口腔学英文课件：Complete dentures

1、Complete dentures,Edentulous jaws,There are not any natural tooth and root of tooth on the dental arch,Complete dentures is mucosa support denture.,character,1、Caries 2、periodontal disease 3、General disease、injury,Cause of disease,1、caries,Cause of disease,2、periodontal disease,Cause of disease,3、tr

2、auma and tumor Cyst of jaws,Cause of disease,1.Old people is more than the other people 2.Woman man 3.maxilla mandible Spongy substance of bonescortex of bone,Disease incidence,patients face、chewing function，and hurting alveolar ridge、mucosa、TMJ、masseter（咬肌） . social contact 、psychological(confidenc

3、e),influence,Chapter 1,Definitions: Complete dentures are the prosthesis of maxilla mandible or maxilla and mandible with edentulous.,Chapter 1,Edentulous is all teeth deficiency of maxilla、mandible or maxilla and mandible.,Definition,Edentulous,Chapter 1,If it is only edentulous of maxilla or mandi

4、ble, so it is respectively named : maxilla complete denture mandible complete denture,Definition,maxilla complete denture,mandible complete denture,edentulous,Complete dentures,Denture base plate Artificial teeth,composition,Occlusal surface tissue surface,composition,Hard tissue Soft tissue,Tissue

5、change,Alveolar ridge resorption,Tissue change,Three months 15% Six months Remarkable decrease Two years Incline to stable 0.5mm,Tissue change,Tissue change,Maxilla : cortex inner side mandible: cortex outer side Cortexspongy,Mx alveolar ridge:inner and upward Md:outer and downward,Maxilla archmandi

6、ble arch,Degree of resorption classification,Four grades(according to shape of alveolar ridge) 一、alveolar ridge is less absorption , have certain altitude and width、plump 二、altitude is decrease , width is remarkable narrow, forming edge shape 三、altitude is remarkable decrease , ridge is low and flat

7、ter 四、absorption is reach base bone , shaping pitting (凹陷）at posterior part,Degree of resorption classification,Soft tissue,Tissue change,Soft tissue,Vestibular（前庭） become shallow，frenum location change,Soft tissue,Skin relax body of tongue,Magnetic attachment,Improve retentive force,Master the defi

8、nition of complete dentures Master the regularity of alveolar ridge absorption Comprehend degree of alveolar ridge absorption,summary,Question,1、what is the compose of the complete denture? 2、why is the resorption rate of maxilla more than that of mandible？ 3、when is the resorption rate of alveolar

9、most quickly after removing tooth? 4、when is the resorption rate incline to stable?,Chatper 2,Anatomical marker and physiological function of edentulous,Chatper 2,一、 Anatomical marker of maxilla and mandible （一）alveolar ridge （二）vestibule of mouth （三）mouth cavity proper,（一）alveolar ridge,Alveola pro

10、cess is gradually absorbed and reconstructed Mucosa layer is keratinized squamous epithelium,（一）alveolar ridge,Submucous layer is joined together periosteum, so it is beared great chewing force,（二）oral vestibule,maxilla labial frenum (唇系带） buccal frenum（颊系带） zygomatic process （颧突） maxillary tuberosi

11、ty（上颌结节）,（二）oral vestibule,Labial frenum,（二）oral vestibule,（二）oral vestibule,Buccal frenum,（二）oral vestibule,（二）oral vestibule,（二）oral vestibule,mandible labial frenum （唇系带） buccal frenum （颊系带） buccal flange area（颊侧翼缘区） distobuccal angle area（远中颊角区）,（二）oral vestibule,BFA,（二）oral vestibule,Buccal fla

12、nge area: stress-bearing 、thick cortex denture fabrication Alveola ridge: thin cortex、thick spongy 、 BAA: front of masseter(咬肌）no excess extension,Buccal angle area,（三）mouth cavity proper,maxilla 1、incisive papilla (切牙乳突） 2、palatal ruga （腭皱） 3、Palatine protuberance（腭隆突）,（三）mouth cavity proper,maxill

13、a 4、palatine fovea（腭小凹） 5、vibrating line（颤动线） 6、pterygomaxillary notch（翼上颌切迹）,（三）mouth cavity proper,Palatal ruge,Incisive papilla,Palatine protubrance,Mid-palatal suture,（三）mouth cavity proper,Incisive papilla is located on palatal side between the two central incisors,through which the incisive ne

14、rve and blood vessels, so the denture need be carefully taken to relieve pressure in this area. Wax rim、arrangement tooth,（三）mouth cavity proper,Palatine protuberance: this area mucosa is very thin and protuberane is very rigid ,any pressure can cause pain,so the denture need be carefully taken to r

