Novak Djokovic

2012/03/12 Complete Denture ProsthodonticsMaking Edentulous Maxillary Impression KGCHING Owner1

Making Endentulous Maxillary Impression----------------------------------------------3 Factors of Retention of Dentures-----------------------------------------------------------5 Landmarks of the maxillary impression------------------------------------------------12 -Facial Expression Musculature--------------------------------------------------------------14 -Labial Frenum-------------------------------------------------------------------------------------16 -Buccal Frenum------------------------------------------------------------------------------------18 -Buccal Vestibular Area--------------------------------------------------------------------------19 -Buccal Space(Distobuccal border)-----------------------------------------------------------21 -Posterior Border Area---------------------------------------------------------------------------25 -Pterygomandibular raphe-------------------------------------------------------------------27 -Hamular Notch---------------------------------------------------------------------------------28 -Ah-line-------------------------------------------------------------------------------------------29 -House M M---------------------------------------------------------------------------------------32 -------------------------------------------------------------------------------------------33 -Levin B--------------------------------------------------------------------------------------------34 Posterior Palatal Seal ------------------------------------------------34 Polymerization shrinkage of posterior of maxillary denture bases-----------40 Relief Area------------------------------------------------------------------------------------------46

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Making Edentulous Maxillary Impression

I. landmark D96 (edentulous state)()

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landmark

I. ridge II. jaw relationship( vertical horizontal) D96 I. jaw relationship face-bow transfer mounting centric relation record mounting () II. ( curve) III.( denture base ) 4

Factors of Retention of Dentures retention suction effect --- atmospheric pressure Oral and facial musculature Adhesive & Cohesion Reciprocal stability Gravity I. suction effect () D96 ( ) (fit) II. III. IV. V. ()

Retentive Force

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Dynamic retention of two platessurface tensio n diameter of plate distance between plates contact angle

viscosity speed to remove

Iida Y,1975 retention force Retention factors I. h( plate )( fit)retention II. a(plate )retention III. (viscosity)()retention

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Retention Force < < Tragacanth gum() < I. viscosity retention force II. viscocity retention force III.(xerostomia)

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% 8 00 w ith o u t s a liv a7 00 6 00 5 004 6 4 .1 7 62 .7

w ith s a liv a

4 00 3 00 2 00 1 00 01 00 3 0 8 .5

s a liv a o n ly p o w d e r

p a s te

c u s h io n

denture adhesive retention Factors of Retention of Dentures. I. Atmospheric pressure

I. ,( ) II. buccal 35mm III. muscle trimmer

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IV. mesial lateral ()

II. Oral and facial musculatureI. II.

neutral zone

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III. Undercut

1. Maxilla tuberosityundercut

I. undercut retention force maxilla tuberositymaxilla tuberosity undercut tuberosity undercut tuberosity retention

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: Maxilla tuberosity : Maxilla tuberosity denture tuberosity undercut retention force : Maxilla tuberosity () : Maxilla tuberosity osteoplasty denture 2.

Retromylohyoid fossa

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I. Retromylohyoid fossa maxilla tuberosity Retromylohyoid fossa undercut retention force undercut II. 1. Buccal/cheek lingual 2. IV. Reciprocal Stability

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II. () reciprocal stability III. reciprocal stability simultaneous contact (balanced occlusion) D96 I. II. III. group function occlusion balanced occlusion occlusion IV. complete denture balanced occlusion I.

V. Gravity

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SUMMARYTo be most effective in providing retention: Denture bases must be properly extended to cover the maximum area possible without interfering with the health and function of the structures that surrund the denture. The occlusal plane must be at the correct level and the occlusion must be well arranged. The arch form of the teeth must be in the neutral zone between the tongue and cheeks. I. Denture base II. III. Arch form neutral zone

Landmarks of the maxillary impression landmark

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incisive papillamedian palatine raphe (suture)

incisive foramen palate mucosa 14

= rugae area

maxilla palatal torus rugae area 3 4 5 labial frenum = labial flange buccal frenum = buccal flange maxillary tuberosity = distobuccal flange Labial frenum labial flangenotch Buccal frenum premolar area buccal buccal flange 3rd molar arch alveolar ridge distobuccal flange Maxillary tuberosity pterygomandibular raphe Pterygomandibular raphe endo burnisher 2 3 4 palatal salivary gland(minor salivary gland) soft tissue by [] 5~10 posterior border area

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pterygomandibular raphe = posterior palatal seal hamular notch

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palatine fovea

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anterior vibrating line

1 0

posterior vibrating line

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I. Facial Expression Musculature

I. Modiolus 1. origin insertion function a. Platysma b. Modiolus c. Modiolus origin d. Depressor anguli oris m. Triangularis m. e. Levator labii superioris alaeque nasi & Levator labii superioris m.16

