which the
lo* er incisors and mandible must move from the overlapping position of centric occlusion to an edge-to-edge relationship with the maxillary incisors.
It is the second end-controlling factor in articulator movement. It is, to some degree, under
the control ofthe dentist. Influencing factors include: l) esthetics, 2) phonetics, 3) ridge
relations, 4) arch space, and 5) inter-ridge space. Esthetics and phonetics are the primary
factors limiting the dentists control of incisal guidance. The incisal guidance on the articulator is the mechanical equivalent ofhorizontal and verlical overlap.
Note: The right and left condylar mechanisms are the other end-controlling factors in articulator movement.

. Optimum occlusion requires minimum adaptation by the patient

. Bilateral balanced occlusion dictates that a minimum number of teeth should contact
during mandibular excursive movements

.Unilateral balanced occlusion or "group function" calls for all teeth on the working side
to be in contact during a lateral excursron

. Mutually protected occlusion, also called "canine guided" or "organic" occlusion is the
one in which anterior teeth protect posterior teeth in all mandibular excursions

. Mutually protected occlusion is the most widely accepted anangement ofocclusion

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. The amount of vertical overlap of the anterior teeth

. The contou ofthe articular eminence

. The height ofthe pulp hom ofthat particular tooth

. The amount and direction oflateral shift in the working side condyle
. The position ofthe tooth in the arch

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Important: In bilateral balanced occlusion the maximum number ofteeth should contact during mandibular excursions. This concept ofocclusal arrangement, though ideal, is
very difficult to achieve.
The determinants of occlusion include the right and left TMJ, the occlusal surfaces of
the teeth and the neuromuscular system. The concepts of occlusal arrangement aim to
place the artificial teeth in harmony with the TMJ and the neuromuscular system. If this
is done properly, it will result in minimum stress on the teeth and only a minimum effort
will need to be expended by the neuromuscular system when performing mandibular
movements.
There are four features ofthe human dentition which directly affect the health ofthe PDL

and its hard tissue anchorage in terms ofresisting occlusal force:

Antrior teeth have slight or no contact in the intercuspal positton.

2, The occlusal table is less than sixty percent ofthe overall faciolingual width ofthe
tooth.
3. The occlusal table of the tooth is generally at right angles to the long axis of the
tooth.
,1. Crowns of mandibular molars are inclined about l5-20 degrees toward the lingual.

The four theoretical determinants needed for restoring a complete and functional oc-

ofa tooth are:

1. The amount ofvertical overlap ofthe anterior teeth
2. The contour of the articular eminence
3. The amount and direction of lateral shift in the working side condyle

clusal surface

4. The position of the tooth in the arch

However, the jaw relationship most frequently used in the actual design of restorations
is the acquired centric occlusion.

Note: The anterior determinant of occlusion is the horizontal and vertical overlap
relationshio of anterior teeth.

. The maximum distribution ofocclusal stresses in centric relation

. The forces of occlusion should be bome

as much as possible by the long axis of the

teeth

. When there is point-to-surface contact of flat cusps, it should be changed to

surface-to-surface contact

. Once centric occlusion is established. never

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take the teeth out ofcentric occlusion

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201l-2012 - Dental Decks

. The distobuccal groove ofthe mandibular first molar

The buccal groove ofthe mandibular second molar

. The mesiobuccal groove ofthe mandibular second molar

. The developmental groove between the distobuccal and the distal cusps of
mandibular first molar

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the

***

This is false; when there is surface-to-surface contact of flat cusps, it should be

changed to a point-to-surface contact.

The basic principles for occlusal adjustment include:

. Maximum distribution olocclusal stresses in centric relation.
. Forces ofocclusion should be bome as much as possible by the long axis ofthe teeth
(Picture A).
. When there is surface-to-surface contact of flat cusps, it should be changed to a
point-to-surface cofiact (Pictut? B).
. Once centric occlusion is established, never take teeth out of centdc occlusion

,w'-w
Surface-to-surlace point-to-suface

Important:
. The mesiobuccal cusp ofthe maxillary ftrst molar opposes the mesiobuccal groove
ofthe mandibular first molar. This relationship is a key factor in the definition of Class

I occlusion.
. The distobuccal cusp ofthe maxillary first molar opposes the distobuccal groov of
the mandibular first molar. Note: This distobuccal groove also serves as an escapeway
fol the )IL cusp ofthe maxillary first molar during non-rvorking excursive movements.
. The oblique ridge ofthe maxillary first molar opposes the developmental groovebet\\'een the distobuccal and distal cusps ofthe mandibular first molar

Remember: The maxillary buccal (facial) and the mandibular lingual cusps are guiding cusps. The inner occlusal inclines leading to these cusps are called guiding inclines
because in contact movements they guide the supporting cusps away from the midline.
Thus. there are the bucco-occlusal inclines (lingual inclines oJ the buccal ctrsps) of the
maxillary posterior teeth and the linguo-occlusal inclines (huccal inclines of the lingttol
c u.rp.s) ofthe mandibular posterior teeth.

. Non-working side condyle only

. Working side condyle only

. Both

the non-working and working side condyles

. Neither ofthe condyles

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201

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When posterior teeth are in a normal ideal relationship, which of the

following cusps are considerd to be guiding cusps?

. Maxillary lingual cusps

. Maxillary buccal cusps
. Mandibular lingual cusps
. Mandibular buccal cusps

125
Coplrigh O 201l-201? ' Dental

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In a lateral movement, the non-working side condyle moves downward, forward, and
medially. The working side condyle moves laterally. Since the mandible is a solid bone,
the amount that the non-working condyle moves medially determines how far the working side condyle moves laterally. The Bennett movement is sometimes called the lateral
shift of the mandible or immediate side shift.

Important: This movement influences the lingual concavity of the maxillary anterior
teeth and directional placement of the ridges and grooves on the mandibular posterior
teeth as well as the mesiodistal position ofthe cusps of posterior teeth. Note: The Bennett angle is the angle formed by the sagittal plane and the path of the non-working
condyle during lateral movement ofthe mandible, as viewed in the horizontal plane.

Right Mandibular Movement

On the right side (worhng side), the condyle moves from C (centric) to right working
/I//. This movement is the Bennett movement.

These cusps are also called balancing, non-supporting, non-centric or shearing cusps.
These cusps do not occlude or fit into fossae or marginal ridge areas on the opposite arch

They allow the dentition to move apart, out ofocclusion. They allow the teeth to'.llnlock" and move back and forth and side to side.

Supporting cusps

are the maxillary lingual cusps and the mandibular buccal cusps. These

working, stamp or centric cusps. Centric stops are areas ofcontact that a supporting cusp makes with opposing teeth. For example, the mesial lingual
cusp ofthe maxillary frst molar (a supporting cusp) makes contact with the central fossa
lcentric stop) of the mandibular first molar.
cusps are also called

Supporting cusps contac! the opposing teeth in their corresponding faciolingual center
on a marginal ridge or a fossa. Non-supporting cusps overlap the opposing tooth without contacting the tooth.
the supporting and guiding cusps are opposite.
lingual would be supporting and the maxillary
and
the
mandibular
The maxillary buccal
lingual and the mandibular buccal would be guiding.

\ote: In posterior cross-bite situations,

of Prmthodontic Terms't defines balanced occlusion rs:

. An

occlusion of the teeth which presents a harmonious relation of the occluding

surfaces in centric only within the functional range

. An occlusion of the teeth which

presents a harmonious relation of the occluding

surfaces in eccentric positions only within the functional range

. An occlusion of the teeth which presents a harmonious relation of the

surfaces in centric and eccentric positions within the functional range

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. After a fixed bridge or a partial denture is delivered to a patient

. Before constructing a fixed bridge or a partial denture for a patient

. After a fixed bridge but before a partial denture is delivered to a patient
. After

partial denture but before a fixed bridge is delivered to

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patient

occluding

Five significant factors that govem the establishment ofbalanced articulation are:

. Inclination ofthe condylar guidance: totally diatated by the patient

.Inclination ofthe incisal guidance: horizontal and vertical overlap

. Inclination ofthe

occlusal plane: plane oforientation

. Convexities ofthe compensating curve
. Angle and height ofthc cusps

Some ofthese,

ifnot all,

are

contolled by
the dentist.

Recommended occlusion for complete dentures: Recommended practice is to develop maximum intercuspation of complete dentures to coincide with CR at an acceptable OVD. Failure to
achieve that can lead to intolerance, usually because of instability of the dentures or because of
pain ofthe alveolar mucosa as a result ofuneven load disftibution and high stress concentralions.
It is also recommended that a balanced occlusion is provided in order to help give occlusal stability.
Note: Balanced occlusion requires that the maxillary lingual cusps of the posterior teeth on the
non-working side contact the lingual incline of facial cusps ofmandibular posterior teeth in conjunction with balanced contact ofteeth in the working side.
Balanced centric occlusion in partial dentures is necessary for the stability ofthe appliance. Design ofthe framework and the relationship ofthe teeth to the ridges also influences the stability of
the partial. Bilateral ecceltric balance is not an objective in partial denture construction unless
the partial prosthesis is opposed by a complete dentur. The vertical relation for RPD'S is usually
determined by the remaining natural teeth (unlike complete dentures).

fiotei.

=;jji

I . Eccentric occlusion is defined as protrusive and right and left lateral contacts of the
inclined planes of the teeth when the jaw is not moving.
2. Articulation can be defined as the relationship ofteeth during movements into and
awav from eccentric Dosition while the teeth are in contact.

***

This is done to prevent duplicating the deflective occlusal contacts in the final restoratron.

