NEET MDS Lessons
Prosthodontics
Impression making is a critical step in prosthodontics and orthodontics, as it captures the details of the oral cavity for the fabrication of dental prostheses. There are several techniques for making impressions, each with its own principles and applications. Here, we will discuss three primary impression-making techniques: Mucostatic, Mucocompressive, and Selective Pressure Impression Techniques.
1. Mucostatic or Passive Impression Technique
- Proposed by: Richardson and Henry Page
- Materials Used: Plaster of Paris and Alginate
- Key Features:
- Relaxed Condition: Records the oral mucous membrane and jaws in a normal, relaxed condition.
- Tray Design: Utilizes an oversized tray to accommodate the relaxed tissues.
- Tissue Contact: Achieves intimate contact of the tissues with the denture base, which enhances stability.
- Peripheral Seal: This technique has a poor peripheral seal, which can affect retention.
- Outcome: The resulting denture will have good stability but poor retention due to the lack of a proper seal.
2. Mucocompressive Impression Technique
- Proposed by: Carole Jones
- Materials Used: Impression compound and Zinc Oxide Eugenol (ZoE)
- Key Features:
- Functional Recording: Records the oral tissues in a functional and displaced form, capturing the active state of the tissues.
- Retention: Provides good retention due to the compression of the tissues during the impression process.
- Displacement Issues: Dentures made using this technique may tend to get displaced due to tissue rebound when the tissues return to their resting state after the impression is taken.
3. Selective Pressure Impression Technique
- Proposed by: Boucher
- Materials Used: Special tray with Zinc Oxide Eugenol (ZoE) wash impression
- Key Features:
- Stress Distribution: Loads acting on the denture are transmitted to the stress-bearing areas of the oral tissues.
- Tray Design: A special tray is designed such that the tissues contacted by the tray are recorded under pressure, while the tissues not contacted by the tray are recorded in a state of rest.
- Balanced Recording: This technique allows for a more balanced impression, capturing both the functional and relaxed states of the oral tissues.
Articulators in Prosthodontics
An articulator is a mechanical device that simulates the temporomandibular joint (TMJ) and jaw movements, allowing for the attachment of maxillary and mandibular casts. This simulation is essential for diagnosing, planning, and fabricating dental prostheses, as it helps in understanding the relationship between the upper and lower jaws during functional movements.
Classification of Articulators
Class I: Simple Articulators
- Description: These are simple holding instruments that can accept a static registration of the dental casts.
- Characteristics:
- Limited to hinge movements.
- Do not allow for any dynamic or eccentric movements.
- Examples:
- Slab Articulator: A basic device that holds casts in a fixed position.
- Hinge Joint: Mimics the hinge action of the jaw.
- Barndor: A simple articulator with limited functionality.
- Gysi Semplex: A basic articulator for static registrations.
Class II: Semi-Adjustable Articulators
- Description: These instruments permit horizontal and vertical motion but do not orient the motion of the TMJ via face bow transfer.
- Subcategories:
- IIA: Eccentric motion is permitted based on average
or arbitrary values.
- Examples: Mean Value Articulator, Simplex.
- IIB: Limited eccentric motion is possible based on
theories of arbitrary motion.
- Examples: Monson's Articulator, Hall's Articulator.
- IIC: Limited eccentric motion is possible based on
engraved records obtained from the patient.
- Example: House Articulator.
- IIA: Eccentric motion is permitted based on average
or arbitrary values.
Class III: Fully Adjustable Articulators
- Description: These articulators permit horizontal and vertical positions and accept face bow transfer and protrusive registrations.
- Subcategories:
- IIIA: Accept a static protrusive registration and
use equivalents for other types of motion.
- Examples: Hanau Mate, Dentatus, Arcon.
- IIIB: Accept static lateral registration in
addition to protrusive and face bow transfer.
- Examples: Ney, Teledyne, Hanau Universit series, Trubyte, Kinescope.
- IIIA: Accept a static protrusive registration and
use equivalents for other types of motion.
Class IV: Fully Adjustable Articulators with Dynamic Registration
- Description: These articulators accept 3D dynamic registrations and utilize a face bow transfer.
