Prosthodontics

Prosthodontics

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(i) Impression procedure, preliminary and final. (ii)

Construction of cast from impression, base or permanent
base & wax rim. (iii) Selection of teeth (Shade & Mould).
Chapter 01
(iv) Alignment of teeth. (v) Trial of complete denture. (vi)
Finishing of complete denture, fitting the finished denture
(insertion). (vii) Complaints of patients.
Complete Denture Prosthesis-

Impression procedure, preliminary and final.

―A complete denture impression is a negative registration of the entire denture bearing, stabilizing and border seal
areas present in the edentulous mouth.‖

Classification Impressions can be classified as:

1. Depending on the theories of impression making:
• Mucostatic or passive impression.
• Muco-compressive or functional impression.
• Selective pressure impression.
2. Depending on the technique:
• Open-mouth technique.
• Closed-mouth technique.
3. Hand manipulation for functional movements (Dynamic impression): Border moulding.
4. Depending on the type of tray:
• Stock tray impression.
• Custom tray impression.
5. Depending on the purpose of the impression:
• Diagnostic impression.
• Primary impression.
• Secondary impression.

6. Depending on the material used:

• Reversible hydrocolloid impression.
• Irreversible hydrocolloid impression.
• Modelling plastic impression (Impression compound).
• Plaster impression.
• Wax impression.
• Silicone impression.
• Thiokol rubber impression.

Primary Impressions or Preliminary Impression

Primary impression is defined as, ―An impression made for the purpose of diagnosis or for the construction of a tray‖
This is the first step in fabrication of a CD. The preliminary impression is made with a stock tray.

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Secondary Impressions or Wash Impression

This is a clinical procedure in complete denture fabrication done to prepare a master cast. This is done after mouth
preparation is complete. It is a very important step as it should record the denture-bearing area in great detail and also
record the muscular peripheral tissues in function. This method makes use of a custom tray or special tray prepared
from the primary cast. The borders of the tray should end 2 mm short of the peripheral structures. The tray can be
made of auto-polymerizing resin or reinforced shellac base plate.

Functions of a Complete Denture

A complete denture functions to restore aesthetics, mastication and speech. Aesthetics The complete denture should
restore the lost facial contours, vertical dimension, etc. Artefacts like stains can be incorporated in order to improve
the aesthetics.
Mastication
A complete denture should have proper balanced occlusion in order to enhance the stability of the denture. Occlusion
is discussed in detail in Chapter 10.
Phonetics
One of the most important functions of a denture is to restore the speech of the patient

COMPONENT PARTS OF A COMPLETE DENTURE

It is important to have a thorough knowledge about the various parts of a complete denture before we discuss about
the various procedures. A denture has three surfaces and four component parts.

Surfaces of A Complete Denture

A complete denture has the following surfaces:
1. Impression surface (Intaglio surface)
2. Polished surface (Cameo surface
3. Occlusal surface

Parts of a Complete Denture

The various parts of a complete denture are:
• Denture base.
• Denture flange.
• Denture border.
• Denture teeth.

Denture Base
It is defined as, "That part of a denture which rests on the oral
mucosa and to which teeth are attached"

Acrylic Resin Denture Bases

It is the most commonly used denture base material. It is easy to
fabricate and economical. It is supplied as a powder (polymer)
and a liquid (monomer).

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Advantages Disadvantages
• Acrylic has a translucent pink color, which closely • It cannot be used in thin sections like a metal denture
resembles the gingiva, providing good aesthetics. base. Hence, it affects the speech of the patient.
• These dentures can be easily rebased /relined as required • It does not transmit any heat. So the patient's
in future. perception of the temperature of the food is
• It is also available in various pigmented colors which can decreased.
be used for characterization. • Difficult to maintain.
• The material is quite strong and can withstand normal
occlusal forces.

Metal Denture Bases

Metal denture bases can be fabricated using Gold, Gold alloys, Chromium-Cobalt or Nickel-Chromium alloys.
Advantages Disadvantages
• Mandibular dentures are heavier. So the retention • More expensive.
and stability are improved. • Require more time for fabrication.
• Improved thermal conductivity gives good sensory • Require refractory cast material.
interpretation. • Difficult to fabricate.
• They are strong even in thin sections. Thin sections • Cannot be rebased.
are very comfortable for the patient.
• Easier to maintain.

Flange of a Denture
a. Labial Flange
b. Buccal Flange
c. Lingual Flange

Based on the material:

• Acrylic teeth.
• Porcelain teeth.
• Inter-penetrating polymer network resin teeth (IPN resin).
• Gold occlusal.
• Acrylic resin with amalgam stops.

Based on the morphology of the teeth:

• Anatomic teeth.
• Semi-anatomic teeth.

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• Non-anatomic teeth or 00/ Cusp less teeth.

• Cross-bite teeth.
• Metal inserts teeth.

Acrylic Teeth VS Porcelain Teeth

Property Acrylic Porcelain
Abrasion resistance Low High
Adjustability Easy to adjust Difficult to trim
Bonding Chemical Mechanical
Staining Easily stained Does not stain
Percolation Absent if acrylic denture base Present when acrylic denture
is used base is used
Clicking sound Absent Present
Ease of fabrication Easy Difficult
Ease of rebasing Difficult to remove acrylic Easy to remove porcelain
teeth teeth
Trauma to denture Less More
bearing area

ANATOMICAL LANDMARKS INTHE MAXILLA

The anatomical landmarks in the maxilla are:
Limiting Structures Supporting Structures Primary stress- Relief Areas
• Labial frenum bearing areas: • Incisive papilla
• Labial vestibule • Hard palate • Cuspid eminence
• Buccal frenum • The postero-lateral slopes of the • Mid-palatine raphe
• Buccal vestibule residual alveolar ridge Secondary • Fovea palatina.
• Hamular notch stress-bearing areas:
• Posterior palatal seal area. • Rugae
• Maxillary tuberosity, alveolar tubercle.

A- maxillary tubrosity G- Mid palatine raphae

B- Buccal Sulcus H- Palatal rugae
C,I- Buccal frenum J- Crest of the alveolar ridge
D- Labial Sulcus K- Hamular notch

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E- labial Frenum L- Fovea platina
F- Incisive papilla M-posterior Palatal seal

Hamular Notch
The hamular notch is a depression situated between the maxillary tuberosity and the hamulus of medial pterygoid
plate. It is soft area of loose areolar tissue.