Note: One cornmon case in which it would be prferable for selectiv grinding to be
completed after the fixed bridge or partial dentue is in place is when a fixed or removable partial denture is to be constructed for a space over which the opposing tooth has ex-

truded slightly. The bridge or partial is frequently constructed to the ideal plane of
occlusion and the opposing tooth is adjusted after insertion.
The most common complaint after cementation of a fixed bridge is sensitivity to hot /
cold and is an indication ofa deflective occlusal contact. The teeth involved may also be
sensitive to touch and this may be noticed by the patient while brushing. In these cases,
an immediate correction ofthe occlusion must be made.
The purpose of selective grinding is to remove all interferences without destroying
cusp height. With such an objective in mind, whenever interferences exist in centric but
not in lateral excursions, the fossa or marginal ridge opposing lhe premature cusp is deepened. It is important that whenever a prematurity is found, the occlusion be checked in all
centric positions before any adjustment is performed. Ifcusps are found to interfere with
one another in excursions, then only the non-holding cusps should be ground to prevent
a decrease in vertical dimension.

Important: Ifyou plan on changing

a patient's vertical dimension through crowns,

it is critical to mount a patient's casts on the true hinge axis (use a Jbce bow).

. Recurrent decay
. A periodontal problem

. Occlusal trauma
. An open margin

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. A pontic should b in contact in centric occlusion

. A pontic may or may not

be in contact in working-side movements

. A pontic should be in contact in non-working side movements

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Coplright O 201 I -20 l2 - Dental Deck

If centric relation occlusion is high, patients will complain of cold sensitivity and pain
upon biting down hard. All patients should have an appointment specifically to check the
occlusion on all crowns and bridges. Excursive movements should also be evaluated.
Many times patients will complain of pain on chewing soft foods, which indicates improper balancing or working contacts. The occlusion ofgold restorations is best checked
with silver plastic shim stock.
Important: Initial sensitivity can be caused by acid irritation accentuated by dehydrated
dentin from prolonged drying ofthe tooth before cementation or incorrect liquid / powder ratio ofthe cement.
Radiographic signs ofocclusal trauma include hypercementosis, root resorption, alteration ofthe lamina dura, and alteration of the periodontal space.
Note: If a marginal ridge is left higher than an adjacent marginal ridge, an interference
in retrusive movement may occur.

***

This is false; a pontic should not be in contact in non-working movements.

Remember: The success or failure of a bridge depends mostly on the design of the
pontic. The design is dictated by function, esthetics, ease of cleaning, patient comfort,
and the maintenance by the patient ofhealthy tissue on the edentulous ridge.
Proper dsign is more important to cleanability and acceptable tissue well-being than is
the choice of materials (porcelain, gold, etc.).
Note: Multiple adjacent pontics on an anterior fixed bridge have reduced facial embrasures to enhance esthetics.

. Is totally controlled by the dentist

. Is totally dictated by the patient
. Is padially dictated by the patient but can be adjusted by the dentist ifnecessary

Can be adjusted by the laboratory technician

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. A loss of interocclusal distance when the mandible is in the rest positton (decreased
free*^ay space)

. An excessive interocclusal distance when the mandible is in lhe restoosrtron ftncreased

freeway space)

as free way space =vdrest-vdocc

. Neither ofthe above, vertical dimension ofocclusion does not affect interocclusal distance

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Condylar guidance is the mechanical device on an articulator which is intended to produce similar guidances in articulator movement that are produced by the paths of the
condyles in mandibular movements.

It is important to realize that condylar guidance is a factor which is totally dictated by

the patient. It cannot be varied or "adjusted" by the dentist. The inclination of condylar
guidance depends on: 1) the shape and size ofthe bony contour ofthe TMJ (fossae and
disc),2)the action ofthe muscles attached to the mandible, 3) the limiting effects ofthe
ligaments, and 4) the method used for registration.
Remembr:

. The incline or angulation ofthe condylar element on the articulator is anatomically

related to the slope of the condylar articular eminences (condylar inclination).
. When adjusting the condylar guidance for protrusive relationship, the incisal guide
pin on the articular should be raised out of contact with the incisal guide table. The
protrusive record is probably the least reproducible maxillomandibular record.

Note: When restoring the entire mouth with crowns, the protrusive condylar path
inclination influences the mesial inclines ofthe mandibular cusps and the distal inclines
of the marillarv cusos.

A classic example of a decreased vertical dimension: People with no teeth or people who have wom
dentures fora long time present with the lower portion ofthe face scrunched up or do not show their lips
anymore (poor facial proftle).

Solution: Make new dentues and increase the vertical dimension ofocclusion. By doing this, you will
decrease the introcclusal distance and decrease freeway space.
Some effects ofexcessive vertical dimension ofocclusion:
. Exccssive display ofmandibular teeth

. Comf'laint of faligue oImuscles ofmasticalion

. Clicking ofpostcrior teeth when speaking
. Strained appearance ofthe lips
. Patient not able to wear dentures
. Discomfofi

. Excessive trauma to the supporting tissues

. Gagging
Some effects of insulficient vertical dimension of occlusion:
. Aging appearance ofthe lower third ofthe face due to thin lips, wrinkles, chin too near the nose,
overlapping comers of the mouth

. Diminished occlusal force

. Angular cheilitis
Conect vertical dimension ofocciusion is evaluated using the foJlowing methods
l- Overall appearance offacial support.
2. Visual obser.r'ation ofspace between the occlusal fims at rest.
3. Measurements between dots on the face f)rrich were placed for thri rearor?./, when the jaws are at
rest and when the occlusal rims are in colltact.
4. Observations when the "s" sound is enunciated accurately and repeatedly. This ensures adequate
speaking space between the occlusal rims/occlusal plane.

Centric occlusion (CO) is

^2

. "Muscle-guided" position

. "Ligament-guided" position
. "Tooth-guided" position

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A prerequisite for the use of this technique for the restoration of a single tooth is the
presence

20ll-2012

ofa

Class

III occlusion

This technique allows the cuspal movements of the dentition to be recorded in wax
intra-orally and transferred to the articulator in the form ofa static plaster cast
This static plaster cast is also called the ftnctional index

By registering the pathways of the opposing tooth

sudaces during mandibular

movements, the technique allows a laboratory technician to provide a restoration with

an occlusal surface less likely to incorporate occlusal interferences

t33
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Ci

2011,2012 - DentalDecks

Three Basic Jaw Positions

1) Centric occlusion {'CO) or the intercuspal /C) position is the relationship between maxillary and
mandibular occlusal surfaces that provides the maximum contact and or intercuspation independent
ofcondylar position. It is a "tooth-guided" position.
2) Centric rel.tion fCR) (also called the retruded contact position) 1s the most unstrained, retruded
anatomic and functional position ofthe heads ofthe condyles ofthe mandible in the mandibular fglenoid) fossae ofthe temporomandibular joints. This is a relationship of the bones ofthe upper and
lowerjaws without tooth contact. The presence or absence ofteeth, or the type ofocclusion or malocclusion, are not factors. It is a "ligament-guided" position. Note: The mandible cannot be forced
into cent c relation from the rest position because the patient's reflex neuromuscular defcnse would
resist the applied force. The mandible should be relaxed and gently guided into cenhic relation.
3) The rest position of the mandible or the postural position is determined mostly by the musculature, The usual reflex cited as the basis for the postural position of the mandible is the tonic stretch
reflex ofthc mandibular levators fi.., the myotatic rellex).lt is a "muscle guided" position.

-..

L In most people (90o/o), CR and CO do not coincide.

No&j.,'2.AccurateCRinterocclusalrecordsrequiremanipulationofthemandiblebythedentist.
,, .-,.--,'11 3. The most common mate als used for interocclusal records are wax f,4/rwax) and faste'
setting elastomeric materials such as polyvinyl siloxane and polyether.

-.

3. Woelfel leaf gauge method of recording CR: a thin flexible wafer is customized. Used
with its leafgauge it helps to guide the mandible superiorly and posteriorly and to maintain
the desired rninimum vertical opening. The recording material ofchoice is polyether, next is

zinc oxide-eugenol paste.

4.. Casts mounted with an interocclusal record are mounted more accurately ifthe material
used is selected according to the accuracy ofthe casts bing afiiculated, (casts produced with
irreversible hydocolloid are more acctrately mounted with vaa records, and casls obtained
vith elastomeric materials are more accurateb mounted v,ith elaslomeric registration materials or zinc and eugenol paste).

***

This is false; a prerequisite for the use ofthis technique for the restoration
gle tooth is the presence ofan optimal occlusion.

ofa sin-

A major difficulty for any dental laboratory technician is to determine the cuspal movements ofthe dentition using hand-held casts or casts mounted on a simple hinge articulator. The functionally generated pathway technique allows these movements to be recorded
in wax intra-orally and transferred to the articulator in the form ofa static plaster cast (the

functional index).
The involved tooth should be immobile and the recording material (low-fusing hi-Ji wax)
retained on the prepared tooth, not moving separately, during the generation ofthe FGP
wax record. The involved tooth should have unprepared teeth anterior and posterior to it
to act as refernce surlaces for checking the complete seating ofthe functional core ofthe
$,orking cast. There should be no occlusal interferences pre-operatively and the opposing surfaces should be properly restored.
I
,,

Notedt

Wi

The functional index becomes a static registration of all the movements

of

the opposing cusps.

2. The important consideration in generating this functional pathway is that all

motion ofthe mandible must be directed from an eccentric to a centric position, never the reverse.
3. Full case articulation is more universally applicable in obtaining occlusal

relationships for the fabrication

ofa wax pattem.