- Subcategories:
- IVA: The condylar path registered cannot be
modified.
- Examples: TMJ Articulator, Stereograph.
- IVB: They allow customization of the condylar path.
- Examples: Stuart Instrument, Gnathoscope, Pantograph, Pantronic.
- IVA: The condylar path registered cannot be
modified.
Key Points
- Face Bow Transfer: Class I and Class II articulators do not accept face bow transfers, which are essential for accurately positioning the maxillary cast relative to the TMJ.
- Dynamic vs. Static Registrations: Class III and IV articulators allow for more complex movements and registrations, which are crucial for creating functional and esthetic dental prostheses.
Applegate's Classification is a system used to categorize edentulous
(toothless) arches in preparation for denture construction. The classification
is based on the amount and quality of the remaining alveolar ridge, the
relationship of the ridge to the residual ridges, and the presence of undercuts.
The system is primarily used in the context of complete denture prosthodontics
to determine the best approach for achieving retention, stability, and support
for the dentures.
Applegate's Classification for edentulous arches:
1. Class I: The alveolar ridge has a favorable arch form and sufficient height
and width to provide adequate support for a complete denture without the need
for extensive modifications. This is the ideal scenario for denture
construction.
2. Class II: The alveolar ridge has a favorable arch form but lacks the
necessary height or width to provide adequate support. This may require the use
of denture modifications such as flanges to enhance retention and support.
3. Class III: The ridge lacks both height and width, and there may be undercuts
or excessive resorption. In this case, additional procedures such as ridge
augmentation or the use of implants might be necessary to improve the foundation
for the denture.
4. Class IV: The ridge has an unfavorable arch form, often with significant
resorption, and may require extensive surgical procedures or adjuncts like
implants to achieve a functional and stable denture.
5. Class V: This is the most severe classification where the patient has no
residual alveolar ridge, possibly due to severe resorption, trauma, or surgical
removal. In such cases, the creation of a functional and stable denture may be
highly challenging and might necessitate advanced surgical procedures and/or the
use of alternative prosthetic options like over-dentures with implant support.
It's important to note that this classification is a guide, and individual
patient cases may present with a combination of features from different classes
or may require customized treatment plans based on unique anatomical and
functional requirements.
Kennedy's Classification is a system used in dentistry to categorize the
edentulous spaces (areas without teeth) in the mouth of a patient who is fully
or partially edentulous. This classification system helps in planning the
treatment, designing the dentures, and predicting the outcomes of denture
therapy. It was developed by Dr. Edward Kennedy in 1925 and is widely used by
dental professionals.
The classification is based on the relationship between the remaining teeth, the
residual alveolar ridge, and the movable tissues of the oral cavity. It is
particularly useful for patients who are wearing or will be wearing complete or
partial dentures.
There are four main classes of Kennedy's Classification:
1. Class I: In this class, the patient has a bilateral edentulous area with no
remaining teeth on either side of the arch. This means that the patient has a
full denture on the upper and lower jaws with no natural tooth support.
2. Class II: The patient has a unilateral edentulous area with natural teeth
remaining only on one side of the arch. This could be either the upper or lower
jaw. The edentulous side has a complete denture that is supported by the teeth
on the opposite side and the buccal (cheek) and lingual (tongue) tissues.
3. Class III: There is a unilateral edentulous area with natural teeth remaining
on both sides of the arch, but the edentulous area does not include the anterior
(front) teeth. This means the patient has a partial denture on one side of the
arch, with the rest of the teeth acting as support for the denture.
4. Class IV: The patient has a unilateral edentulous area with natural teeth
remaining only on the anterior region of the edentulous side. The posterior
(back) section of the same side is missing, and there may or may not be teeth on
the opposite side. This situation requires careful consideration for the design
of the partial denture to ensure stability and retention.
Each class is further divided into subcategories (A, B, and C) to account for
variations in the amount of remaining bone support and the presence or absence
of undercuts, which are areas where the bone curves inward and can affect the
stability of the denture.
- Class I (A, B, C): Variations in the amount of bone support and presence of
undercuts in the fully edentulous arches.
- Class II (A, B, C): Variations in the amount of bone support and presence of
undercuts in the edentulous area with natural teeth on the opposite side.