Posterior Palatal Seal Area (Post dam)

It is defined as " The soft tissues at or along the junction of the hard And soft palates on which pressure within the
physiological limits of the tissues can be applied by a denture to aid in the Mention of the denture.

Functions of the posterior palatal seal

The posterior palatal seal, that is recorded and reproduced in the denture, has the following functions:
• Aids in retention by maintaining constant contact with the soft palate during functional movements like
speech, mastication and deglutition.
• Reduces the tendency for gag reflex as it prevents the formation of the gap between the denture base and the
soft palate during functional movements.
• Prevents food accumulation between the posterior border of the denture and the soft palate.
• Compensates for polymerization shrinkage. The posterior palatal seal area can be divided into two regions
based upon anatomical land-marks, namely:
a. Pterygomaxillary seal
b. Post-palatal seal.
Posterior Palatal Seal Area

Postpalatal seal
This is a part of the posterior palatal seal that extends between the two maxillary tuberosities.

Vibrating Line
It is defined as "The imaginary line across the posterior part of the palate marking the division between the movable
and immovable tissues of the soft palate which can be identified when the movable tissues art moving." - GPI.
• It is an imaginary line drawn across the palate that marks the beginning of motion in the soft palate, when the
individual says "ah".
• It extends from one hamular notch to the other.
• It passes about 2 mm in front of the fovea palatina. The fovea is formed by coalescence of the ducts of several
mucous glands. This acts as a guide to locate the posterior border of the denture.
• This line should lie on the soft palate.
• The distal end of the denture must cover the tuberosities and extend into the hamular notches. It should end 1-2
mm posterior to the vibrating line. Another school of thought considers the presence of two vibrating lines
namely:
a. Anterior vibrating line.
b. Posterior vibrating line.

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Fovea palatina
The fovea is formed by coalescence of the ducts of several mucous glands. This acts as an arbitrary guide to locate
the posterior border of the denture.

ANATOMICAL LANDMARKS IN THE MANDIBLE

They can he broadly grouped into:
Limiting Structures Supporting Structures Relief Areas
• Labial frenum. • Buccal shelf area • Crest of the residual alveolar ridge.
• Labial vestibule. • Residual alveolar ridge • Mental foramen.
• Buccal frenum.
• Genial tubercles
• Buccal vestibule.
• Lingual frenum. • Torus mandibularis
• Alveololingual sulcus. • Prominent mylohyoid ridge
• Retromolar pads.
• Pterygomandibular raphe.

OBJECTIVES OF IMPRESSION MAKING

An impression should be made with the purpose of obtaining the following characteristics in the dentures to be
fabricated.
a. Retention.
b. Stability.
c. Support.
d. Aesthetics.
e. Preservation of remaining structures.

Retention
It is defined as "That quality inherent in the prosthesis which resists the force of gravity, adhesiveness of foods, and
the 'bites associated with the opening of the jaws- GPT.
Retention is the ability of the denture to with-stand displacement against its path of insertion.

The factors that affect retention can be classified as:

a. Anatomical factors.
b. Physiological factors.
c. Physical factors.
d. Mechanical factors.
e. Muscular factors.

Anatomical Factors
The various anatomical factors that affect retention, are:
a. Size of the denture-bearing area.
b. Quality of the denture-bearing area.

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Physiological Factors
Saliva The viscosity of saliva determines retention. Thick and ropy saliva gets accumulated bet-ween the tissue
surface of the denture and the palate leading to loss of retention. Thin and watery saliva can also lead to
compromised retention. Cases with ptyalism can lead to gagging and in patients with xerostomia, dentures can
produce soreness and irritation.

Physical Factors Mechanical Factors

The various physical factors which affect retention, The various mechanical factors, which aid in
are: retention, are:
• Adhesion. • Undercuts.
• Cohesion. • Retentive springs.
• Interfacial surface tension. • Magnetic forces.
• Capillarity or capillary attraction. • Denture adhesives.
• Atmospheric pressure and peripheral seal. • Suction chambers and suction discs

Stability
Stability is defined as, "The quality of a denture to the firm, steady or constant, to resist displacement by functional
stresses and not to be subject to change of position when forces are applied" - GPT. Stability is the ability of the
denture to with-stand horizontal forces. The various factors affecting stability are
a. Vertical height of the residual ridge.
b. Quality of soft tissue covering the ridge.
c. Quality of the impression.
d. Occlusal rims.
e. Arrangement of teeth.
f. Contour of the polished surfaces.

Cold Mould Seal

Cold mould seal is the most commonly used separating medium, It is basically an aqueous solution of sodium
alginate.

Composition:
a. Sodium alginate (2% in water)
b. Glycerin
c. Alcohol
d. Sodium phosphate
e. Preservatives

Fabrication of a Special Tray

Fabrication of the special try depend on the type of material used. Most commonly used materials for making special
tray are:
a. Shellac
b. Cold cure acrylic
c. Vacuum formed Vinyl or Polystyrene
d. Vacuum formed thermoplastic resin.
e. Type II impression compound (Tray com-pound).

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Shellac
It was the most commonly used material for pre-paring special trays and base plate. This material is basically a type
of wax. It is commercially available in separate shapes for the maxilla and the mandible.

Composition
a. Resin — 90.9%
b. Wax — 4%
c. Glutin — 2.8
d. Moisture- 1.8%
e. Colouring agent — 0.5%

Advantages Disadvantages
• Inexpensive. • Very brittle and hence it breaks easily.
• Can be easily manipulated. • It tends to distort easily.
• Can be readapted even if it distorts. • Sometimes wires may be required to strengthen it.
• Very heat sensitive, it loses its flow properties if over heated.

FABRICATING THE TEMPORARY DENTURE BASE

Materials used for Making Base Plates
The common materials used to fabricate a denture base include:
a. Auto-polymerising resins
d. Heat cure resins
b. Thermoplastic resins
e. Shellac
c. Base plate wax.

Base plates can be stabilized using the following materials:

• Zinc oxide eugenol impression materials
• Elastomeric impression materials
• Soft and hard curing resins.