(A) A

decreased vertical dimension

of occlusion

refers

to

excessive interocclusal

di stance (i n cr e a s e d fre ew ay sp a c e)

(B) A decreased vertical dirnension of occlusion refers to the loss of interocclusal

distance in the rest position

(C) Al excessive vertical dimension frequently results in cheek biting

(D) An excessive vertical dimension is the usual cause ofclicking ofteeth

(E) Phonetics helps in verifying the vertical dimension ofocclusion

(F) Esthetics helps in verifying the vertical dimension ofocclusion
. (A), (C), and (E) are true
. (B), (D), ard (F) are fue
. (A), (C), (E) and (F) are true
. (B), (C), (E) and (F) are true
. (A), (D), (E) and (F) are true
. All of the above statements are true
13r|
Copyrighr O 2011"2012 - Denral Decks

One disadvantage ofdntal porcelaln restorations ls:

. Poor esthetics

. Expansion
. Brittleness
. Radioactivity

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35

,2012 - Dental Decks

The following must be considered while verifying the vertical dimensions of the
occlusion:
. Pre-extraction records
. The amount ofinterocclusal distance (freeway space) to which the patient was previously accustomed to
. Esthetics
harmony should be noted along with facial expresston

. Phonetics -facial

sounds

-speech
. Length ofthe
lip in relation to the teeth
. The condition and amount of shrinlage ofthe ridges

The compressive strength ofceramic bodies is greater than either their tensile or their shear strength The
tensile strength is low because ofthe unavoidable surface defects. The shear strength is low because of
the lack ofductility or ability to shear, caused by the complex stluctule ofthe glass ceramic materials.
The shear and tensile strengths of the fired porcelain are so low that the slightest imperfection in the
preparation ofthe cavity in the tooth may cause thejacket crown to ilactue in service.

Remember;

. Tle tooth preparation reduction for the mettl-ceramic restorations (1.5-2.0 nn) must provide
space for the metal f0. 5 ht ) and porcel^in (1 .0- 1.5 nm)
. The metal substructure provides support and increases the strength ofthe porcelain
. All intemal line angles where porcelain is veneered should be rounded to prevent shess concen-

tration
. The metal-porcelain junction should be at a right atrgle to avoid porcelain fracture
. Occlusal contacts must be at least 1.5 mm away from porcelain/metal junctton
. The coefficient ofthermal expansion ofthe porcelain must be slightly lower thafl that ofthe metal
to place the porcelain in slight compression when cooled
. Porcelain is stronger under compressive forces than it is in tensile forces
. Metal oxide formation is necessary for the metal-cemmic bond
Many porcelains rust at a temperature over 2000pF.
firing is the last firing and it produces a smooth, translucent surface.
3. Denlal porcelain has good biocompatibility. but is very brinle.
4. All-porcelain crowns are superior to ceramo-metal crowns in esthetics oriy (as compared
wilh stre gth, hanlness and toughness).
5. In a ceramo-metal unit, the porcelain surfacc should be under slight compressive stress
(it should not be under tensile or shear stress).
6. The core material in an all ceramic crown is usually a high strength sintered ceramic.
7. Porcelain substrate alloys, when comparcd to faditional alloys, melt at a higher tem1.

,.

*-o6g]

e_
ry _ i

2. The glaze

perature.

. Interposition ofan intermediate metal layer

. Mixing of oxidized metal layem with porcelain oxides
. Wetting ofthe porcelain onto the metal surface
. Mixing of the metal atoms with the porcelain structure

136
Coplrighr O 20ll-2012 'Denial Decks

. Hue

. Chroma
. Value

.Intensity

137

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- Dental Decks

Porcelain attaches to metal substrates by mechanical and chemical bonding. Roughness from sandblasting the cast metal restoration allows porcelain to mechanicaliy bond to metal. The mixing ofoxidized metal layers with porclain oxides allows the porcelain to chemically bond to metal. Note: Tle
elements Sn,In, Fe, and Cr all conhibute to metal oridation for chemical bonding to porcelain. Important: (l) Fe is key in PFM bonding to gold b.sed alloys (2) Cr is key in PFM bonding to gold-substitute alloys.

Three layers of porcelain

. The opaque porcelain must mask the dark oxide color as well as provide the porcelain-metal bond
. The body porcelain makes up the bulk ofthe restolation, providing most ofthe color or shade
. The incisal porcelain is

translucent layer ofporcelain in the incisal or cuspal portion ofthe tooth

The opaque is applied lirst to mask the metal and to give the restoration its basic shade. Body porcelain is then added overthe opaque. Incisal porcelain is added to the incisalone{hird to give translucency.
The restoration is bufked out (overcontoured) to compensate for the 20yo shrinkage, which occurs during firing.

Opaque porcelain showing through on the facial surface ofa metal-cemmic crown may be caused by
the following:
. Inadequate tooth reduction
fault ofthe dentist

- ofthe lab
. The metal is too rhick fault
. The opaque porcelain is too thick
of the lab
-fault
. Inadeouate thickness ofthe bodv Dorcelain
ofthe lab
-fault

L All ofthe following can lead to "pop-off' ofporcelain from PFM crowns:
. Contamination of the porcelain-to-metal interface
. Thick layers ofsurface conditioners on the metal
. Under-firing ofthe opaque layer
2. Surface mic.o-cracks in porcelain are caused by cooling stresses related to thc poor thcrmal conductivjty of porcelain.
3.Built-in strcsscs in the Dorcelain contributcs most to PFM failure.

Thre standard descriptions of color:

l. Chroma: is the saoration or sffength ofa color fdegree ofsaluration ofthe lue)
2. y^hte (or brightness): is the relative amount oflightness or darkness in a color
3. Hue: refels to color tone (e.g., rerl, hlue, vellov, etc.) and is synonymous with the term coLor.

1. Value is the single most important factor in shade selection.

l.lntensit\ is included rn the term value.
'toY I fh. hu".hould be <elected first \rhen picking a shade.
-1-a- 4. The Vitepan r'r 3D-Master shade guide ft'?/e nt, Brea, CA) is ananged

in five lightness levels

and a level for bieached teeth. Each lightness level has sufTicient variations in chroma and hue to
cover the natural tooth color space.

Characterization is the ar! ofreproducing natural dcfects. This can be particularly successful in making a
cro\\ n btend \\'ith the adjacent natural teeth
. T}e addition ofyellow stain increases the chroma ofa basically yellow shade. Addition oforange has the
same effect on a crowl as ayellow-red hue. Too high a chroma is impossible to decrease in hue or increase
tn |aluc.
. The only two modifications that usually are done to hue are: pink-purple will move yellow toward yqllo\l'red. whereas yellow will decrease the red content ofa yellow-red shade. Note: This is because a natural tooth always lies in the yellow-red to yellow rangc.
. Adding a aomplimentary color can reduc value. Violel is used on ycllow restorations, which has the
added effect of mimicking translucency.
. Stains are metallic oxides that fuse to the porcelain during a predetermined firing cycle
. Staining a porcelain restoration will reduce the value fas t1,i11 ll sing 4 complementarv color). It ls
almost impossible to increasc the value

\ote:

In esthetics, the value ofa denture tooth depends upon the relative whiteness orblackness of its color

The surface characteristics ofporcclain can affect the perceived form ofthe final restomtion in the following ways:

. A smooth

surface

will give

the impression

ofa larger size

. Changes in contour can be used to alter the apparent long axis inclination of

tooth

. Fluorescence

. Metamerism
.

Opaqueness

. Opalescence

138
Cop),righr O 201 I -20 l2 - Dental Dcks

. Obtained by heating

the previously fired body very slowly for 60 minutes at its fusing

temperature

. Nonporous, resists abrasion, possesses esthetic ability and is well tolerated by

gingiva

. Not
.

as durable

(in

its surface characteristics) as an over-glazed porcelain

All of the above

139
Cop)'right O 20ll-2012 - Dental Deck

the

This property is important in matching the shade of a metal-ceramic crown to a natual

tooth. Thus, ifpossible, color matching should be done under two or more different light
sources, one of which should be sunlight. Note: Staining ofthe porcelain will increase
metamenc responses,
Fluorescence is the optical property by which a material (for example, teeth) reflects r0.ltraviolet radiation. The energy that the tooth absorbs is converted into light with longer
wavelengths, in which the tooth actually becomes a light source. Human teeth fluoresce
mainly blue-white furcs (400450 nm range). Fhtorescence makes a definite contribu-

tion to the brightness and vital appearance ofnatural teeth.

Opalesence is the light effect of a translucent material (incisal edge of some teeth) appearing blue in reflected light and red-orarge in transmitted light.

Note: The production of color sensation with a pigment is a physically different phenomenon from that oblained by optical reflection, refraction and dispersion. The color
a pigment is determined by selective absorption and selective radiation (scattering).

of

Remember: The light source affects the perception of color, because the light source
must contain the wavelensth ofthe color to be matched in order to see that color.

At least three stages are generally recognized in the firing of dental porcelain: 1) low
bisque firing 2) medium bisque firing and 3) high bisque firing. The temperature at which
each occurs depends upon the type ofporcelain used.

A natural glaze occurs when the porcelain restoration itselfis glazed by a separate firing
(this process is referred to as "the glaze firing'). Ifthe body, previously fired as a high
bisque, is heated rapidly (10- I 5 ninutes) to its fusion temperature and maintained at that
temperature for approximately 5 minutes before it is cooled, the glass grains flow over the
surlace to form a vitreous layer, which is called a glaze. Note: This type ofglaze is much
more permanent than the overglazes.
Overglazes (or applied glazes) are ceramic powders that may be added to a porcelain
restoration after it has been fired. A transpa:ent, glossy layer forms over the surface of the
porcelain restoration at

maturing temperature lower than that ofthe body porcelain. The

result is a glossy or semiglossy surface that is non-porous. Erosion of this overglaze

may occur in the mouth and this leaves a rough and sometimes porous surface.

Note: Glazed porcelain (either type) is the least irritating to the gingival tissues compared with polished cast gold, polished direct filling gold and polished acrylic resin.

. Denture teeth
.