- Class III (A, B, C): Variations in the amount of bone support and presence of
undercuts in the edentulous area with natural teeth on the same side, but not in
the anterior region.
- Class IV (A, B, C): Variations in the amount of bone support and presence of
undercuts in the edentulous area with natural teeth remaining only in the
anterior region of the edentulous side.
Understanding a patient's Kennedy's Classification helps dentists and dental
technicians to create well-fitting and functional dentures, which are crucial
for the patient's comfort, speech, chewing ability, and overall oral health.
Arrangement of Teeth in Complete Dentures
The arrangement of teeth in complete dentures is a critical aspect of prosthodontics that affects both the function and aesthetics of the prosthesis. The following five principal factors must be considered when arranging teeth for complete dentures:
1. Position of the Arch
- Definition: The position of the arch refers to the spatial relationship of the maxillary and mandibular dental arches.
- Considerations:
- The relationship between the arches should be established based on the patient's occlusal plane and the anatomical landmarks of the residual ridges.
- Proper positioning ensures that the dentures fit well and function effectively during mastication and speech.
- The arch position also influences the overall balance and stability of the denture.
2. Contour of the Arch
- Definition: The contour of the arch refers to the shape and curvature of the dental arch.
- Considerations:
- The contour should mimic the natural curvature of the dental arch to provide a comfortable fit and proper occlusion.
- The arch contour affects the positioning of the teeth, ensuring that they align properly with the opposing arch.
- A well-contoured arch enhances the esthetics and function of the denture, allowing for effective chewing and speaking.
3. Orientation of the Plane
- Definition: The orientation of the plane refers to the angulation of the occlusal plane in relation to the horizontal and vertical planes.
- Considerations:
- The occlusal plane should be oriented to facilitate proper occlusion and function, taking into account the patient's facial features and anatomical landmarks.
- The orientation affects the alignment of the teeth and their relationship to the surrounding soft tissues.
- Proper orientation helps in achieving balanced occlusion and minimizes the risk of denture displacement during function.
4. Inclination of Occlusion
- Definition: The inclination of occlusion refers to the angulation of the occlusal surfaces of the teeth in relation to the vertical axis.
- Considerations:
- The inclination should be designed to allow for proper interdigitation of the teeth during occlusion.
- It influences the distribution of occlusal forces and the overall stability of the denture.
- The inclination of occlusion should be adjusted based on the patient's functional needs and the type of occlusion being utilized (e.g., balanced, monoplane, or lingualized).
5. Positioning for Esthetics
- Definition: Positioning for esthetics involves arranging the teeth in a way that enhances the patient's facial appearance and smile.
- Considerations:
- The arrangement should consider the patient's age, gender, and facial features to create a natural and pleasing appearance.
- The size, shape, and color of the teeth should be selected to match the patient's natural dentition and facial characteristics.
- Proper positioning for esthetics not only improves the appearance of the dentures but also boosts the patient's confidence and satisfaction with their prosthesis.
Bevels are the angulation which is made by 2 surfaces of a
prepared tooth which is other than 90 degrees. Bevels are given at various
angles depending on the type of material used for restoration and the purpose
the material serves.
Any abrupt incline between the 2 surfaces of a prepared tooth or between the
cavity wall and the Cavo surface margins in the prepared cavity
Bevels are the variations which are created during tooth preparation or cavity
preparation to help in increased retention and to prevent marginal leakage.
It is seen that in Bevels Occlusal cavosurface margin needs to be 40 degrees
which seals and protects enamel margins from leakage and the Gingival Cavo
surface margin should be 30 degrees to remove the unsupported enamel rods and
produce a sliding fit or lap joint useful in burnishing gold.
Types or Classification of Bevels based on the Surface they are placed
on:
Classification of Bevels based on the two factors – Based on the shape and
tissue surface involved and Based on the surface they are placed on –
Based on the shape and tissue surface involved:
1. Partial or Ultra short bevel
2. Short Bevel
3. Long Bevel
4. Full Bevel
5. Counter Bevel
6. Reverse / Minnesota Bevel
Partial or Ultra Short Bevel:
Beveling which involves less than 2/3rd of the Enamel thickness. This is not
used in Cast restorations except to trim unsupported enamel rods from the cavity
borders.