FABRICATION OF OCCLUSAL RIMS

An occlusal rim (occlusion rim) is defined as "Occluding surfaces built on temporary or permanent denture bases for
the purpose of making maxillomandibular relation records and arranging teeth." -GPT.
It is also defined as a "wax/arm used to establish accurate maxillomandibular relation and for arranging artificial
teeth to form the trial denture." Occlusal rims are fabricated to record various maxillomandibular relations, lip lines,
vertical and horizontal overlaps, etc. They are usually fabricated to a larger size so that they can be reduced as
needed.

Technique of Fabrication of Occlusal Rim

Occlusal rims can be fabricated by using the following techniques
 Rolled wax technique.
 Metal occlusal rim former.

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 Pre-formed occlusal rim.

Rolled wax technique
 This is the most commonly used technique. A sheet of base plate wax is taken and one end of the sheets is
softened over the flame and rolled to a width of 4 mm.

The occlusal rims are inserted into the patient’s mouth and the following factors are checked:
• Lip support and labial fullness
• Overjet
• Cheek support and buccal fullness
• Level of the occlusal plane
• Orientation of plane of occlusion

Face bow
It is defined as, "A caliper-like device which is used to record the relationship of the maxillae and/or the mandible to
the temporomandibular joints".

Parts of a Face-bow
The component parts of a face-bow are:
a. U-shaped frame
b.Codylar rod
c. Bite fork
d. Locking device
e. Orbital pointer with clamp
Importance of Vertical Jaw Relation
As mentioned previously the vertical jaw relation is the most critical record because errors in this record produce the
first signs of discomfort. In the following table the effects of altered vertical dimension is enlisted.
Increased vertical dimension Decreased vertical dimension
• Increased trauma to the denture-bearing area • Comparatively lesser trauma to the dos tune-bearing Med.
• Increased lower-facial height • Decreased lower-facial height.
• Difficulty In swallowing and speech. • Angular chelitis due to folding of the comer of the mouth.
• Pain and clicking in the TM joint • Difficulty in swallowing.
• Stretching of facial muscle • Pain, clicking, discomfort of the TM joint accompanied with
• Increased volume or cubical space of the headache and neuralgia.
oral cavity • Loss of lip fullness
• Loss of free way space • Obstruction of the opening of the eustachian tube due to the
elevation of the tongue/mandible
• Loss of muscle tone.
• Corners of the mouth are turned down.
• Thinning of the vermilion borders of the lip.
• Decrease volume or cubical space of the oral cavity.
• Cheek biting

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ANTERIOR TEETH SELECTION

Anterior teeth play an important role in the aesthetics of a patient. They are not subjected to heavy occlusal load like
the posteriors. Hence, aesthetics is given more importance during anterior teeth selection. The following factors are
also considered during the selection of anterior teeth:
• Size of the teeth
• Form of the teeth
• Colour/shade of the teeth
Size of the Anterior Teeth The tooth size should be appropriate to the size of the face and sex of the patient.
The following methods are used as a guide to select the size of the teeth:
• Methods using pre-extraction records.
• Methods using anthropological measurements of the patient.
• Methods using anatomical landmarks.
• Methods using theoretical concepts.
• Other factors.

POSTERIOR TEETH SELECTION

It is classified under two divisions, namely:
• Size of the teeth
• Form of the teeth.

Size of the Posterior Teeth

The following factors are considered while selecting the size of the teeth:
• Buccolingual width.
• Mesiodistal length.
• Occlusogingival height,

Form of the Posterior Teeth

Posterior teeth are available in different forms. Before we go into the details about each tooth form, we shall discuss
the factors that control the selection of the form of a tooth.

Factors that control the selection of the form of a tooth:

Condylar inclination:
Teeth with a high cuspal height are required for patients with steep condylar guidance. This is because the jaw
separation will increase for patients with acute condylar guidance dorm g, protrusion.
• Height of the residual ridge: Shallow cusped teeth go better with shallow ridges.
• Patient's age: Teeth with shallow cusps are preferred in older people.
• Ridge relationship: monoplane teeth are preferred for cases with posterior cross bite or severe class II relationship.
• Hanau's quint (discussed later).

Natural teeth VS Artificial teeth

Natural teeth Artificial teeth
Function independently and each individual tooth Function as a group and the occlusal loads are not
disperses the occlusal load. individually managed
Malocclusion can be non-problematic for a long time Malocclusions pose immediate drastic problems
Non-vertical forces are well tolerated Non-vertical forces damage the supporting tissues

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Incising does not affect the posterior teeth Incising will lift the posterior part of the denture
The second molar is the favored area for heavy
Heavy mastication over the second molar can tilt or shift
mastication for better
the denture base
leverage and power.
Bilateral balance is not necessary and usually considered Bilateral balance is mandatory to produce stability of the
a hindrance denture
Proprioceptive impulses give
There is no feedback and the denture rests in centric
feedback to avoid occlusal pre-
relation. Any pre-maturities in this position can shift the
maturities. This helps the patient to have a habitual
base
occlusion away from centric relation

Trial of complete denture.

Primary Evaluation
• Check for adaptation: Adaptation of base plate is first checked extraorally on an articulator before intraoral try-in.
• Evaluation of occlusion: There should be complete intercuspation of the denture teeth in centric relation.
• Evaluation of vertical height: The vertical height at rest and occlusion are verified.
• Evaluation of polished surfaces: The polished surfaces should be smooth and void-free to avoid discomfort and
food entrapment.

Evaluation in Mouth
1. Evaluation of Individual trial Denture (Maxillary and Mandibular) in Mouth
2. Evaluation of Lip and Cheek Support
3. Evaluation of the Occlusal Plane
4. Evaluation of Vertical Height
5. Evaluation of Centric Relation
6. Eccentric Relation
7. Incorporation of Posterior Palatal Seal Area

Finishing of complete denture, fitting the finished denture (insertion).

Finishing and polishing includes:
a. Trimming
b. Sand papering
c. Pumice wash.

