1. Prosthetic treatment of the edentulous patient. Fourth edition. R.Basker, J.Davenport. Blackwell. 2002 – 316 p.
2. Complete Denture. Manual. Robert W. Loney, DMD, MS. 2009.- 99 p.
ORGANIZATIONAL STRUCTURE OF THE practical CLASSES
(Implementation of practical class plan):
At the beginning of the class a teacher calls the register and designates a student on duty, names the topic and purpose of the class, finds out unclear questions, which appeared during independent work of students.
Then the teacher analyzes subject questions, tasks of students’ research work and methods of practicing skills in accordance with the methodologic instruction, by means of actively questioning all students of the group.
The teacher is guided by the extent of knowledge obtained by the students during their independently studying the material in the textbooks, lecture notes and methodologic instructions, as well as preparing students’ research work in the albums for independent work.
Besides, the teacher can choose to check the hometask in oral or written form, as well as in mixed and oral-and-written form. The teacher can use situational tasks and test questions in addition to routine subject questions.
Having controlled the students’ knowledge for the class, the teacher demonstrates to the students methods of preparation and obtaining of a print thermoplastic impression material.
After the demonstration the students start to independently train practical skills on each other under supervision of a senior laboratory assistant or the teacher.
At the end of the class the teacher gives marks for oral answer or written work, for independent students’ work, signs the protocol of the laboratory work, as well as names the next topic and questions for study.
Patient Assessment and Treatment Planning
Treating the edentulous patient is both a complex and rewarding clinical challenge that demands skill and knowledge.
The homeostasis characterizing the healthy masticatory system depends on the dynamic relationship between dental occlusion, masticatory musculature, and the temporomandibular joints. In the edentulous patient, this balance can only be reestablished when the patient’s anatomy, muscular capabilities, esthetics, and expectations are in harmony.
As with any dental treatment, the medical/health history provides information vital to planning appropriate treatment and completing successful therapy. Knowledge of disease states, medication, and previous dental therapies will provide insights indispensable for optimizing the course and enhancing the likelihood for successful treatment.
By tailoring his/her interpersonal approach according to each patient’s characteristics, the successful dentist can address each patient’s needs appropriately. The focus of complete denture therapy may be more directed toward esthetic considerations for one patient and more on function for another. Some patients are not interested in knowing the exact techniques to be used, while others want to follow every detail of each procedure. The patient interview is essential for identifying the expectations, misconceptions, personality traits, and socioeconomic circumstances that will uniquely predict each patient’s reaction to care. The phrase, “Never treat a stranger,” embodies an important concept in dental treatment, particularly for complete denture prosthodontics. Comprehensive patient care for the complete denture patient includes an assessment of the psychologic and physical conditions identified in the patient history as well as the oral and orofacial considerations on which the treatment efforts will be focused. Testing for functional disturbances is necessary to identify those patients likely to experience special needs.
The patient should be instructed to perform the following movements:
• Extend the tongue
• Move the tongue from side to side while extended
• Lick the lips
• Open wide
• Protrude the mandible
• Move the mandible from side to side
Hesitation or incorrect action in following any of these directions can signal potential challenges in treatment and treatment outcomes. Often an inability to perform these normal oral functions may confirm a medical condition highlighted in the medical/health history (e.g., stroke).
An inspection of the patient’s existing denture, in combination with patient comments about the appliance’s fit, function, appearance, etc., provides critical information on patient expectations for the new dentures.
Examination of the patient
Extra-oral examination of the patient
Simply by talking to the patient and making careful observations at the same time, the dentist may obtain important information that will help in treatment planning:
(1) Discrepancy between actual and biological ages. Any discrepancy between the actual age and biological age should be noted as this can be important in assessing the likely adaptive capability.
(2) Skeletal relationship. The skeletal relationship of the patient should be assessed because this will indicate the appropriate incisal relationship of the planned dentures.
(3) Occlusal vertical dimension. The facial appearance provides valuable information about the occlusal vertical dimension of existing dentures. If loss of occlusal vertical dimension is noted, correction may be required before new dentures are started.
(4) Dental appearance. If the patient already has dentures, the dental appearance should be evaluated at this stage of the examination. It is particularly important that the appearance of the dentures is assessed during speaking and smiling. Features such as inadequate lip support or poor appearance of the anterior teeth should be noted. If the
patient has a complaint regarding the appearance of the current dentures it is essential that the details are carefully recorded when obtaining the history of the complaint.
(5) Extra-oral lesions. Inflammation and fissuring at the corners of the mouth (angular stomatitis) may be present; the significance and treatment of this condition.
(6) Intolerance or other difficulties with the dentures. While the patient is speaking it may be possible to detect any obvious looseness of dentures, or whether the patient is having difficulty in controlling the prostheses.
Intra-oral examination of the patient
The broad objectives of this part of the examination are to determine:
• Whether there is any pathology in the mouth;
• What the prospects are for the new dentures providing a satisfactory level of comfort and function.
Residual Ridge Form
Ideal residual ridge characteristics include:
• Healthy attached keratinized mucosa of even thickness
• No bony spicules, sharp ridges or undercuts
• No muscle attachments or frena in critical areas; frena attach to the ridge closer to the base than to the crest
• No scars or mucosal hypertrophies
• Prominent residual bone
• Rounded ridge crest
• Slightly tapered labial, buccal and lingual sides
• Distinct vestibules buccal and facial of both ridges; distinct retromylohyoid vestibule for lower ridge
It may be necessary to take radiographs, organise blood tests, arrange for microbiological examination of swabs or smears, or to carry out diagnostic modifications of existing dentures.
The Radiographic Survey
Evaluation of a recent panoramic radiograph is recommended prior to initiating care of an edentulous patient. Conditions to look for include: residual root tips, impacted teeth, cysts, or other pathologic conditions.
Changes to alveolar bone occur following the extraction of teeth. The edentulous patient will likely display diminished alveolar bone volume and notable changes in ridge morphology. A consistent finding in the edentulous population is that the volume of residual ridge decreases over time. The decrease is most dramatic in the first weeks and months immediately following removal of teeth but continues at a variable but diminishing rate for the rest of the lifetime. The mandible is more severely affected than the maxilla. Many factors affect ridge resorption including local and systemic biochemical factors and load or physical factors.