15、elieve pressure in this area,（三）mouth cavity proper,Palatine fovea,pterygomaxillary notch,（三）mouth cavity proper,Palate fovea are two depressions that lie bilateral to the midline of the palate,at the approximate junction between the soft and hard palate.they are often useful in the identification o

16、f the vibrating line because they generally occur within 2mm of the vibrating line.,Palatine fovea,（三）mouth cavity proper,Important feature、junction between the hard and soft palates、extent of the posterior palatal seal area,vibrating line,（三）mouth cavity proper,Is located distal to the maxillary tu

17、berosity.this notch is a key clinical mark in maxillary denture because the maximum posterior extent of the denture is the vibrating line that runs bilaterally through the notches.,pterygomaxillary notch,1、labial frenum (唇系带） 2、buccal frenum（颊系带） 3、 zygomatic process （颧突） 4、maxillary tuberosity（上颌结节

18、） 5、incisive papilla (切牙乳突） 6、palatal ruga （腭皱） 7、Palatine protuberance（腭隆突) 8、palatine fovea（腭小凹） 9、vibrating line（颤动线） 10、pterygomaxillary notch（翼上颌切迹）,1,2,3,4,5,6,7,8,9,10,（三）mouth cavity proper,mandible 1.lingual frenum（舌系带） 2.Sublingual gland（舌下腺） 3.Torus mandibularis（下颌隆突）,（三）mouth cavity prop

19、er,mandible 5.Mylohyoid ridge （下颌舌骨嵴） 6.lingual flange area (舌侧翼缘区） 7.Retromolar pad （磨牙后垫）,（三）mouth cavity proper,Torus mandibularis,lingual frenum,Retromolar pad,Sublingual gland,（三）mouth cavity proper,Mylohyoid ridge,（三）mouth cavity proper,Retromolar pad :it should be covered by denture.because i

20、ts location is stability,so it is an important mark of denture construction for the plane of occlusion standpoint and arrangement teeth.,（三）mouth cavity proper,1、labial frenum （唇系带） 2、buccal frenum （颊系带） 3、buccal flange area（颊侧翼缘区） 4、distobuccal angle area（远中颊角区） 5、lingual frenum（舌系带） 6、Sublingual g

21、land（舌下腺） 7、Torus mandibularis（下颌隆突） 8、Mylohyoid ridge （下颌舌骨嵴） 9、lingual flange area (舌侧翼缘区） 10、Retromolar pad （磨牙后垫）,1,2,3,4,5,6,7,7,8,9,10,Questions,1、why is the incisal papilla a good mark to note when making occlusion rims and arrangement teeth? 2、what structure is located distal to the last man

22、dibular molar and why is it important in the making of complete denture? 3、what is the different between the labial frenum and the buccal frenum? 4、why is the location of the palatine fovea important to note in the edentulous patient?,Chapter 3,The first section Subregion of edentulous jaw,1、labial

23、frenum (唇系带） 2、buccal frenum（颊系带） 3、 zygomatic process （颧突） 4、maxillary tuberosity（上颌结节） 5、incisive papilla (切牙乳突） 6、palatal ruga （腭皱） 7、Palatine protuberance（腭隆突) 8、palatine fovea（腭小凹） 9、vibrating line（颤动线） 10、pterygomaxillary notch（翼上颌切迹）,1,2,3,4,5,6,7,8,9,10,（三）mouth cavity proper,1、labial frenum

24、 （唇系带） 2、buccal frenum （颊系带） 3、buccal flange area（颊侧翼缘区） 4、distobuccal angle area（远中颊角区） 5、lingual frenum（舌系带） 6、Sublingual gland（舌下腺） 7、Torus mandibularis（下颌隆突） 8、Mylohyoid ridge （下颌舌骨嵴） 9、lingual flange area (舌侧翼缘区） 10、Retromolar pad （磨牙后垫）,1,2,3,4,5,6,7,7,8,9,10,（三）mouth cavity proper,Mylohyoid r

25、idge,Chapter 3,（一）primary stress bearing area(主承托区) （二）axillary stress bearing area(副承托区) （三）border seal area (边缘封闭区) （四）relief area (缓冲区),（一）primary stress bearing area,Alveolar ridge of maxilla and mandible Keratinize squamous epithelium, submucosa is dense Bearing chewing pressure Denture base is

26、 contact tightly with mucosa, primary stress bearing area(主承托区),（二）secondary stress bearing area,Labio-buccal and glosso-palatine of alveolar ridge(except hard area) Submucosa is loose, full of fat、gland and muscle attachment Can not bearing major chewing pressure Denture base is contact tightly wit