CHECKING FOR THE FIT OF THE PROSTHESIS

a. Examining the Dentures
b. Examining the Patient‘s Mouth
c. Checking for Adaptation
d. Checking for Border Extension
e. Checking for Frenal Relief
f. Evaluating the Denture Aesthetics

CHECKING OF THE DENTURE FUNCTION

a. Evaluating the Retention and Stability of the Denture
b. Checking the Jaw Relation
c. Speech

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d. Occlusal Harmony

RELINING
Definitions Relining is defined as, ―A procedure to resurface the tissue surface of the denture with new base material
to make the denture fit more accurately‖

Indications for Relining

• Immediate dentures after 3-6 months where maximum residual ridge resorption would have occurred.
• When the adaptation of the denture to the ridge is poor due to residual ridge resorption
• Economical reasons where the patient cannot afford a new denture.
• Geriatric or chronically ill patients who cannot withstand physical and mental stress of construction of new
dentures

Contraindications for Relining and Rebasing

• When the residual ridge has resorbed excessively.
• Abused soft tissues due to an ill-fitting denture.
• Temporo-mandibular joint problems.
• Patient dissatisfied with the appearance of the existing dentures.
• Unsatisfactory jaw relationships in the denture.
• Dentures causing major speech problems.
• Severe osseous undercuts.

Advantages Disadvantages
• Eliminates frequency of patient visits. • Likelihood of altering the jaw relationship during the process.
• Economical for the patient. • Cannot correct aesthetics, or jaw relations.
• Improves fit of the denture. • Cannot correct occlusal arrangement.
• A soft liner can be incorporated in this • Cannot be used when excessive resorption has occurred. Hence it
denture, if necessary. cannot be a substitute for a new denture

SEQUELAE OF WEARING COMPLETE DENTURES

The use of complete dentures is not free of trouble. The dentures can produce severe side effects, which if left
unchecked will produce:
• Destabilization of occlusion.
• Loss of retention.
• Decreased masticatory efficiency.
• Poor aesthetics.
• Increased ridge resorption.
• Tissue injury.
Model Question

1. Metallic special tray is made by – 2. Materials are used for registration blocks as rim
a) Non brittle impression materials –
b) Shellac base plate a) Modeling Wax
c) Plumbers solder b) Compound
d) Acrylic resin c) Plaster- pumice combination
Ans: C d) Metals
Ans: D

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Ans: A
3. Which is not concerned for restoring speech in
case of CD? 10. The ideal or class-I type of tissue are not
a) Teeth shade selection located in –
b) Balk of material used in the denture base a) The anterior palatal section
c) Reproduction of the rugae of the palatal vault b) The posterior palatal section
d) Contours of the alveolar ridge c) The lower anterior section
Ans: A d) The lower posterior section
Ans: B
4. The retention of CD does not depend on – 11. Impression procedure for edentulous patient
a) The force of intermolecular alteration does not include –
b) The phenomenon of leverage a) Strive for the minimum areal courage
c) The force of gravity b) Anon- interfering periphery
d) Artificial teeth c) Peripheral valve seal
Ans: D d) Accurate adaptation
Ans: A
5. Contraction of masseter muscle result in
movement of which border of lower CD- 12. If patient has small jaw bone size. The amount
a) Anterior of closing pressure for that patient compared with
b) Posterobuccal one having large jaw bones will be:
c) Posterolingual A. Same
d) B& C B. Less
Ans: D C. More
D. None of the above
6. On lingual aspect –which muscle does not Ans: B.
provide resistant tissue – Explanation: The best thing to do in case of a
a) Genioglossus medium sized torus is to relieve the denture in the area
b) hyoglossus of the torus.
c) Mylohyoid
d) palatoglossas 13. The stability of a denture refers to:
Ans: B A. Resistance against vertical forces
B. Resistance against horizontal forces
7. Which is not common complaint for DM Patient C Resistance to removal in the opposite direction
in case of CD? D. All of the above
a) Lose Denture in the morning Ans: B.
b) Painful in the afternoon Explanation:
c) Lose denture in the afternoon Stability refers to resistance against horizontal forces
d) Painful in afternoon & loose in morning that tend to alter the relationships between the denture
Ans: C base and its supporting foundation in a horizontal or
rotatory direction.
8. Following which is correct in case of artificial
denture? 14. Retromolar pad area should be covered:
a) Easily carry out 50% natural function A. To give better stability
b) 80 to 90% proper speech B. To allow border seal
c) 100% esthetics C. To decrease the rate of resorption of alveolar
d) a, b, c ridge
Ans: D D. All of the above
Ans: B.
9. Thick dense and elastic or resilient Explanation:
mucoperiosteum indicates- Denture impression should be extended to retromolar
a) U shaped ridge pad area. This area provides border seal which is
b) V shaped ridge important for retention and stability of denture.
c) U & V shaped ridge
d) None of two 15. Fovea palatini are found:
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A. Behind the vibrating line will be eccentric contacts which will lead to these
B. In front of vibrating line problems.
C. On the vibrating line
D. Has no relation to vibrating line 20. The Gothic arch tracing device is used to
Ans: B. record:
Explanation: A. The vertical dimension of occlusion.
The vibrating line extends from one pterygo-maxillary B. The centric relation
notch to the other. At the midline it usually passes C. The centric occlusion
about 1 mm in front of the fovea palatini. The D. None of the above
vibrating line should not be confused with the junction Ans: B.
of the soft and hard palates. Since the vibrating line is 21. The occlusal rim in the molar region should
always on the soft palate. be:
A. Slightly lingual
16. The upper denture should extend: B. Slightly buccal
A. Up to the vibrating line C. On the ridge
B. 1-2 mm behind the vibrating line D. None of the above
C. Anterior to vibrating line Ans: A.
D. Has no relation to vibrating line Explanation: This is because the mandible in the
Ans: B molar region becomes wider.
Explanation: The distal end of the upper denture must 22. The occlusion rim in the anterior region should
extend to at least the vibrating line. In most instances the be:
denture should end 2 mm posterior to the vibrating line. A. Slightly lingual
B. Slightly buccal
17. The recording base during recording the bite C. On the ridge
has a sharp point which pinches the patient every D. None of the above
time he bites. The CR recorded by the doctor will Ans: B.
be: Explanation: The mandible in the anterior region
A. Correct with resorption will move lingually.
B. Incorrect
C. Depends on the patient's ability to bear pain 23. Distance of incisional edge of the maxillary
D. None of the above central incisor from the incisive papilla is:
Ans: B. A. 6-7 mm
Explanation: Incorrect. Pain will cause the mandible B. 8-10 mm
to shift in position, every time it tries to go into centric C. 10-12 mm
relation position. D. None of the above
Ans: B.
18. The interocclusal distance at rest positions
when viewed in the premolar region should be: 24. The Hanau articulator has the condylar
A. 1-2 mm guidance as:
B. 2-4 cm A. Lower member
C. 2-4 mm B. Upper member
D. 6-8 mm C. Any of the above
Ans. C D. None of the above
Ans: C.
19. Centric occlusion and centric relation in a Explanation: It can be on anyone of the above.
complete denture patient do not coincide. The Different models of the Hanau semi-adjustable
problem that the patient will have will be: articulators are available.
A. Soreness
B. Loose denture 25. In a whip mix articulator, the intercondylar
C. Inability to eat distances can vary or can be adjusted from:
D. All of the above A. 88-112 mm
Ans: D. B. 80-110 mm
Explanation: All the above problems can be C. 90-120 mm
attributed to the CR and CO, not coinciding. There D. 75-125 mm
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Ans: A. (88-112 mm).