All ceramic crowns

. Metal-ceramic crowns
. All ofthe above

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201

l'2012'

Dntal

Deks

prior to adding porcelrin is called:

. Quenching

. Pickling
. Degassing

. Investing

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- Denbl Decks

The difference beween low- medium- and high-fusing porcelains is the firing temperature used to fuse
the glass. Today's low-fusing porcelain was developed to be less abrasive to opposing dentition by incorporating finer leucite crystals in lower concentrations.
Classifi cation based or\ fusion (vitrif ic a t io n ) temperature:
. High-fusing: 1288 to 137l"C (2350 to 2500"F): wed for denture teeth
. Medium fusing: 1093 to 1260'C (2000 to 2300"F): $ed fot all-ceramic and porcelain Jacket crowns
. Low fusing: 8'71to 1066"C (1600 lo /950'F): uesd for metal-ceramic crowns

Remember:

I. The compressive strength (350-550 MPa) of a porcelain testoration is greater than its tensile
(20-60 MPa) or shear strengths, which is typical ofa brittle solid.
2. Aluminous porcelain uses alumina instead ofquartz as a strengthener. This type ofporcelain is
considerably stronger than conventional porcelains.
3- Dental porcelain restorations are brittle and are not capable ofmuch plastic deformation.
Ceramic Properties:
L Physical Properties:

. Inrermediate density (1.0-3.8 gns/cc)

. High melting point (: reJi'actory,t

. Low coefficient ofthermal

2-

expansion

(l-l5 ppmfC)

Chemical Properties:

. Low chemical reactivity

. Low absorption and solubility
J. \Iechanical Properties;
. High modulus ofelasticity
. Much stronger in compression than tension (approximately 10X)
.
-+.

Biftle

(\o'|, plostic deformation (<0.1%o);low fracture toughness

BiologicalProperties:
. Relatively inert

It is necessary for all gold-porcelain systems. Degassing ofthe metal at too low a temperature will effect the formation of the oxide layer, which is important in bonding ofthe porcelain. The number ofbubbles formed at the interface decreases as the time and temperature of
degassing are increased.
the casting is ready for porcelain addition. The metal liamework must not b
contaminated by handling prjor to porcelain addition. Ifit is, the bond ofthe opaque will be

After degassing
veakened.

Causes of porcelain fracture at porcelain-mtal interface:

. Poor metal fiamework design: main cause offracture

. Fusing the opaque coat ofporcelain at too low a temperature or for too short a time
. Degassing ofthe metal at too low a tmpratur, which effects the formation ofthe
oxide layer. thus decreasing the bond
. Contamination of metal prior to opaque application
the metal (alloy) and ceramic (porcelain) must have coefficients of thermal expansion that are clos ely malched (alloy is usually slightl, harder) ifundesirable tensile stresses
at the interface are tobe avoided (racnre of the porcelain). Alloys should have a high proportional limit, and particularly, a high modulus of elasticity. Alloys with a high modr.rlus
\\'ill reduce shess on the porcelain.

\ote: Both

is the process ofremoving surface oxides from a casting prior to polishing. The casting is placed in an acidic solution which reduces the surface oxides. To prevent injury safety
goggles should always be wom when pickling.

Pickling

. The first statement is true; the second statement is false

. The first statement

is false; the second statement is true

. Both statements are true

. Both statements are false

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Coplrighr O 201 l-2012 - Denrnl Decks

Sintering ofa ceramic:

. Involves heating the raw materials above the melting point

. Results in an increase in porosity
. Decreases its mechanical strength
. Increases its density

143
CoptlighrO 20lt 2012, Denral Decks

Classilicstion according to method of frbrication:

. Powder condensation:This is considcrcd thc tmditional way for f'abrication ofan all-ccramic rcstoration. This
tcchniquc involvcs applying moist porcelain using a spccial brush, thcn compacting the porcelain by rcmoving thc
cxccss moisturc- Thc porcclain is (hcn fircd undcr vacuum allowing fu(hcr compaction. Ccramics fabricatcd by
this technique havc a great amount oftranslucency and are highiy csthciic, and arc uscd maidly as vcnccrirg ]aycrs. Notei Powder condcnsation utilizcs fcldspathic porcclain.
Feldspathic porcelain: Potassium and sodium fcldspars arc naturally occurring clcmcnts composed mainly ofpotash
(Na
20) , thcy also contain alumina (Al2O) and soda (Na2O) . Leucitc and a glass phasc arc fonncd
whcn potassium feldsparis fircd to high tcmpcraturcs. Thisglass phase softens during firing allowing coalescencc of
thc porcclain powdcr particlcs. This proccss is callcd liquid phasc sintcring. This proccss occurs at a relativcly high
temperaturc allowing thc formation ofa dense solid. Sincc lcucitc has a largc cocfl'icient ofthermal cxpansior, it is
added to somc glasscs to control thcir thcrmal expansion. Feldspathic porcclain is composed mainly ofoxidc componcnfs including:

(K20) and sod^

. SiO2 62-62

"'t

%)

'Al2O/ll-16fl!/o)

. Na2O (5-7 wt %)

. Li"O and B2O as additivcs

Since the porosity ofa ceramic is highly correlated with ils mechanical properties, reducing thc number ofdcfbcts in
ccramic is a common way ofincrcasing its sfcngth, Thc most common way oflowcring a ccmmic's porosity is sina ceramic material isheated in a fumace or ovcn likc dcvice;where it is crposcd 10 high lempcratu.cs. Thcse tcmpcratures depend on the material,butyou should know that they\yill alwaysbe below thc mclting
point of$e ceramic. During thc sintcring proccss thc porcs in thc ccramic will closc up thcrcby reducing the number oidelccts. Sintered all-cerNmic matrials include: alumina based ceramic, leucitc-rcintbrccd feldspathic porcclain, magncsia-bascd corc porcelain, heat-pressed all-cemmic matcrial and lcucite-based Iithium disilicate basc.
a

iering. During sjntcring

. Slip Casting: This techniquc involves forming a mold ofthc desired framework gcomctry and pouringa slip inlo
rhe formcd mold. Gypsum is usually utilized to form thc mold due to its ability ofcxtracting somc ofthe watcr
from ihe slip. Thc slip thc bccomcs compactcd against thc mold forminga fiamcwork. Thc frameq,ork is thcn remolcd from the mold by partial sintcring. Thc rcsulting ccramic is vcry wcak and porous and must be infiltcred
$ith glass or fully sinlcrcd bcforc application ofthcvcnccring porcclain. Matcrials processed by this tcchniquc tcnd
ro halc tcwcr defects from proccssing, and cxhibit highcr toughncss lhan thc convcntional fcldspathic porcclain.
Thc usc of this tcchnique in dcntistry has been limited to one ofthrce products. This limitation might bc duc thc
complicatcd stcps, which makcs achicving an accuratc fit diflicult. Slip cast all-ceramic materials include: alumina brscd. sDincl zirconia-based. and machined all-ceramic material.

Firing porcelain causes the powders to become "sintered." Sintering changes the porcelain from a powder to a solid. The powder is not melted, so the general shape is maintained. Sintering porcelain is the same process that is used to fire clay pots, china, and
ceramic tiles. Reducing the porosity of the resulting product is very important. The less
porous (more dense) the product is, the greater the strength of the final product will be.
After sintering, the final shape ofthe restoration is refined by grinding.

l. When porcelain is fired too many tirnes, it may devitrify. This appears as a
state" and makes glazing very difficult.
:.;Xot"J;.':. "milky
2. Aluminum oxide is added to low-fusing dental porcelains (during its mantufacture) in order to increase its resistance to "slumping down" during firing.
3. Glass, which is a prevalent phase in dental porcelain is arnorphous and fragile.
4. The strength ofa ceramic decreases with flaw size.
5. Ceramic restorations are severely damaged by acidulated fluoride.
6. All-ceramic restorations are more prone to fracture ifthe preparation line angles are not rounded.
7. Machine grinding of ceramics induces surface cracks.

. A tooth-bome removable partial denture

. A bilateral distal extension removable partial denture

. A unilateral distal extension removable partial denture

. None ofthe above

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Cop}Tighl O 20ll-2012 - Denral Decls

The mrjor connecter fu:

. The connecting tang between the denture and other units ofthe prosthesis
. The part of the denture base which extends from the necks of the teeth to the border

of the denture
. The unit of a partial denture that connects the parts of the prosthesis located on one
side ofthe arch with those on the opposite side

. None of the above

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20ll-2012,

Dental Decks

A distaf extension removable partial dentve (either bilateral or unilateral) receives its
suppoft ftom the residual ridge, tissue-bearing areas, selected abutment teeth and the fibrous connective tissues overlying the alveolar process.
The most important factor in detemining the success of distal extension removable partial dentures (bilateral and unilalera, is proper coverage over the residual ridge. Coverage of the free-end should extend over the retromolar pad to create stability of the
RPD and to minimize the torquing forces on the abutment teeth.

,:
.

iiote3'rl
::;:i:::,.:l

1. The first step in relining a distal extension removable partial denture is to

vrify the fit ofthe framework. Important: This is done first even if you are
also relining a marillary complete denture which is opposing this distal exten-

sion.
2. When relining a distal extension panial denture, apply finger pressure to the
rests and indirect retainer.
3. Ifthe indirect retainers are not seated as the extension bases are depressed. the
bases need relining.

Important: Ifa patient complains ofsensitivity to percussion on an abutment tooth of a

distal extension partial denture, the most likely cause is the occlusion on this abutment.
Deflective occlusal contacts can also cause a feelins of "looseness" to the denture.

The major connector must be rigid so that stresses applied to any one portion ofthe denture may be effectively distributed over the entire supporting area. lt connects other components ofthe prosthesis and provides cross-arch stabilization.
They should be designed and located with the following guidelines:

. They should be free of movable

. Relief should be provided

tissues

. They should not impinge on gingival tissues

. Bony and soft tissue prominences should be avoided during placement and removal

.
.
.
.
.
.