Short Bevel:
Entire enamel wall is included in this type of Bevel without involving the
Dentin. This bevel is used mostly with Class I alloys specially for type 1 and
2. It is used in Cast Gold restoration
Long Bevel:
Entire Enamel and 1/2 Dentin is included in the Bevel preparation. Long Bevel is
most frequently used bevel for the first 3 classes of Cast metals. Internal
boxed- up resistance and retention features of the preparation are preserved
with Long Bevel.
Full Bevel:
Complete Enamel and Dentinal walls of the cavity wall or floor are included in
this Bevel. It is well reproduced by all four classes of cast alloys, internal
resistance and retention features are lost in full bevel. Its use is avoided
except in cases where it is impossible to use any other form of bevel .
Counter Bevel:
It is used only when capping cusps to protect and support them, opposite to an
axial cavity wall , on the facial or lingual surface of the tooth, which will
have a gingival inclination facially or lingually.
There is another type of Bevel called the Minnesota Bevel or the Reverse Bevel,
this bevel as the name suggest is opposite to what the normal bevel is and it is
mainly used to improve retention in any cavity preparation
If we do not use functional Cusp Bevel –
1. It Can cause a thin area or perforation of the restoration borders
2. May result in over contouring and poor occlusion
3. Over inclination of the buccal surface will destroy excessive tooth structure
reducing retention
Based on the surface they are placed on:
1. Gingival bevel
2. Hollow ground bevel
3. Occlusal bevel or Functional cusp bevel
Gingival bevel:
1. Removal of Unsupported Enamel Rods.
2. Bevel results in 30° angle at the gingival margin that is burnishable because
of its angular design.
3. A lap sliding fit is produced at the gingival margin which help in improving
the fit of casting in this region.
4. Inlay preparations include of two types of bevel Occlusal bevel Gingival
bevel
Hollow Ground (concave) Bevel: Hollow ground bevel allows more
space for bulk of cast metal, a design feature needed in special preparations to
improve material’s castability retention and better resistance to stresses.
These bevels are ideal for class IV and V cast materials. This is actually an
exaggerated chamfer or a concave beveled shoulder which involves teeth greater
than chamfer and less than a beveled shoulder. The buccal slopes of the lingual
cusps and the lingual slope of the buccal cusps should be hollow ground to a
depth of at least 1 mm.
Occlusal Bevel:
1. Bevels satisfy the requirements for ideal cavity walls.
2. They are the flexible extensions of a cavity preparation , allowing the
inclusion of surface defects , supplementary grooves , or other areas on the
tooth surface.
3. Bevels require minimum tooth involvement and do not sacrifice the resistance
and retention for the restoration
4. Bevels create obtuse-angled marginal tooth structure, which is bulkiest and
the strongest configuration of any marginal tooth anatomy, and produce an acute
angled marginal cast alloy substance which allows smooth burnishing for alloy.
Functional cusp Bevel:
An integral part of occlusal reduction is the functional cusp bevel. A wide
bevel placed on the functional cusp provides space for an adequate bulk of metal
in an area of heavy occlusal contact.
→ Following rules should be considered to classify partially edentulous
arches, based on Kennedy's classification.
Rule 1:
→ Classification should follow, rather than precede extraction, that might
alter the original classification.
Rule 2:
→ If 3rd molar is missing and not to be replaced, it is not
considered in classification.
Rule 3:
→ If the 3rd molar is present and is to be used as an abutment, it
is considered in classification.
Rule 4:
→ If second molar is missing and is not to be replaced, it is not
considered in classification.
Rule 5:
→ The most posterior edentulous area or areas always determine the
classification.
Rule 6:
→ Edentulous areas other than those, which determine the classification are
referred as modification spaces and are designated by their number.
Rule 7:
→ The extent of modification is not considered, only the number of additional
edentulous areas are taken into consideration (i.e. no. of teeth missing in
modification spaces are not considered, only no. of additional edentulous spaces
are considered).
Rule 8:
→ There can be no modification areas in class IV.