26. The basic function of anterior teeth is:
A. Aesthetic
B. Incision.
C. Phonetic
D. All of the above
Ans: D.
Explanation:
The anterior teeth play an important role in all the
above functions of aesthetics, incision and phonetics.

27. Thickness of palatal surface of maxillary

denture should be:
A. 2mm
B. 2.5mm
C. 1.5mm
D. 3 mm
Ans: A. 2 mm
28. Occlusal correction is done in immediate den-
tures after:
A. 24 hours
B. After 48 hours
C. Before insertion
D. None of the above
Ans:. B.
Explanation:
Occlusal correction should be done after 48 hour
period because by that time most of the swelling has
disappeared and the denture can be remove frequently
without much discomfort.

29. The chair side reline technique uses:

A. An alginate impression
B. A tissue conditioner
C. Acrylic
D. Functional impression
Ans: C.
Explanation:
Acrylic. The chair side reline technique is of little use
and not in much practice. This is because acrylic used
has several disadvantages like:
1. This may produce a chemical burn
2. The reline is porous and may develop a bad odour
3. Colour stability was low
4. If the denture was not positioned properly the
material could not be easily removed.

16  EDUDENT
 Prosthodontics

30. The borders of the denture should not be

altered after try-in, before:
A. 48 hours
B. They can be altered immediately
C. 72 hours
D. 24 hours
Ans: D.
Explanation:
The borders of the denture should not be altered or
polished until the.1 dentures have been used for 24
hours. This way any overextension can be easily
detected.

31. The width of the posterior palatal seal area is:

A. 2mm
B. 3-4 mm
C. 1-5 mm
D. None of the above
Ans: C.
Explanation: The width of the posterior palatal seal
itself is limited to a bead on the denture that is 1 to 1.5
mm high and 1.5 mm broad. A greater width creates
an area of tissue placement that will have a tendency
to push the denture down in other words the PPS
should not be made too wide.

EDUDENT  17
 Quick Bite

(i) Impression. (ii) Treatment planning and mouth

preparation. (iii) Model Surveying. (iv) Component parts
of partial denture. (v) Materials used in partial denture
Chapter 02
construction. (vi) Design of partial dentures. (vii) Wax
pattern for cast denture and acrylic dentures. (viii)
Recording of occlusion. (ix) Trial of partial denture
Removable prosthodontics is defined as,
―The replacement of missing teeth and supporting tissues with a prosthesis designed to be removed by the wearer.

Removable Partial Denture is Generally Preferred in the Following Clinical Conditions

• When more than two posterior teeth or four anterior teeth are missing.
• If the canine and two of its adjacent teeth are missing. (e.g. central incisor, lateral incisor, canine), (lateral incisor,
canine, premolar) etc.
• When there is no distal abutment tooth. Even single cantilever is not generally preferred.
• Presence of multiple edentulous spaces.
• If the teeth adjacent to edentulous spaces are tipped, they cannot be used as an abutment for a fixed prosthesis.
• If periodontally weakened teeth are present near the edentulous spaces.
• Teeth with short clinical crowns (unsuitable for fixed partial denture).
• Insufficient number of abutments.
• Severe loss of tissue on the edentulous space.
• Old patients.

Removable Partial Denture is generally avoided in the Following Cases

• Patients with a large tongue which tends to push the denture away.
• Patient attitude: Mentally retarded patients cannot maintain a removable prosthesis.
• Poor oral hygiene: In such cases, any prosthesis is better avoided.

Kennedy’s Classification
• Class I: Bilateral edentulous areas located posterior to the remaining natural teeth i.e. there are two edentulous
spaces located in the posterior region without any teeth posterior to it

• Class II: Unilateral edentulous area located posterior to the remaining natural teeth, i.e. there is a single edentulous
space located in the posterior region without any teeth posterior to it.

• Class lll: Unilateral edentulous area with natural teeth anterior and posterior to it.

• Class 1V: Single, bilateral edentulous area located anterior to the remaining natural teeth. This is a single
edentulous area, which crosses the midline of the arch, with remaining teeth present only posterior to it.

18  EDUDENT
 Prosthodontics

PARTS OF A REMOVABLE PARTIAL DENTURE

a. Major connector
b. Minor connector
c. Rest
d. Direct retainer
e. Indirect retainer
f. Denture base
g. Artificial tooth replacement

Major Connector
It is defined as ‗‘A part of a removable partial denture which connects the components on one side of the arch to the
components on the opposite side of the arch‘‘ GPT.

Types of Maxillary Major Connector Mandibular Major Connectors:

• Single posterior palatal bar There are six common types of mandibular major
• Palatal strap connectors.
• Single board palatal major connector or Palatal plate type • Lingual bar
major connector • Lingual plate
• Double or anteroposterior palatal bar • Kennedy bar or double lingual bar.
• Horseshoe or U-shaped connector • Sublingual bar
• Closed Horseshoe or anteroposterior palatal strap • Mandibular cingulum bar (continuous bar)
• Complete palate. • Labial bar

Lingual Bar
It is the most commonly used mandibular major connector:
• It is half pear-shaped in cross section with the thickest portion placed inferiorly.
• It is made from a thick (6-gauge) half pear-shaped wax pattern.
• There must be a minimum of 8 mm vertical clearance from the floor of mouth. The upper border of the pattern
should have a 3 mm clearance from the marginal gingiva to avoid any soft tissue reaction.
• The minimum height of the major connector should be at least 5 mm.
• Lingual bar should be placed as inferior as possible so that movements of the tongue is not restricted and sufficient
space can be avail-able above it.