Palatal plate
Single palatal strap
Anterior-posteriorpalatalstraps
Single palatal bar
Horseshoe design
Anterior-posterior palatal bars

.
.
o

Lingual plate
Lingual bar
Labial bar

Note: A minor connector is the connecting link (or tang)between the major connector
or base ofthe partial dentue and other units ofthe prosthesis, such as clasps, indirect retainers and occlusal rests.

. 2-4 mm wide
. 6-8 mrn wide

. 8-10

mm wide

. At least 12 mm wide

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201 l-2012 - Dental

Decl!

. 3 mm ofvertical height between the gingival margin

and the floor

. 5 mm ofvertical height between the gingival margin

and the floor ofthe mouth

. 7 mm ofvertical height between the gingival margin

and the floor of the mouth

.9

ofthe mouth

mm ofvertical height between the gingival margin and the floor ofthe mouth

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Structurally, this combination of major connectors exhibits many ofthe same disadvantages as the single palatal bar To be sufficiently rigid and to provide the needed support
and stability, these comectors could be too bulky and could intefere with tongue functron.

Pllrt

l plrt: is a thin, broad conueclor ihat is indicated when all posterior teth are missing bilateratly. when used the portion contactiDg the teeth rnust have positive lupport hom adequate rest
sea6.
Slngle prlstaf strrp: is indicated in tooah-bot[ e &PDs (Keknedy Class 1,4, s'ith bilatral, short
span edentulous areas,
Anterlor-posterior p.lrtd strapsi structumlly, this is a rigid palatal major connector; it lnay be
used in almost any maxillary partial denture design.
Sirgle palrtal brr: are objctiomble because they lack rigidity. Their use is limited to tooth-bome
restorations for bilateml short spar edenlulous areas. The wide, thirr bar 6tdp) is more riSid with
less bulk compared 10 a narow bar.
Horsshoe designi is the le.st rigid maxillary connertor; should only be l]sed when a large,
inopemble palalal torus prvenls the use ofo$er desigts.
Antrior-posterlor pslatal baft: to b sufficieDtly rigid to pfovide required suppon and stability,
these majoi connector must be excessively bulky, which ofien irterteles with the tonglle.

Remember: The major and minor connectors must be rigid in order for the functional
stresses that are applied to the partial dentures to be distributed evenly throughout the
mouth

used when the depth ofthe lingual vestibule is less than 7 mm; when lingual
are present and when al1 posteiior teeth are to be replaced bilaterally. Contraindication is
severe anterior crowding.

Linguoplrte:

tori

Lingual bar: requires a minimum of 7 Inm of vertical heiglt between the gingival margin and
the floor of the mouth. Lingual bars should be placed so that the upper border is a minimum of
3 mm below the gingival margins 8nd at least 4 mm is required for ihe vertical height ofthe
lingual bar; simplest and most commonly used major cormector.
Labial bar: is .srly indicared. It can be used satisfactorily when large mandibular tod interfere with conventionat lingual bar placement or when lower teeth are severely lingually tipped
and placement ofthe lingual ba! is aot possible.

inclined mandibular premolars interfere most frequently with major

mandibular connectors.

\ote: Lingually

. Resistance to tamish
. Low material cost
. Low densiry (weight)
. High flexibility
. High modulus of elasticity (stffiess)

ta8
CoplriSht O2011,2012 - Dental Decks

. Looking at the x-rays

. Talking to the patient

Surveying the cast

. The initial try-in of the metal framework

't4t'
Cop)'right O

201 I

-2012 - Dental

Drck

A high yild strength and low modulus ofelasticity produce higher flexibility' The gold alloys are approximatly twice as {lexible as the chromium-cobalt alloys, which is a distinct
advantage in the optimum location or retentive elements ofthe framework in many instances.
Note: The std?ess ofthe chromium-cobalt alloys can be overcome by including wroughtwire retentive lments in the framework.
The popularity of chrcmium-cobalt alloys for fabrication ofcast frameworks for removable
partial dentures has been attributed to their low density (weight), hrgh modulus ofelasticity
(stffiess),low material cost and resistance to tamish. Note: Chromium-cobalt alloys are more
rigid in comparison to gold or palladium alloys.

Composition of chromium alloys for partial dentures:

. Chromium:

ensures that the alloy will resist tamish a\d corrosion (due
of a complex chromium oxide Jilm)
. Cobalt: contributes strength, rigidness and hardness

to

formation

. Nickel: increases ductility

. Minor constituents: carbon has a pronounced effect on the strength, hardness and ductility. Tin, indium and other readily oxidized minor components ofthe alloy firnction to improve bonding.
Remember: The form ofchrome-cobalt alloy connectors is flat, broad and reinforced along
the borders by the bead on the tissue surface. The process ofbeading not only helps maintain
tissue contact, but also provides additional strer,gth (for maxillary major connectors).
Possible causes of fracture of chromium-cobalt partials include cold-working (which re'
duces the percentage of elongation that causes a decrease in hardness), shrinkage porosity
Ithese alloys shrink approximately 2.3o.4 and the result is porosi4,), low percent longation
/is directl!- related to greater brittleness) and excessive carbon in the alloy (wrlrlch rcucts with
the other constituents to form carbides).

Surveying is generally perfomed at right-angles to the occlusal plane in the first instance, as this is the

likely path ofdisplacement. Sun'eying will identiry three principal factors: (1) The pfesence ofundercuts (2) The contour ofthe undercuts rclativc to the gingival margin and (3) The depth ofthe undercuts

Extracoronal retainers are the most common type ofdirect retainer that is used for removable partial dentures. They arc called clasps. The purpose ofthe clasp is fetain the RPD by means ofthe abutments. To prevent horizontal movement of the clasp, this should encircle the tooth more than 180
degrees or one-halfthe circumference ofthe tooth. Their ability to provide retention is based on the resistance of metal to defotmation. Note: Retentive clasps should beoome active only when dislodging
forces are applied to thcm. There are two basic categories ofextracoronal retainers: suprabulge and

in-

fr.bulge retainers.
Requirements ofa properly designed clasp:
l. Support - against vertical forces
2. Bracing - against horizontal forces
3. Retention - resist forccs in a occlusal direction
4. Encirclement - of more than halfit's circumference
5. Rcciprocity - equal and opposite forces by clasp arms
6- Passivity - at rest when seated

Intracoronal retainers (precisio attuchmettlt are the other tlpe ofdirect retainer that is somctimes
used for removable partial dentures. These are attachments which are built into the contour of a crown
/c.rs,ingl to produce mechanical and frictional retention. By eliminating the need for a visible retentive
clasp, these retainers give optimtl esthetics. They provide vertical support through the rest seat located

more favorably in relation to the horizontal axis ofthe abutment teeth.

lmportanti Intracoronal

retaineas are not used when a partial denture depends upon an edenfulous area

for support /distdl eiter.slorl. These retainers may provide a rigid con[ection between the denture and
the abrltment (line for looth-bone pdrlials). However, in distal extensions, functional motion must be
permitted without torquing the abutment teeth.

. Below the height ofcontour

. Above the height ofcontour

origin only

. Above the 0.08" undercut

. Above

the occlusal surface of most molars

150
Copyrighr O2011,2012 - Dental Decks

. More efticient retention

. Less distortion ofcoronal contours
. Less tooth contact

. Cleaner
.

Less bothersorne to vestibular tissues

. Less prone to caries

. Esthetically superior in most

. Greater

adjustability

cases

151

Coplright O 201 I -20

12

- Denral Decks

Clasps that originate from above the survey line, usually liom an occlusal rest, and angle downward across
the cfinical cro\rn until the tip is located in a prescribed amount ofundercut are suprabulge ret^iners (clasps).

Examples of suprabulge ret.iners:

. Circumlerentirl clasp:

is composed ofa buccaland lingual arm originating from a common body. Usually one arm is retentivc while thc other functions in bmcing. This clasp is used to engagc underculs locaicd
on the side /merrdl-disr.r// ofthe tooth opposit to the site ofthe rest.
. Ring clasp: encircles nearly all ofa tooth in order to ngage an undercut located on the same side of the
tooth as the rcst. It should not be usd where the caries rate is high orwhere esthetic considerations are dom-

inant.

. Embrasure clasp: is used when no edenlulous space exists at the clasp assemblysite.
. Reverse-action clasp or hairpinchsp: may be used to engage an undercut located on the

same side of
the abutment as the rst. It may be used on any posterior tooth, but it covers a lot oftooth surface and may
be esthetically objectionable.
. Extended ,rm clasp: is a circumferential clasp which extends to neighboring teeth in order to provid
increased splinting and to engage a more favombly located undercut.
. Halfand halfclasp: consists ofone circumfrential clasp emanating liom the rest area and another arm
from the minor connector on the opposite side.

The current concept ofbar clasp design is the R.P.I. system:

. Nlesial rest - point ofrotation which exerts a mesial force on the tooth
. P.orimal plate - supeior edge at bottom ofguide plane to disengage during loading. Slightly lingual for
.

I Bar - 2.5 mm liom gingival margin, crosses at right angles in a .01" undercut at the greatest M-D prominence to permit it to disengage during function
Adrantages of the R.P,I.:

l. Proximal plate and I bar move away from the tooth during function to reduce torque.
2. \Iesial minor connector and proximal plate provide reciprocation and eliminate need for a lingual arm.
-i. I bar more esthetic.
,1. \linimal contact alters contour less, advantageous on caries p.one individual.
5.. Mesial rest eliminates Class I lever.

***

This is false; infrabulge retainers are more bothersome to vestibular tissues.

Other disadvantages of infrabulge retainers:

. Too flexible for effective bracing
. Can be esthetically objectionable in patients with a high lip line
. Where there are not enough guideplanes to positively establish the path of insertion,
opposing cross-arch u.ndercuts can be used. In these cases, the effectiveness ofinfrabulge clasps are diminished because the unseating motion (without guideplanes) is ro-

tary vertical and horizontal.