27、h mucosa, secondary stress bearing area(副承托区),（三）border seal area,Soft tissue part of denture margin contact mucosa duplicature、frenum attachment postdam area、retromolar pad large loose connective tissue Can not bearing chewing pressure Denture base is contact tightly with mucosa margin seal, border

28、 seal area (边缘封闭区),（四）relief area,Palatine protuberance（上颌隆突）、 zygomatic process （颧突）、 buccal of maxillary tuberosity（上颌结节颊侧）、 incisive papilla (切牙乳突）、 Torus mandibularis（下颌隆突）、 Mylohyoid ridge （下颌舌骨嵴）、bony tip and spur of alveolar ridge(骨尖、骨刺） Mucosa which covering protuberance is very thin( incisi

29、ve papilla 切牙乳突） Not bearing chewing pressure , it is easy to result in pressing pain and shaping supporting point Tissue surface of base need buffer at these position for reducing pain, primary stress bearing area(主承托区) secondary stress bearing area(副承托区), border seal area (边缘封闭区) relief area (缓冲区)

30、,The second section,Space and surface of complete dentures,tissue,occlusal,polished,space,tissue surface is the surface of denture base contact with tissue mucosa it must adaptation with mucosa , there are adsorption affinity and atmosphere pressure between the both sides for dentures retention,occl

31、usal surface： Is the surface of artificial teeth occlusion, it conduct occlusal force to supporting tissue. In order to keeping denture stabilization, occlusal force must effect on denture vertically, reducing lateral force.,polishing surfce is the surface of dentures contact with lip、buccal and ton

32、gue, for concavity .when the shape of polishing surface and the position of artificial teeth are correct, the function of lip、buccal、tongue muscle is help for retention and stabilization,中性区 Neutral zone,The third section,Retention and stabilization of complete dentures,The third section,Retention（固

33、位）: The quality of a denture that resists movement of the denture away from the tissues Stabilization（稳定）: The quality of a denture that resists movement of the denture in a horizontal direction,一、retention theory,1、adsorption force（吸附力）： The mutual attraction between two object molecule tissue surf

34、ace-spit spit-mucosa adhesive force:the different object molecule cohesion:the same object molecule spit interior Adsorption force is concern with base area、 adaptation and spit quality（viscosity),一、retention theory,2、atmosphere pressure border seal negative pressure precondition,A and B is differ f

35、rom ten times,一、retention theory,3、surface tension: The resistance when separating two parallel faces which adsorption together through liquid film,二、The factor of influence retention and stabilization,（一）the factor of influence retention 1、anatomic form of jaw bone base area dental arch widenarrow

36、alveolar ridge tall、widelow、narrow frenum attachment talllow,（一）the factor of influence retention,2、quality of mucosa thickness is suitable elasticity（弹性） and ductility（韧性）excessive thin, no elasticity,（一）the factor of influence retention,3、base plate adaptation（密合） extend scope: under not hampering

37、 function movable of around tissue, to greatest extend the base plate thickness and shape of border is the same as mucosa plica（粘膜皱襞） border seal,（一）the factor of influence retention,4、the quality of spit viscosityflowability highlow salivation normaltoo much or too little,（二）the factor of influence

38、 stabilization,1、anatomic form of jaw bone dental arch widenarrow alveolar ridge tall、widelow、narrow palatal top tall archflatness,（二）the factor of influence stabilization,2、shape of polishing surface border extend normalexcessive extend shape concavityconvexity relief area supporting point,Artifiti

39、al teeth must arrange at neutral region, can not hamper muscle movement,Questions,1、How many areas are there at the complete dentures? and what are these respectively? 2、what is the retention theory of complete denture? 3、what are the anatomic mark of relief area? 4、what is the function of border se

40、al area? 5、where should be the artificial teeth arranged at?,The fourth section,pre-prosthetic preparation,一、communicate with the patient,1、subjective demands 2、past treatment history 3、general condition 4、psychologic status,1、subjective demands, expectancyprosthesis effect comprehendtreatment cours

41、e the prices the effect,2、past treatment history, edentulous reasons periodontal disease、caries、injury edentulous time how long prosthesis history types(removable or fixed)、how long effect,3、general condition, disease: xerostomia endocrine disturbance: osteoporosis diabetes brain injury add ages cha

42、nge alveolar ridge shrink tissue sensitive regulating ability is bad,4、psychologic status,optimistic、patience、 positive、open-minded Voluntarily adapt,sensitive、lack patience、 suspicious、unconcerned Not adapt,4、psychologic status, comprehend the purpose、process and result of prosthesis building well

43、doctor-patient relationship inform the process of prosthesis and prognosis,二、oral examination,1、maxillofacial region form: bilateral symmetry proportion coordinate upper lip fullness upper lip length facial form mandibular movement TMJ: pain、snap,2、alveolar ridge evenness： tooth extraction wound bon