Advantages: Disadvantages:
• It is easy to fabricate. • Cannot be used in cases with tori (contraindicated).
• It has mild contact with oral tissues and no contact with • In cases with limited vestibular depth, the bar will be
teeth (no decalcification due to food and plaque thinned out and tends to flex.
accumulation, etc).

Rest and Rest Seats

Classification of Rests
Based on the position of the rest on the abutment
Based on the position of the rest on the abutment it can be classified as:

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 Quick Bite

Occlusal rest
Placed on occlusal surface of a posterior tooth.

Cingulum or lingual rest:

Placed on the lingual surface of a tooth, especially in a maxillary canine
Incisal rest:
Placed on the incisal edge eta tooth, usually in a mandibular canine and incisors.
Occlusal Rest and Rest Seat (MS)
An occlusal rest can be defined as, "A rigid extension of 6i partial denture which contacts the occlusal surface of the
tooth"- GPI

Functions of an Occlusal Rest

• Transmit stress along the long axis of the tooth.
• Secure the clasp in a proper position and maintain the tooth-clasp relationship.
• Prevent spreading of the clasp arms and subsequent displacement of the clasp and the prosthesis.
• Assist in distribution of occlusal load.
• Prevent extrusion of the abutment.
• Avoid plunging of food between the tooth and the clasp.
• Provide resistance to lateral displacement.
• Sometimes contributes to indirect retention.
• Used to close small spaces where a tooth replacement cannot be placed.
• Helps to build up the occlusal plane of a tilted tooth.
Direct Retainers
Direct retainers are broadly classified as:
Extra-coronal direct retainers (Clasps): Intra-coronal direct retainers Attachments):
• Manufactured retainers (Dalbo) • Internal attachment
• Custom-made retainers: • External attachment
• Occlusally approaching (Circumferential or Aker's • Stud attachment
clasp) • Bar attachment
• Gingivally approaching (Bar or Roach's clasp) • Special attachments

Extracoronal Direct Retainers (Clasps)

Component parts of a clasp
The component parts of a clasp have been described in detail here. These components may be rigid or flexible. The
flexible components are designed below the height of contour so that they provide retention when they engage the
undercut at the same time they can flex and pass through the height of contour without requiring much effort during
insertion or removal.
(1) Retentive terminal
(2) Retentive clasp arm
(3) Reciprocal arm
(4) Occlusal rest
(5) Shoulder
(6) Body
(7) Minor connector

20  EDUDENT
 Prosthodontics

Functional Requirements of a Clasp

The functional requirements of a clasp include
a. Retention b. Stability c. Support
d. Reciprocation e. Encirclement f. Passivity

Type of clasps
• Circumferential or Aker‘s clasps
• Vertical projection or Bar or Roach clasps
• Continuous clasp

Differences between circumferential and bar clasps

Circumferential clasp Bar clasp
• It approaches the undercut from the occlusal aspect • It approaches the undercut from the gingival aspect of
• It arises above the height of contour of the abutment the abutment.
• It has a rigid minor connector. • It arises below the height of contour of the abutment.
• It is easier to remove. This is because only the • It has a flexible minor connector- The minor connector
retentive terminal should flex to be relieved from the for the bar clasp is reflect approach arm.
undercut. • It is easier to seat but difficult to remove because the
• It has a pull type mention- That is the retentive tip minor connector should flex along with the retentive
should pull occlusally to crime the undercut. arm to be relieved from the undercut
• Due to continuous tooth contact it has a good bracing • It has a push type retention That is the retentive tip
effect- should push occlusally to engage the undercut.
• It is lea aesthetic, due to more metal exposure. • Due to limited 3-point tooth contact, it has less bracing
• It has reduced food debris accumulation as tt adapts effect
mom closely to the tooth. • More aesthetic as it is present below the height of
• Easy to repair due to it's sample design. contour.
• It increases the width of the occlusal table because the • Increased food debris accumulation, because a space
retentive arm arises near the occlusal surface of the exists between the minor connector and the abutment
abutment. It increases the occlusal load on the surface and the length of the clasp assembly is mom.
abutment. • Difficult to repair as the design is more complex.
• Due to increased tooth coverage it may cause • No such problem as it ix placed in a lower position.
decalcification. • No decalcification due to limited 3-point contact.
• It can be used in tilted abutments and in cases with • It cannot be used in cases with tilted abutment and soft
soft tissue undercuts. tissue undercut

Indirect Retainers
A part of a removable partial denture which assists the direct retainers in prevent displacement extension denture
bases by functioning through lever action on the opposite side of the fulcrum line"- GPT: An indirect retainer is one,
which helps the direct retainer to prevent displacement of the distal extension denture by resisting the rotational
movement of the denture around the fulcrum line.

EDUDENT  21
 Quick Bite

The functions of the Indirect Retainers

•It shifts the fulcrum line away from the point of application of the force, thereby counter-acting the lifting force
and stabilizing the denture.
• It counteracts horizontal forces by providing support and stability to the denture. Support and stability is
obtained from the contact of the proximal plate of the minor connector with the axial tooth surface.
• Anterior teeth can be splinted and protected against lingual movement with an indirect retainer.
• It may act as an auxiliary rest to support a part of the major connector.
• The dislodgement of indirect retainer (rest) from its rest seat when the denture base is depressed indicates the
need for relining.

Types of Indirect Retainers

1. Auxiliary occlusal rest
2. Canine extension from the occlusal rest
3. Canine rest
4. Continuous bar retainers and linguoplates
5. Modification areas
6. Rugae support
7. Direct indirect retention
8. Indirect retention from major connectors

Making the Diagnostic Impression

Diagnostic impressions for removable partial dentures are made using irreversible hydro colloid (alginate).
This impression is made using a stock tray. The most commonly used impression materials for making the
preliminary impression are:
• Irreversible hydrocolloids (alginate)
• Reversible hydrocolloid (agar)
• Elastomeric impression materials (for cases with deep undercuts).

Disinfecting the impression

The impression is disinfected using iodophor. It should be left undisturbed for ten minutes. Two percent
glutaraldehyde is also the disinfectant of choice. Glutaraldehyde has been proved to cause damage to the impression
surface of elastomeric impression. Hence, it is avoided for the disinfection of elastomeric impression.

Onlay
An onlay is defined as a restoration, which covers more than two cusps of a tooth. Before placement of an onlay, the
tooth should be reduced sufficiently so that the occlusal plane can be reestablished by the onlay.