Infrabulge retainers are clasps that originate from below the survey line. They are metal
projections emanating from the denture base struts in the framework. They course tluough
the denture base and project parallel to the mean plane ofthe gingiva until they make a
gentle right angle tum. Then they cross the gingiva and come to rest upon the abutment
tooth in a specified undercut area.
Infrabulge retainers must not be placed into tissue undercuts, nor should they contact the
abutment at any place except at the specified undercut.

The bar clasp arm has been classified by the shape of the retentive terminal. These include the T, modified I I, or Y. These bar clasp arms and circumferential clasp arms (a
suprabulge retainet), both provide retention by the resistance of metal to deformation,
rather than frictional resistance created bv the contact ofthe clasD arm to the tooth.

The one located the closest to the clasp tips which is located furthest from the
edentulous area

The one located the furthest from the clasp tips which is located nearest to the
edenfulous area

The one located the furthest from the clasp tips which is located furthest from the
edentulous area

152
Copltish

O 201l-2012 - Dental Dcts

Which of the folowing Kennedy classes of removlble partial

dentnres are not tooth-borne?

I
. Class I

. Class II
. Class

III

. Class IV

Coplriehr O

201

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l-2012 - Dertal Decks

Explanation ofanswr: As unseating occurs in the edentulous segments, a line through

III lever
system. Moving the fulcrum line still further from the clasp tips improves the mechanical advantages ofthe lever arm system. By maintaining this position, the most distant
rests augment the retentive action ofthe clasp and indirectly contribute to retention. Thus,
the term indirect retainers Dertains to rests. which ausment mechadcal retntion.
the rests located furthest from the retentive clasp tips acts as the fulcrum in a Class

As the denhrre base moves upward, the most anterior rcst (lrhich is the indirect
retainer) rcsists downward movement and this increases the effectiveness of the direct
retainer.

Tooth-borne removable partial dentures fclass 1/1and Class IV) depend entirely on abutment
teeth for support.

Kennedy classifications are based on the most posterior edentulous area to be restored. Although
Class Ilt and IV partial dentures are supported entirely by the abutment teeth, Class I and ll partial
dentures are supported also by the residual ridge, the subjacent tissues and the fibrous connective
tissue overlying the alveolar process.
Applegates rules governing the application ofthe Kennedy classification system:

. Rule

l:

follow, not precede extractions.

is missing and not to be replaced, it's not considered in the classifica-

the classification should

. Rule 2; ifa 3rd molar

hon-

. Rule 3: if

a 3rd molar is present and not to be used as an abutment,

it's not considered in the

classification.

. Rule 4: if

2nd rnolar is missing and not to be replaced, it's not considered in the classifica-

tron.

. Rule 5:

the most posterior area always determines the classification.

. Rule 6: edentulous areas other then those determining the classification are referred to as rnodifications and are designated by their numbers.
. Rule 7: the extent ofthe modification is not considered, only the number ofadditional edentulous areas.
. Rule 8: there are no modification areas in Kennedy Class IV arches.
Note: The alveolar ridge resorption under the distal extension partial denture is ofparticular concem and can be reduced by maximizing the coverage ofthese supporting areas.

Very Important! Likewise, the periodontal damagc to abutment teeth is avoided with firm tissue
support

-maintaining

a stable base-tissue

relationship.

Remembr: Rests should be placed on abutment teeth next to the edentulous areas for maximum
support when designing a tooth-bome partial. These rests limit movement ofthe denture in a gineival direction.

The followlng partially edentulous rrch would be classilied as:

. Kennedy Class

. Kennedy Class II

'i:-_(--

-_:-

. Kennedy Class

III

I --

s<

. Kennedy Class IV

1g
Coplaight O 201l-2012, Denral Decks

\
What is the recommended treatuent for a patient who has lost
her four maxillary incisors some time ago and has suflered
excessive ridge resorption?

. A conventional six - unit fixed bridge

. No treatment
. A removable partial denture
. A Maryland bridge

'155

Coplaight O 20ll-2012 - Dertal Dcks

Kennedy Class I
Bilateral distal extension

Kennedy Class

II

Unilateral distal extension

Kennedy Class IV
Anterior extensions
crossing the midline

Any other additional edentulous area is referred to as modification (except in Class IV)
e.g.. If Kennedy Class I (bilateral clistol extension) above, also has another edentulous
area anteriorly, then it would be referred to as Class I modification I.
Remember: Craddock classification is based upon the denture type.
. T.'-'pe I: Mucosa bome
. Type II: Tooth-bome
. Type III: Mucosa and tooth-bome

*** Ifexcessive ridge resorption

has occurred after tooth loss in the anterior region, the

pontics required to replace these teeth may be quite unesthetic. A removable partial denture rvith its tissue colored acrylic base can provide this esthetic consideration.

Other situations in which a removable partial denture is specifically intended rather

than a fixed bridge:

. Distal extension: obviously, ifseveral teeth must be replaced and no posterior abutment is present, then a removable partial denture must be used (other option would be
irplarls). It is possible, howevel to cantilever one tooth in a fixed bridge if at least two
\.ery sound teeth exist anterior to the space.

. Long span edentulous area: sufftcient abutment teeth are not present to support the
occlusal forces, which would be placed on the fixed bridge.

. Periodontally involved abutment teeth: the bracing and cross-arch stabilization of

a removable partial denture in this case makes it the ideal treatment.

. Following recent extractions:

a temporary removable padial denture may be provided until tissues have had time to heal properly and fixed bridgework can be done.

. Economics: may force the use ofa partial denture as an interim solution to
lem that must evcntually be solved with fixed prosthodontics.

a prob-

. When the lingual frenum is high or the space available for the lingual bar is limited

.In

Class I situations in which the residual ridges have undergone excessive vertical re-

sorption

. For stabilizing periodontically weakened teeth

Severe anterior crowding

. When the futue replacement of one or more incisor teeth

dition ofretention loops to an existing linguoplate

Copltigh C

201

will be facilitated by the ad-

'| 56
l-2012 - Dertal Decks

. More than

25%o, allowing the clasp to bend without microstructure changes that could
compromise its physical properties

. More

than 6%, allowing the clasp to bend without microstructure changes that could
compromise its physical properties

Less than 6%, allowing the clasp to bend without microstructure changes that could
compromise its physical properties

Less than 250lo, allowing the clasp to bend without microstructure changes that could
compromise its physical properties

157
Cop)righr O 20i

2012 - Denlal Decks

***

This is a contraindication to the use oflinguoplate

The linguoplate is a lingual bar that has been extended upward to cover the cingula and interproximal spaces between mandibular anterior teeth. It should be thin and follow the contours ofthe teeth and embrasures. The upper border should be located at the middle thAd of
the lingual surface ofthe teeth and extend upward to cover interproximal spaces to the contact Doint.

Mandibular lingual bar

Mandibular linguoplate

Mandibular labial bar

A lirought wire clasp is fabricated by d&wing the metal from which it is made into a wire.
The success ofwrought wire clasps depends on their physical properties and the changes that
ma-,- occu during fabrication. Laboratory ptocedures can compromise desiable physical propenies due to improper heating and cooling. Manufacturer directions should be followed for
each panicular alloy. It is important that a wrought wire clasp have an longation percentag

ofmore than 670, allowing the clasp to bend without microstructure changes that could compromise its physical properties. Tapering a wrought wire clasp to 0.8 mm at the tip before conrouring allows for more uniform stress distribution throughotlt the clasp, making it more
sen iceable and efficient. Remember: The most important mechanical property involved
when a clasp is adjusted is elongation.
Desig:ning a chrom cobalt clasp to engage less undercut is the most reliable way to decrease its retentiveness; switching to a gold clasp while maintaining the same amount ofundercut will have a similar result. Gold clasps offer half the retention ofchrome cobalt clasps
$hile engaging identical undercuts. Because the grain size ofchrome cobalt is large by comparison, it possesses a lower proportional limit; as a result, the risk offracture increases as its
bulk decreases. Since cobalt work hardens more rapidly than gold, bending chrome cobalt
clasps is associated with an increased likelihood of fiacture.
cast into a mold (e.g., an inlay, crown or
c/nspl. When the casting is cold-worked in some manner to provide the required article or appliance (e.g.,lrire), it is calted a wrought metal in contrast to a cast metal. As stated above,

Note: A cast mtal is any metal that is mlted and

many mechanical properties ofthe wrought structure are suprior to those ofthe cast struci)re (e.g., tensile strength, hardness and strength). Tttis means that a wrought structue having a smaller cross-section than a cast stmctue may be used as a retainer arm (retentive) to
Derform the same function.

. It

is a rest seat

. It is located

as far anterior as possible

. The function is to prevent vertical dislodgement ofthe distal extension base ofa removable partial denture

. It

is usually an MO rest seat on a first molar

Coplright () 201 1,2012 - Denral Decks

The strength, hardness, and tensile strength of wrought wire is approxlmatelyi

50lo

25olo

greater than the cast alloy from which it was fabricated

. 50%
.

greater than the cast alloy from which it was fabricated

less than the casl alloy from which it was fabricated

7570 greater than the cast

alloy from which it was fabricated

159
Cop)'righ! O 20ll-2012 - Denral Decks

***This is false; it is usually found on

a canine or premolar.

Indirect rtention is the component ofan RPD that assists the direct retainers (clasps)
in preventing displacement of a distal extension base by functioning through lever action on the opposite sid of the fulcrum line when the denture base rotates away from
the tissues around the fulcrum line.
It is an anti-rotational devic fabricated by a rest/connector combination and placed as
far forward from the embrasure clasp as possible. It counteracts the upward rotation ofthe
edentulous base. This also serves as a 3'd reference for seating ofthe framework and making altered cast impressions. Note: The indirect retainer may be omitted in some designs
tooth-bome partial dentures.

