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Occlusion and function

Considerations are the finish line: supra, sub, equigingival

And the factors are hygiene, aesthetic zone, functional lip line, caries experience
If someone has caries, dont have it subgingival, because its not good for cleaning
Measure the free gingival sulcus depth of the sulcus, if you have enough, you can do a
subgingival margin
The best fit is metal to chamfer
Ceramic: you want to have a shoulder finish line, thickness of ceramic, mixing the
powder with liquid
Pressing ceramic, you want a rounded internal line angle for chamfer FL
Avoid acrylic partial dentures when you want to use an implant, b/c the bone resorbs,
because you dont want to load the saddle area
Cold cured dentures: monomer causes tissue inflamm, and there is a smell from the
monomer vs. heat cure: very porous, not durable, irritant to tissue if it is worn too long,
tissue needs to be rested
o We use cold cures for a temporary measure and for repairs
o If you are repairing a denture you can use cold cure
We only use mesh when you think you have to realign
Teeth have eruption potential
o Mandibular and maxillary? Posterior teeth have a greater eruption potential
because there is a mesial force on the teeth
o Maxillary teeth are due to over eruption due to gravity, significance is the
occlusal plane is disrupted
o Have to establish occlusal plane, with enameloplasty or removing the tooth
o Disruption in occlusal plane is in dynamic occlusion, not MIP
Tilting teeth, makes guide planes and rest seats more complicated
Mandibular teeth tend to tilt mesially, and maxillary teeth tend to tilt mesially-palatal,
which can lead to an problem with the rest seat prep, because the rest seat can be on
the occlusal surface
Significance of parafunction in pxs with PFM
o If you have tooth wear, use metal and it is kinder to opposing dentition than the
ceramics is
o Metal is more durable when withstanding wear
o Px would need a nightguard, and consciousness of daytime grinding
o Placement of positioning is you want it to be in enamel
40% of teeth with pins can become non-vital and can lead to stress in tooth
1st thing to check is check the proximal contacts, the teeth get abraded the opposing
dentition and parallelism of abutment teeth
when considering pontics?
o Aesthetics: coming out of the tissue, sufficient interdental space, connector
design-thickness and thinness-to give an occlusal and gingival embrasure
If you have 2 abutment teeth, unless they have the same retention, same Root surface
area, then one tooth will have more loaded than the other
Every bridge flexes, which creates stress on the least supported tooth
Free end saddle is supported by tissue, if the saddle area moves in a tissueward, the
distal abutment tooth will move distally b/c of differential mobility, it goes from 5-5 to
4-4 and it stops at 3-3 because the canines can withstand mobility
Discs rarely reposition distally. Antero-medially displacement is very common, and distal
displacements are very rare
o Late on opening and late on closing
o If initial displacement is trauma, or yawn, it can be painful b/c the bilaminar
tissue is highly innervated and vascular
o Clicking doesnt cause pxs any discomfort
o Lubrication of the fluid
o Steroid injections immediate relief, but you can get scarring
Concept of dahl is to use overruption of posterior teeth to your advtg
o Pxs with no teeth, have occlusal vertical dimension
o But f you have parafunction, you lose vertical dimension, your chin will get closer
to the nose,
o If you want to reestablish vertical dimension, you can make a bite block with a
splint, or but up resin paltally with anterior teeth have a higher end-stop than
the posterior teeth
Tx of overrupted teeth
o Rectangular wires for ortho
Trailing edge? Leading edge?
If its a psychological problem
o Continually relapsing
o Bulimia erodes the palatal of anterior teeth
Class 2 div 2: lower incisors went to the palate, and the ?????
Arch, form symmetry, embrasure, (intra-arch)
Interarch (horizontal, vertical overlap, occlusal plane)
Cast restorations as an abutment for rpd?
o Guide planes
o Rest seat
o Mill rest
You can put RPD components into crown even tho the px doesnt want a denture, b/c
they can change their mind
clasp can break through work-hardening, contour the cervical portion of the tooth until
the clasp is 0.25,
predict if the px can open their mouth for the whole treatment, dont be halfway
through and the px cannot open it
common reason for mouth locking, the condyle moves in front of the eminence, it is
more likely with pple who are hyper-flexible, and can get very distressed
need to move mandible downwards, if you have mouth locking, but if you have inter-
masseter spasm, you wont be able to do it
problem 1: concept of transitioning people to partial to full edentulous teeth, man
responded well to tx, and if you say to someone.some people cannot wear dentures,
replace missing teeth with partial dentures? Make a impression with denture in the
mouth, extract the tooth, and put the denture in immediately and wear it for 24 hrs,
and it will be useful pain control. Dont extract the tooth in the morning and fit the
denture in the afternoon, b/c the area will be very sore..warn them that there will be
blood. Allow teeth to be lost.
o tell them that the denture will not be comfortable
o 3-6 weeks for tissues to heal, to allow for speech,
problem 2: has to do with overactivity. If you have a dislocation without reduction the
mandible will deviate to that side and stay there. If you have a dislocation with
reduction it will click and move in the midline. Chronic TMD, habitual mvmts are too
short to diagnose, so you have to use commanded mvmts
problem 3: concept of eliminating deflective path. No evidence that occlusal
equilibration will treat joint dysfunction. You dont have to have coincident mip and
cmmr to have a healthy dentition
problem 4: no implants because of proximity to ID nerve, and not enough bone. Tipping
of the molars. Using rpd to stabilize inter-arch and intra-arch. chrome overlay on the
molars. Acrylic isnt a opton b/c it will cause too much damage . you will have food
impactation, because the undercuts will be blocked out
problem 5: acrylic dentures dont blockout, if a denture has been made in undercuts, if
you adust it a lot, then the denture will not be . master cast should be copied, and the
denture has to fit the master cast. Clasps can be placed on acrylic.
o Divided it into clinic vs. lab mistakes
o Problem with impression, pouring off cast, synergisis, imbition
o Copying of the cast: not blocked out, use silicone instead of agar
o Polishing
Always go from simple to
Problem 6: history exam special tests to make a diagnosis.
Crown in your hand, the history of the tooth, she probably fell off a bike, and it was
exposed to crown, and they didnt assess the remaining tooth structure. Resin is bonded
to enamel and dentine
o Take some GP, parapost, aluminium post, drill out dentine and enamel, and
aluminum post can be cemented with SNAP
o Long term: depends on length of root, ortho extrude, crown lengthening, high
smile line, implant