Indications
• Supra-erupted teeth.
• Severely attrited teeth.
• Teeth with inadequate crown height.
• Grossly decayed abutment teeth.

Advantages Disadvantages

22  EDUDENT
 Prosthodontics

• Minimal tooth preparation is required, compared to that • Unaesthetic due to metal display.
of a full veneer crown. • Less retentive.
• Only occlusal reduction is done. Hence, the natural • A chrome alloy onlay will produce attrition of the
contours of facial and lingual tooth surfaces can be opposing tooth
maintained.

Surveyor
A surveyor is defined as "An instrument used in the construction t31a removable partial denture to locate and
delineate the contours and relative positions of abutment teeth and associated structures"-G PT.

Objectives of Surveying
• To design a RPD such that it's rigid and flexible components are appropriately positioned to obtain good
retention and bracing
• To determine the path of insertion of a prosthesis such that there is no interference to insertion along this path.
• To mark the height of contour of the area (hard or soft tissues) above the undercut.
• To mark the survey lines. (height of contour of a tooth)
• To mark the undesirable undercuts into which the prosthesis should not extend.

Types of Surveyors the surveyors commonly used are:

• Ney surveyor (widely used).
• Jelenko or Will's surveyor.
• William‘s surveyor.

Uses of a Surveyor
1. Surveying the diagnostic and primary casts.
2. Tripoding the cast. (Recording the cast position).
3. Transferring the tripod marks to another cast.
4. Surveying the master cast.
5. Contouring crowns and cast restorations.
6. Placing internal attachments and rests.
7. Performing mouth preparation directly on the cast to determine the outcome of treatment.
8. Surveying the master cast.
9. Surveying ceramic veneers before final glazing.

Objectives of surveying the primary cast

a. To determine the most accepted path of placement that has the least interference and the best aesthetics.
b. To identify proximal tooth surfaces on which guiding planes can be prepared.
c. To locate and measure the retentive areas in a tooth.
d. To determine the soft tissue and / or bony interferences which are to be eliminated?
e. To identify the height of contour.
f. To identify undesirable undercuts that should be blocked out during casting.
g. To record the cast position for future reference.
h. To plan and determine the required mouth preparation procedures like preparing guiding planes, rest seats, etc.
i. Analyzing the cast
j. Surveying the teeth
k. Surveying the soft tissue contours on the cast.

EDUDENT  23
 Quick Bite

Framework fabrication of partial denture/wax pattern for cast denture

After recording the master impression, the framework is fabricated for a cast partial denture. The framework is
essential for other procedures like preparing occlusal rims, jaw relation, etc. Framework fabrication involves the
following steps:
a. Wax-up
b. Duplication and preparation of refractory casts
c. Waxing
d. Investing
e. Burn out
f. Casting
g. Finishing and polishing

Factors Influencing Path of Insertion

The major factors that determine the path of insertion are:
a. Retentive undercuts
b. Interference
c. Aesthetics
d. Guiding planes.
e. Denture base.
f. Location of vertical minor connector
g. Point of origin of the approach arm.

Interference
Certain areas of the mouth can cause interference to insertion. If surgery cannot be done to remove these
interferences, the path of insertion should be altered. A few examples for structures that may produce interference are
stated below.
Interferences in the mandible Interference in the maxilla
• Lingual tori. • Torus palatinus.
• Lingual inclination of remaining teeth. • Bony exostoses.
• Bony exostoses. • Buccally tipped teeth.

Denture Base
Denture Base is defined as, "That part of a complete or removable partial denture which teeth are attached". "That
part of a complete or removable partial denture which rests upon the basil seat and to which teeth are attached‖ -
GPT.

Types of Denture Bases

The most commonly used types of denture bases include:
• Acrylic
• Metal
• Combination

Plastic teeth
They have high impact strength but poor wear resistance compared to porcelain. They have adequate strength even in
smaller dimensions. Their aesthetic reproduction is adequate for most cases.

24  EDUDENT
 Prosthodontics

Advantages: Disadvantages:
• Most aesthetic • Difficult for single tooth replacements
• Wider stress distribution • Needs more bulk to achieve adequate strength
• Easy to reline
• Can restore the lost ridge contour

Duplication and preparation of Refractory casts

Agar is the duplicating medium of choice. The blocked relieved and beaded master cast should be duplicated so that
the resultant refractory cast, is ideal to fabricated the framework. Refractory cast will not be similar to the master
cast. It will have the following characteristics:
•All the blocked out undercuts will be invisible in the refractory cast.
• The spacer relief will appear as an elevation on the edentulous ridge.
• The stopper holes on the spacer will appear as depression on the elevated saddle area.
• The gingival relief will appear as an elevated band on the refractory cast.

Model Question

1. The classification is determined by: A. Palatal torus

A. The most anterior tooth missing B. Ridge area
B. 1 he first tooth to be lost C Elevated mid suture line
C. The largest tooth in the space D. Rugae area
D. The most posterior tooth missing Ans: A.
Ans: D.
6. Anterior palatal strap should be:
A. As for anterior as possible
2. Patient comes with only the first molars in the B. As for posterior as possible
lower arch. The classification is: C. Flat or strap like
A. Class I mod I D. Half oval
B. Class IV mod 2 Ans: A.
C. Class II mod 2
D. Class lll mod 2 . 7. The lingual bar must be:
Ans: A. A. Flat
B. Half pear-shaped with the bulge superiorly
C. Half pear-shaped with the bulge inferiorly
3. A successful major connector must be: D. Deep in the lingual sulcus
A. Rigid Ans: C
B. Flexible
C Bulky 8. Labial bar is indicated when:
D. Relieved of all mobile tissues A. There is a diastema
Ans: A. B. Labial inclination of teeth
C. Lingual inclination of teeth
4. The minor connector should cross the gingival D. Periodontally weak teeth
tissue: Ans: C
A. Gradually
B. Abruptly 9. Lingual plate is indicated when there is:
C Covering a bigger area A. High lingual frenum
D. Without any relief. B. Class III situations
Ans: B. C. Periodontally strong anterior teeth
D. All class I situations
5. Palatal major connectors should be given relief Ans: A.

EDUDENT  25
 Quick Bite

D. Flat
Ans: C

10. Single palatal strap is indicated in: 17. The best lingual rest will be on:
A. Class II A. Thecingulum
B. Long span class III B. Lingual pit
C Small span class III located anteriorly C. Near the cervical region
D. Small span class III mod I located posteriorly D. Prepared rest seat on a cast restoration
Ans: D. Ans: D.