Indirect retainers also serve another related function. In their absence, upward dislodgement ofdistal expansion bases would be accompanied by downward motion ofthe
anterior part of the major connectot By preventing such downward movement, the indirect retainer protects the soft tissues from impingement by the major connector.
Remember:

. An indirect retainer should

far from the distal extension base as possible in a prepared rest seat on a tooth capable of supporting its function
. The term indirect retainer pertains to rests, which augment mechanical retention
be placed as

Wrought wire clasps:

. Have a grater flexibility and adjustability than the cast clasps
. Are tougher than cast clasps
Har,e a greater tensile strength than cast clasps and therefore can be used in smaller
diameters to provide greater flexibility without fatigue and ultimate fracture

Important: Having been formed by being drawn into a wire, the wrought-wire clasp has
toughness and ductility exceeding that of a cast clasp arm. The clinical effect of this is
that there is an increased capacity for deformation ofthe wrought-wire without breaking.
Horvever, the yield strength ofboth gold and chromium-cobalt alloy wrought wires can
be drastically reduced simply by subjecting the wire to too much heat.

lfthe

heat is high

enough. the fibrous microstructure of the wrought wire disappears and is replaced by a
grain or crystalline microstructure. This process is known as recrystallization or gain
gro$th and is a most undesirable occurrence in wrought-wire retainer arms.
The terminal end ofthe retentive arm is optimally placed in the middle ofthe gingival third ofthe clinical crown. However, it is acceptable to place it at thejunction ofthe
gingival and middle one-third ofthe clinical crown. When the partial is completely seated,
the retentive arm should be passive and applying no pressure on the teeth.

\ote:

. Rigid plating
. Minor connectors

. Guide planes extended around the vertical line of abutments

. Achieving balanced occlusion

. Contact

aras

ofproximal teeth

. Reciprocal clasp arms

't

60

Coplri8h O 201l-2012

- Deotal Decks

. Maxillary lateral incisors

. Maxillary canines
. Mandibular lateral incisors
. Mandibular canines

tG1

Coplriehr

@ 201

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Reciprocation as applied to partial dentures refers to the function of the lingual clasp arm
(which is the reciprocal clasp arm or stabilizing clasp orm) to counteract forces exerted by
the buccal clasp arm (which is the retentive clasp arm).

Reciprocation is the means by which one part ofthe fiamework opposes the action of the retainer in function. Reciprocation may be achieved by opposing flexible retainers with guide
planes, minor connectors, rigid clasp arms or plating. lf true reciprocation is to occur, the reciprocating element must be placed opposite the direct retainer and must contact the abutment
as the retentive tip passes over the height ofthe contour ofthe tooth,

Remember: Th currnt concpt of bar clasp design is the R.P,I. system:

. Mesial rest - point olrotation which exerts a mesial force on the tooth
. Proximal plate - superior edge at bottom of guide plane to disengage during loading.
Slightly lingual for reciprocation
. I Bar - 2.5 mm from gingival margin, crosses at right angles in a.01" undercut at the
greatest M-D prominence to permit it to disengage during function
as two or more parallel, vertical surfaces of
abutment teeth, so shaped to direct a prothesis during placement and removal. The functions
ofguiding plane surfaces are as follows:
. To provide for one path ofplacement and removal ofthe denture
. To ensure the intended actions ofreciprocal, stabilizing, a nd retentive components
. To eliminate gross food haps between abutment teeth and components ofthe dentue

Important: The term guiding plane is defined

As a rule, proximal guiding plane surfaces should be about two thirds as $ide as the distance
benveen the tips ofadjacent buccal and lingual cusps or about one third ofthe buccal lingual width of the tooth and should extend vertically about two thirds of the length of the
enamel crown portion ofthe tooth from the marginal ridge cervically. Note: Proximal plates
are metal plates that contact the proximal surface or guide plan ofan abuhrent tooth.

***

These teeth have a gradual lingual incline and a prominent cingulum. In some instances, cingulum rests may be placed on mfiillary central incisors. The lingual slope of
the mandibular canine is usually too steep for an adequate cingulum rest to be placed in

the enamel.
The cingulum rest is a veftical stop on an anterior tooth whose lingual anatomy lends
selfto ready preparation for a positive seat.

ir

. Inverted V or U shape

. Mesiodistal length = 2.5 to 3 mm

. Labiolingual width : 2.0 mm
. incisoapical depth = 1.5 nm

*** Not all teeth

have sufiicient cingulum contour to receive a seat (i.e., mandibular

central snd lateral incisors).

The incisal rest is employed when other preferred support is not available. The high placement ofthis style ofrest may be esthetically objectionable. The distal incisal rest is usually less esthetically visible than the mesial incisal rest. Never place an incisal rest so deep
that it interferes with the proximal contact.

. Rounded notch at an incisal anele

. Width = 2.5 rnm

. Depth = 1.5 mm

l) It is more esthetic;
influence.
the
has
a
less
torquing
abutment
2) The resulting stress relayed to
Note: Two advantages of a cingulum rest over an incisal rest are:

Important: The prirnary purpose of the rest (any type -+ occlusal, cingulum or incisal)
is to provide vertical support for the removable partial denture.

. Occlusal third

. Middle third
. Gingival third

162
Cop}1ighl O

20ll-2012

Denial Decks

qurlity ot
Which
w|lrc|l ol
of the
r|lc lurrowr[g
following rs
is ocrxrcu
delined as
rI|c qu![ty
ru ''"The
of a rcslorauofl
restoration to
be lirm, steady constant and not subject to change of position
when forces are applied?"

. Retention

. Stability
. Adhesion

. Reciprocation

163
Coplright O 201 l-2012, Dental Decks

Retentive components should be located as close as possible to th tooth's horizontal axis of

rotation. It is easier to overstress the tooth support by clasping it near the occlusal surface.
The distal extension moves up and down during function, indicating that a clasp design in the
gingival third ofthe tooth that disengages the undercut during function would be less stressful to the periodontal support ofthe tooth.
The clasp assembly consists ofa retentive clasp arm and a reciprocal or stabilizing clasp
arm, plus any minor connectors and rsts fiom which they originate or with which they are
associated.
The functions ofthe rciprocal clasp arm of a removable partial denture include reciprocation, stabilization and auxiliary indirect reterfii.on (bracing). Points to remember concerning
reciprocal clasp arms:

. ln positioning

cast clasps on abutment teeth, the horizontal undercut is considered a sig-

nificant measurement and height of contour is considered a controlling factor in clasp posittLoning. (Reciprocal clasp should contacl tooth on or qbove contour). See note below.
. In general, you should not use retentive areas on the buccal and lingual ofthe same tooth.
Reciprocal bracing on the lingual and retenlive portion of the clasp on the buccal is
more desirable.

. As with all

clasps, they should be designed to permit insertion and removal without ap-

plying excessive force.

. _ l. Altering the natural tooth form to allow effective clasping may involve producNoredi ing guiding planes or changing the location of th hight of contour. Facial and

,*--

proximal contours of premolars and molars most often need to be altered. Crown
fabrication may be necessary to provide the appropriate contour.
2. Guiding planes serve to ensure predictable clasp retention. Failure ofpartials due
to poor clasp design can be avoided by altering tooth contours.

base to bone that resists dispartial dentures stain

horizontal
direction.
In
removable
lodgement of the denture
a

In dentures, stability is the relationship of the denture

bilit_v is best insured by incorporating a harmonious occlusion.

Retention is that quality in a restoration, which resists the force ofgravity, sticky foods
and tbrces associated with mandibular movement. Note: For RPD's the distal parts of the
rerenti\ e clasps produce the aclive retention. resist dislodge denture in vertical dimention
Reciprocation is the means by which one part ofa restoration is made to counter the effects created by another part. Note: For RPD's true reciprocation can only be achieved
the reciprocating element touches the tooth before the retentive clasp

if

For panial dentures, support is given by occlusal rests and the edentulous ridge areas. This
design characteristic (support) is most important to oral health. Other design character-

istics of

partial denture include:

. Retention: by clasps placed in undercut areas of abutment teeth

. Bracing: or horizontal force transmission through placement of rigid portions of
clasps or other parts ofthe partial denture in non-undercut areas of abutment teeth
. Guidance: during insertion and removal obtained by contact of rigid parts of the
framework with areas on axial tooth surfaces parallel to the path of insertion

. Labial notch and labial flange

. Buccal notch and buccal flange
. Posterior border

. Distobuccal flange

1U
Coplrighr O 201l-2012 - Denral Decks

Free end saddles are liable to be displaced under occlusal pressure

(onteru-posterior rocking around the abutment tooth,lehich acb as a pivol).
This is as r result ofthe displaceability ofthe mucosa. \trhich technique is
employed to try and prevent this by taking an lmpression ofthe
mucosa under controlled pressure?