44、e cusp bone protuberance tissue undercut,Shape of alveolar ridge,fullness,flatness,knife-edge shape,3、jaw arch,Mandibular protrusion,normal,Maxillary protrusion,4. Palatal top,5、attachment position of muscle and frenum,Distance between the attachment position and alveolar ridge crest Retention and s

45、tabilization,6、position and form of tongue,Tongue large tongue retraction,7、oral mucosa character: thick or thin、loose or dense pathologic change: congestion（充血）、edema(水肿） ulcer（溃疡）、hyperplasia（增生） 8、spit excrete more or little thin or thick,Denture stomatitis （义齿性口炎）,Mucosa hyperplasia （黏膜增生）,9、old

46、 denture examine, adaptation jaw position relation: centric relation、vertical distance occlusion: artificial teeth position damage condition: fracture、defect、attrition,三、pre-prosthesis surgery manage,Bone cusp,三、pre-prosthesis surgery manage,下颌隆突,三、pre-prosthesis surgery manage,Excision hyperplasia

47、tissue,三、pre-prosthesis surgery manage,Oral mucosa： 1、stop wear 2、treatment,Denture stomatitis,四、implanted complete denture,1、price、process 2、oral condition,Question,What will be prepared before prosthesis of complete denture?,The fifth section,Making complete dentures,全口义齿的印模技术 Impression of comple

48、te denture,什么是印模？ Whats Impression?,Silicone rubber impression,Alginate impression,印模的分类 Impression Classification,Once impression,Twice impression,Method of twice impression,一、primary impression,materials,1.Selecting tray,2.Coating adhesive,3.Spatulation impression,4.Placing material on the tray,5.

49、Taking primary impression,no bubble edge is smooth and continue,6.examine,avoid bubble override edge ensure thickness of foundation,7.Casting plaster model,8. Plaster model,二、making individual tray,1. light-cured resin individual tray,1. light-cured resin individual tray,2. self-solidifying resin tr

50、ay,2. self-solidifying resin tray,3、final impression,Examine tray border,Frenum movable,Examine maxillary tuberosity,Silicon rubber impression,Padding,massage cheek bite lip traction mouth and cheek tongue tip scroll moving tongue from side to side,Muscle function trimming,finished final impression完

51、成的终印模,Cut out spare material,Disinfection,Perfusion final cast,Why will proceed to recording and transferring maxillomandibular relations?,The sixth section Maxillomandibular relation record,一、concept 二、contents 三、manufacture,Stable reference jaw-position, central occlusion ( intercuspal position) a

52、nterior teeth is normal overbite and overlay, the cusp and fossa of posterior teeth is interlace. centric relation position It is physiology retroposition that the mandibular condyle is located the middle of articular fossa and inclined to back, meanwhile around tissue is not confined.,Stable refere

53、nce jaw-position,The relation between central occlusion and centric relation position : central occlusion is located the front 1mm of centric relation position or the two is accordance,Stable reference jaw-position,After edentulous， central occlusion have lost， mandibular is moving at any position b

54、ecause of without supporting of denture and locked occlusion of teeth .It is common that mandibular protract and the distance of one third below the face is shorten. centric relation position is unique and stable reference position.,Maxillomandibular relation record,一、concept Using the record base t

55、o confirming the dimension of one third below the face and centric relation position, in order to rebuilding central occlusion relation of edentulous patient with complete dentures,Maxillomandibular relation record,二、contents （一）vertical jaw relation （二）horizontal jaw relation,（一）vertical jaw relati

56、on,Vertical dimension distance of one third below the face Intermaxillary dimension distance between alveolar ridge crest,Method of determining vertical dimension,1、interocclusal distance method 2、facial equidistance measurement 3、facial apperance observational method 4、pre-extraction record 5、old d

57、enture reference,1、interocclusal distance method,vertical dimension(O.V) postural vertical dimension (R.V) interocclusal distance (F.S) 2mm,2、facial equidistance measurement,Vertical dimension is approximately the distance that from pupil to oral fissure,3、facial apperance observational method,Upper

58、 and lower lips are close naturally Oral fissure is straightness Corner of the mouth is not droop 4. The depth of nasolabial groove and mentolabial groove is suitable,4、pre-extraction record,Periodontal disease,5、old denture reference,What is the clinical manifestation if the vertical dimension has

59、recovered mistake?,Recover overtop,mentolabial groove shallow Upper and lower lip is open Muscle is easy tense and tiredness Alveolar ridge will bear pressure Interocclusal distance is undersize Dentures occur crash when speaking,Recover too low,Expression is aged, mandibular is obviously protrusion Nasol