Quadratus 2. Modiolus 8 a. Buccinator m. b. Orbicularis oris m. c. Levator anguli oris m. d. Zygomatic major m. e. Depressor anguli oris m. (Triangularis m.) f. Risorius m. g. Platysma m. h. Zygomatic minor m. 3. Depressor labii inferioris m.//// Modiolus 4. Mentalis m Modiolus D95 Modiolus buccinator m. modiolus Depressor labii inferioris modiolus Depressor anguli oris(triangularis)

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Mentalis modiolus

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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

Buccinator m Modiolus Orbicularis oris m Levator anguli oris m.(canine) Zygomatic major m Zygomatic minor m Levator labii superioris m Levator labii superioris alaeque nasi m Depressor anguli oris m (triangularis) Depressor labii inferioris m Mentalis m Risorius m Masseter m

Retentive force 1. 2. () 3. fit II. Labial Frenum labial frenummainly consisting of fibrous connective tissue lip movement vertical by orbicularis oris m. constraction long and narrow labial notch In some cases, depressions are recorded due to muscle bands of the origins of nasal septum depressor m. & orbicularis oris m. (Kamijio Y, 1969) I. II. Labial frenum III. labial notch IV. muscle nasal septum depressor m( ) orbicularis oris m origin base ()

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incisive papilla 1. Buccinator m. superior constrictor m.( ) Pterygomandibular raphe() 2. Buccinator m 3. Buccinator m. pterygomandibular raphe modiolus

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1. 2. external oblique ridge

D96 frenum III. Buccal Frenum buccal frenumV-shaped buccal notch (pursing the lips) elevator anguli oris mmovement vertical and horizontal forwardorbicularis oris m. backwardbuccinator m. 1. V buccal notch() 2. a. elevator anguli oris m b. orbicularis oris m buccinator m 3. size labial frenum D96 buccal frenum labial frenum (V-shaped) 4.

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1. frenum denture notch 2. frenum 3. Labial frenum Buccal frenum V

IV. Buccal Vestibular Areabuccal frenum tuberosity hamular notch

tuberosity

1. buccal vestibular area 2.

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A: hamular process of medial pterygoid plate B: tuberosity C: hamular notch

1. Medial pterygoid muscle originlateral pterygoid plate insertionmandibular angle 2. Lateral pterygoid muscle originlateral pterygoid plate insertioncondyle 3. A hamular process 4. Pterygomandibular raphe hamulus mylohyoid line By I. P.15, 17, 18 ,,, II. ppt96 95 ftp 96

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!

V. Buccal Space (Distobuccal Border) Coronoid process of the mandible Slightly opening, move the jaw laterally

I. buccal space maxillary tuberosity condyle rotation 20mm translation II. coronoid process temporalis m. buccal space coronoid process

Distobuccal flange

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distobuccal flange buccal frenum

condyle head (rotation) condyle head mandible( translation) coronoid head distobuccal flange coronoid head (coronoid space)25

distobuccal flange

coronoid head coronoid space II. distobuccal flange() coronoid head I.

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distobuccal flange

distobuccal flange

individual tray compound compound 27

border

VI.Posterior Border Area1. 2. 3. 4. 5. tuberosity pterygomandibular raphe hamular notch ah-line(vibrating line; area) palatine fovea

hamular notch tendon posterior palatal seal D96 I. Posterior Border Area retention 28

landmark II. buccinator m. sup. constrictor m. tendon pterygomandibular raphe III. palatine fovea ramus

superior constrictor m. buccinator m. pterygomandibular raphe II. medial pterygoid m. lateral pterygoid m. insert I.

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Buccinator m. insert denture

1. Pterygomandibular raphe

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pterygomandibular raphe

2. Hamular Notch

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T-burnisher(OD almagum ) C hamular notch pterygomandibular raphe

@@

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3. Ah-line (Vibrating line; Area) posterior palatal seal palatal area

I. palatine soft tissue uvula minor salivary gland palatine fovea II. soft tissue PPT

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I. II.

soft palatine minor salivary gland

A : clinical junction of hard & soft palates

B : ah-line

C : palatine fovea

A B ~ posterior palatal seal Cminor salivary gland D D96 () AhBah-lineB AB ah-line vibrating line p.217 I. palatine fovea ah-line ( ah-line) 2 II. junction of hard and soft palates ah-line ()34

Vibrating zone Vibrating line (anterior vibrating line) (posterior vibrating line)

posterior vibrating line Vibrating zone postdam posterior palatal seal

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I. House M M,1985

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Class I > 5 mm past the junction of the hard and soft 1~2 mm thick palates Class II 2~5 mm past the junction of the hard and soft 2 mm thick palates Class III < 1 mm past the junction of hard and soft 3~5 mm thick palates I. palate II. post-dam palatine fovea 3mm vibrating line palate III. House M M,1985 palate classclass I class III IV. Class IClass IIIvibrating area D96 3mm () palatine vault vibrating line II. (1991)