. The functional load technique

. The altered cast technique

. The residual ridge technique

. The total occlusal load technique

165
Cop]rishr O

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Excessive thickness of this area can lead to this problem. As the buccal frenum moves
posteriorly during smrling (or otherfacial expressions) it encroaches on the denture border that is too thick and the denture becomes loosened.
You can test the borders for overextension by slowly seating the denture. Ifyou observe
premature contact with frenae or vestibular tissues as the denture conlinues toward its
final position, then the border is probably overextended. Adapt a thin roll ofdisclosing wax
to the denture border Seat the denture and instruct the patient to exeft vigorous muscle
function. In about one minute, the wax will soften and be displaced by muscular action
across the overextended denture border

l. The complaint that the denture becomes loose when the mouth is wide opened
distobuccal flange ofthe denture being too
thick. This may interfere with the movement ofthe coronoid process.
2. Ifpatient complains ofsore gums and aching muscles at the bottom ofthe face
after wearing dentures for several hours, opposing teeth ofthe denture have insufficient space. Reduce the vertical dirnension of the occlusion.
3. Tingling or a numbing sensation at the comer ofthe mouth or in the lower lip
after a few days of denture wearing is caused by excessive pressure from th
lower truccal flange in the region of the mental foramen.

otedr' as in yawning, could be due to the

Impression materials cannot record anatomic form ofthe teeth and physiologic form ofthe soft tissue in a functional relationship all at the same time. To achieve these objectivcs, the altered cast
technique can be used. This technique is a secondary irnpression system which utilizes the metal
frame\\'ork to hold customized imprssion trays for the edentulous area. The advantage of the altercd cast procedure is that an accurate relationship between the denture base and the metal frame$ork is established prior to tooth arrangement which should result in less occlusal adjustment at th
time of insertion. The objectives ofthe altered cast technique are to obtain thc maximum possible
support from the distal extension base ofthe RPD and to accurately relate the soft tissue surface ofthe denture basc to the metal ftamework

Distal extension removable partial dentures fRPDb/ derive their support from the abutment teeth
and the mucosal tissues overlaying the residual alveolar process. There are di{Iering philosophies
in the scientific literature regarding how much support should be provided by the abutment teeth and
how much support should bc provided by the soft tissues. Howevet thre is consensus that: (1) occlusal stress should be shared by both in such a manner that neithr the abuhnent teeth nor the residual ridge is abused; (2) accurate fit ofthe denture base is an important factor in minimizing stress
on the abutment teeth; (3) stability ofthe prosthesis is the most important requirement fbr propr
function and patient comfort.

Important points to remember conceming removablc paiial dentures:

. In order to determine whether the alveolar bone is capable ofwithstanding occlusal forces of
a rcmovable partial denturc, an x-ray should b taken ofthe abutment teeth and the bone lovel surrounding these teeth should be evaluated.
. Periodontal health of the abutment teeth and maintaining th health ofthe supporting tissues
is best achieved by maintaining tissue support (preserving denture bone support) ofthe edentulous areas.
. The total occlusal load applied to an RPD is influenced by the occlusal surface area, occlusal
efliciency and the number ofexisting teeth.

. The periodontal ligament ofthe abuftnent teeth

. The alveolar suppod ofthe abutment teeth

. The residual ridge

. All ofthe above

't66
Coprright O 2011,2012 - Dental Decls

. They provide retention without an unsightly display of metal

. They are easy to repair
. The functional load is dispersed down the long axis ofthe abutments by virtue ofthe
low central loading at the base ofthe attachments

. The restorations permit the patient

access to

all areas of the tissues when the denture

is not in place

. If both sides of the dental arch have this t)?e of restoration and

are

joined by a rigid

major connector, excellent bilateral stabilization is provided to the abutments

167
Cop),righr O 201l-2012 - Dental Decks

When these devices are incorporated next to a free-end distal extension RPD, the thrust

of the functional stress is directed onto the residual ridge, Only minimal transfer of
functional stress to the abutment teeth occurs. Since vertical and horizontal forces are
concentrated on the residual ridge, increased ridge resorption frequently occurs. Relining ofthe free-end saddle area must be done when needed to prevent excessive ridge resorptlon.
Types of Stressbreakers:
1. Have a

flexible connection between the direct retainer and the denture base:

. Simplest form ofstress reliefis the wrought-wire retentive clasp

. Split bar major connectors; example is the Ticonium "Hidden-Lock" design
2. Have a movable

.
.
.
.

\ote:
$

The

joint between the direct retainer

and the denture base:

"DE" hinge

The Dalbo attachment

The Crismani attachment
The ASC-52 attachment

When a stressbreaker is placed on the distal surface of a pontic, occlusal forces

ill tend to unseat the key from the key.

***

This is false; precision attachment restorations are difficult to repair.

A precision attachment (intracoronal direct retainer) is preconstructed with male and

fernafe portions (both constructed ofa metql) that f\t together in a precise fashion with little tolerance. It may be rigid in function or it may incotporate a movable stress control unit
to reduce the torque on the abutment.

Disadvantages of precision attachments:

. They must nver be used in a distal extension removable partial denture without
using a stressbreaker the primary indication for precision attachments is when teeth
are present on both ends ofthe edentulous area
. Full cast crowns must be prepared for all abutments
. They cannot be used on short clinical crowns
. They cannot be used when the pulp is large (requires extensive tooth reduction)

. Both clinical and laboratory procedures require special skill

. They are difficult to repair
. The metal parts wear and lose retention
. The cost is much greater

A semiprecision attachment is cast into the crown and the RPD. The female portion is
normally made ofpreformed plastic that is positioned into the wax form and then cast. The
male portion is cast with the RPD framework. The female and male parts fit together with
much more tolerance than in the precision attachment, resulting in less retention.

When surveying casts, the clinician/technician must perform an important step

in order to correclly record the path of insertion, the position ofthe
survey line and the location of undercut and noD undercut Nreas.
tttL:^L
-^--:,J^--r
^f.L^
Which of
the a^tl^-..:-following :is considered
to be that step?

. The recontouring ofproximal walls ofabutments parallel to the path ofinsertion

. The use of indelible lead marker

. Placing tripod marks on the cast to record the orientation of the cast to the surveyor
. Fixing the casts with screws on the surveying table
. All of the above steps are equally imponant

168
Cop)righr

201l-201? - Denral Decks

Which primary design-quality ofthe occlusal rest would

gpositive"
categorize it as a
rest?

. Allow no tilting ofthe appliance

. Prevent the movement ofthe appliance

. Transmit stress down the long axis olthe tooth

. Form

acute angles with the minor connectors that connect them to the major connectors

. Have

a thickness

of 1.5 mm

All of the above

169

Cop)rightO 20ll-2012 - Dental Decks

The tripod marks (which are three spots placed at three different locations around abutment teethfrom a single point ofview) ensure reproducible orientation ofthe cast to the
surveyor.

The dental surveyor (picture on left) is an instrument used to

determine the relative parallelism oforal anatomy. Note: Areas
used for support cannot be determined by surveying.

When surveying casts, the corect procedure is to lirst adjust

the tilt to permit the establishment ofguiding planes. The anterior edentulous space will frequently dictate the angulation selected. Normally, some recontouring ofthe proximal walls of
abutments is necessary to improve guideplane alignment.
These alterations are accomplished by disking the proximal
surface parallel to the path of insertion.

Tilting of the cast during surveying changes the:

. Path of insertion
. Position ofthe survey line
. Location ofthe undercut and non-undercut areas ofeach tooth

The prirnary purpose ofthe rest is to provide vedical support for the RPD.

Note: Occlusal rests are prepared primarily to resist the vertical forces of occlusion. In
doing so the rest also does the following:

. It maintains established occlusal relationships by preventing settling ofthe denture

. Prevents impingement of soft tissues
. Directs and distributes occlusal loads (through the long

at,

to abutment teeth

Forrn of the occlusal rest and rest seats:

l. The outline form should be a "rounded" triangular shape with the apex toward the
center of the occlusal surface.
2. It should be as long as it is wide and the base ofthe triangular shape should be at least
2.5mm for both molars and premolars.
3. The marginal ridge ofthe abutment tooth at the site ofthe rest seat must be lowered
to permit a sufiicient bulk of metal for strength and rigidity. This means that a reduction of the marginal ridge of about l.5mm is usually necessary.
4. The floor ofthe occlusal rest should be apical to the marginal ridge and be concave
or spoon shaped (no sharp edges or line-angles in the prep).
5. The angle formed by the occlusal rest ald the vertical minor connector from which
it originates should be less than 90o.

Remembr: The rest must be rounded (spoon shaped) to permit functional movement.

. The useful posterior tooth space

. The lip line ofthe patient
. The age ofthe patient

. The characteristics ofthe denture-supporting tissues

. The face-bow tralsfer

170
Cop)'right C 201l-2012 - Dental Decks

. 20 - gauge

gauge

. l8 -

gauge

gauge

19

16

171
Coplright c) 201 1,2012 - Denial tlecks

Factors which are relevant to the selection of posterior teeth for a removable partial
denture:

. Occlusogingival length: the most important factor in determination ofposterior tooth

length is the available interarch space.
. Mesiodistal width: the total mesiodistal space available for the posterior teeth is determined by measuring from the distal of the lower canine to the point where the
mandibular residual ridge begins to slope upward.
. Buccolingual width: the buccolingual width is narrowed in rlation to the missing
natural tooth. It is thought that reducing the area of the occlusal table decreases
stressed transferred to the denture support area during food bolus penetration. Additionally, reducing the buccolingual width increases tongue space.
. Shade: the shade for posterior teeth is usually selected to harmonize with that ofthe
anteriors.
. Occlusal surface form: at this time, it appears that no superior tooth form or arrangement is identified. It is therefore logical to use the last complicated approach that fulfills the needs ofthe patient.
. \Iaterial: plastic bonds well to the acrylic resin and therelore plastic teeth are retained bener than oorcelain leeth

***

20 - gauge or finer, as < 7 mm, is a short arm clasp and shorter length clasps must
har.e a finer gauge of wire for optimum flexibility.

flexibility ofa retentive clasp arm depends on:

the flexibility of a clasp varies directly with the cube of its
lengrh. Thus, increased length results in a marked increase in flexibility
. Thickness of the clasp: as a clasp becomes thicker; its flexibility is reduced by a

The

. Length of the clasp:

cube ratio

. Width of the clasp: as the width of a clasp increases; its flexibility decreases by a
ratio of l: I
. Cross-sectional form: a rourd form is equally flexible in all directions. In contrast,
a half-round form flexes readily only when the stress is applied perpendicular to the

flat surface

. Taper of the clasp: a uniform

taper permits increasing flexibility toward the tip

of

the clasp

. Clasp material: different

metals flex more than others. Remember: Wrought wire

retentive arms have increased flexibility