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(,1991) palate type A B C

I. vault (V-shape, Levin B PPT )vibrating line II. vibrating line III. Levin B, 1984

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I. (Levin B,1984) palate vault Aflat Brounded CU-shaped DV-shaped II. palate vault (V-shape)()vibrating line vibrating area palate vault Class III posterior palatal seal(post-dam)

Posterior Palatal Seal astringent mouthwash to remove stringy saliva Technique : 1. Arbitrary Scraping Method 2. Conventional Method -T burnisher -indelible pencil or Thompsons Sanitary Color Transfer Applicators -Valsalva maneuver (blowing out air) or phonate ah 3. Fluid Wax Technique39

4. Extended Tray Technique 1. Arbitrary Scraping Method palatine fovea palatine vault palatine vault flat vibrating line palatine fovea 3mm V-shape palatine fovea 3mm 2. Conventional Method I. vibrating line Valsalva maneuver vibrating line II. indelible pencil Thompsons Sanitary Color Transfer Applicators( ) III. T burnisher palate vibrating line 3. Fluid Wax Technique Conventional Method Valsalva maneuver 4. Extended Tray Technique palate ( House M M, , Levin B)

Valsalva maneuver()40

indelible pencil ()

Thompsons Sanitary Color Transfer Applicators

By

Conventional Method

I.

alginate aliginate ( )() vibrating line 41

II. vibrating line vibrating line T burnisher

III. vibrating line

Discussion ( III )

J Prosthet Dent 1985;53:380-83

questionnaire 56 dental schools I. II. JPD(J Prosthet Dent) 1985 56 posterior palatal seal region Table II vibrating line 1. Ah 42.8% 2. Ah 3. 42

III. Table III vibrating line Response to question, Which concept is currently taught in your department for the number of vibrating lines? Responses one Two Not a total line lines clinical procedure Number 42 13 1 56 Percent 75 23.2 1.8 100 1. 2. vibrating line vibrating zone anterior vibrating line posterior vibrating line D96 vibrating line 1. Ah~ vibrating ling 2. nausea Vibrating line retention vibrating line posterior vibrating line anterior vibrating line retention Table IV termination posterior vibrating line

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I. II. CD impression impression !! !!

D96 Table X posterior palatal seal Dr. House Butter Fly Pattern according to faculty

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Polymerization shrinkage of posterior of maxillary denture bases I.

D96 Denture Base Conventional acrylic cement 0.3~0.4% QC20 20 Rapid heat-cured acrylic resin

II. Denture Base

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I. denture II. 1-9 1-9 1. denture base acrylic resin(PMMApolymethyl methacrylate) 0.3% palate arch form 2. denture base denture palate retention 3. heat-cured acrylic 4. chemically cured acrylic injection-processed vinyl acrylic III. vibrating line/zone D96 46

denture base denture base

(by

) 1/10 mm 2 7 ( 3 8 ) 1 5 9 4 4 6 D95 1. margin (1&9) alveolar ridge (3&7) 2. 456 4 6 5 fit

III. Denture 2~3 weeks

I. Denture packing II. denture 60 III. 7024 hr curing()

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IV.

IV. Injection Denture Processing SystemsSR Ivocap Injection System Ivoclar Vivodent Palajet / Palamat elite Heraeus Kulzer Success Dentsply Unipress Complete Schtz-Dental Acri-Dense IV GC America SPAD System Sankin PVPM Phoenix Dent FRP Micro-Dental DS system High-Dental Japan I. heat-cured packing (injection)

V. SR Ivocap Injection System

I.

I.

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II. SPAD System Dentsply

() DS system

()

I. denture denture base palate II. denture vibrating line 49

palatal area

I. denture base denture

Relief Area Incisive papilla; anterior palatine foramen incise canal or nasopalatine canals (Scarpas canals) nasopalatine n. & a.

median palatal raphe; medial palatal suture torus palatinus / torus mandibularis spiny ridge

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I. denture base palate palate base retention denture base function II. denture denture tissue surface base median palatine suture/raphe base ( 0.2) median palatine suture 0.1 suction retention denture III. denture base 0.1() base relief IV. relief median palatine suture/rapheIncisive papilla()torus palatinus / torus mandibularis()spiny ridge(ridge ) V. complete denture relief

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denture

denture denture

relief

denture

I.

relief

Summary

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I. complete denture !! 1. Buccal frenum orbicularis oris muscle buccinator muscle levator anguli oris muscle 2. Coronoid process coronoid process complete denture 3. pterygomandibular raphe () I. II. denture III. complete denture palate

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