11. U-shaped palatal major connector has the dis- 18. Flexibility of the clasp arm is dependent upon:
advantage of being: A. Length.
A. Rigid B. Diameter
B. Flexible C. The height of contour
C. Bulky D. All of the above
D. Traumatic to underlying tissues Ans: D.
Ans: B.
19. The greatest circumference of the crown
12. The advantages of palatal plate major covered so that the clasp assembly is effective is:
connectors are: A. More than 90°
A. Thick metal plate B. 180°
B. Thin metal plate C. More than 180°
C. Corrugated D. Less than 180°
D. Surface irregularity Ans: C
Ans: B.
20. The retentive component is placed in:
13. The mandibular minor connector should be: A. Gingival l/3rd
A. Ladder like B. Occlusal l/3rd
B. Full length of the ridge C. Middle l/3rd
C. Lower on the lingual side only D. Junction of middle and occlusal l/3rd
D. Thick for strength Ans: A.
Ans: A.
21. The heel raising movement of the partial
14. The outline form of the rest seat should be: denture is prevented by:
A. Flat bottomed A. Occlusal rest
B. Round bottomed B. Indirect retainer
C. Triangular C. Minor connector
D. Rectangular D. Direct retainer
Ans: C Ans: B.

15. The angle formed by the occlusal rest of the 22. On depressing the denture base the deficiencies
vertical minor connector should be: of the basal seat support are manifested by the
A. Less than 120° dislodgement of:
B. Less than 100° A. Occlusal rest
C. Less than 90° B. Indirect retainer
D. 90° C. Direct retainer
Ans: C D. Major connector
Ans: C
16. The rest seat on the canine should be:
A. Rounded 23. The spring mounted horizontal is seen in:
B. Triangular A. Ney surveyor
C. V-shaped B. Jelenko surveyor
26  EDUDENT
 Prosthodontics

C. William's surveyor C. Should not be prepared

d. Dipak surveyor D. Either
Ans: B. Ans: B.
Explanation: Guiding planes .should b;' created so that
24. The path of placement and removal will be they are nearly as parallel to the long axis or" the
governed by: abutment teeth as possible.
A. Guiding plane
B. All undercut areas 27. A patient is seen with high lingual frenum. The
C. Retentive areas major connector of choice would be:
D. All of the above A. Lingual bar
Ans: D. B. Labial bar
C. Lingual plate
25. Mouth temperature waxes are: D. None of the above
A. Modelling wax Ans: C.
B. Korecta wax
C. Iowa wax 28. Removable die system does not include –
D. Green stick compound a) Dowel pin system
Ans: C. b) Di- lok system
c) Pindex system
26. Guiding planes prepared on enamel surfaces d) Separate die system
should be: Ans: D
A. Rounded
B. Flat

EDUDENT  27
 Quick Bite

(i) General indication of crown. (ii) Tooth reduction steps

& preparation of principle crown. (iii) Full veneer
crown. (iv) Partial veneer crown. (v) Inlay retainer. (vi)
Impression technique. (vii) Construction of porcelain
Chapter 03 jacket crown. (viii) Construction of veneered gold crown.
(ix) Construction of veneered jacked crown using resin. (x)
Abutment general principles retention and support. (xi)
Pontics. (xii) Design of the pontic. (xiii) Construction of
bridge.
A fixed partial denture is defined as “A partial denture that is cemented to natural teeth or roots which
furnish the primary support to the prosthesis”-GPT.
Parts of a FPD
a. Retainer
b. connector
c. Pontic
d. Abutment
INDICATIONS FOR FPD/Crown CONTRAINDICATIONS FOR FPD/Crown
A fixed partial denture is preferred for the Fixed partial dentures are generally avoided in the following
'following situations: conditions:
• Short s an edentulous arches • Large amount of bone loss as in trauma.
• Presence of sound teeth that can offer sufficient • Very young patients where teeth have large pulp chambers.
support adjacent to the edentulous space • Presence of periodontally compromised abutments.
• Cases with ridge resorption where a removable • Long span edentulous spaces.
partial denture cannot be stable or retentive. • Bilateral edentulous spaces, which require cross arch
•Patient's preference stabilization.
• Mentally compromised and physically • Congenitally malformed teeth, which do not have adequate
handicapped patients who cannot maintain the tooth structure to offer support.
removable prosthesis) • Mentally sensitive patients who cannot co-operate with
invasive treatment procedures.
• Medically compromised patients (e.g. leukemia, hypertension).
• Very old patients.

Classification of FPD
Class I: Posterior edentulous spaces.
Class II: Anterior edentulous spaces.
Class III: Antero-posterior edentulous spaces.

Other systems of Classification

28  EDUDENT
 Prosthodontics

IV. Durations of user:

•Permanent fixed partial dentures
•Long span bridges
- Interim Prosthesis
- Periodontally weak abutment (Mary-land bridge)
- Splints
Abutment
It is any tooth, root or implant which, gives attachment and support to the fixed partial denture.

ROTARY INSTRUMENTS USED FOR FULL VENEER PREPARATIONS

Shape Use
Round end tapered diamond 1.Depth orientation grooves
2.Occlusal reduction
3.Functional cusp
Torpedo diamond 1.Axial reduction
2.Chamfer finish line
Short needle 1.Initial interproximal axial reduction in posterior teeth
Long needle 1.Initial proximal axial reduction in anterior teeth
Small wheel diamond 1. Lingual reduction in anterior teeth
Tapered fissure bur 1.Seating groove
2.Proximal groove (posterior teeth)
3.Smoothing and finishing
4. Occlusal and incisal bevels
Tapered fissure burs 1.Initial groove alignment (169L & 170L)
2.Angles of proximal boxes
3.Smoothing and finishing
4.Occlusal and incisal bevels
End cutting bur Conventional shoulder finishing
Torpedo bur l. Axial wall finishing
2. Chamfer finishing
Flame bur 1. Flare and bevel finishing

PRINCIPLES OF TOOTH PREPARATION

BIOLOGIC ESTHETIC MECHANICAL
a. Conservation of tooth structure a. Minimum display of metal a. Retention form
b. Avoidance of over contouring b. Maximum thickness of porcelain b. Resistance form
c. Supragingival margins c. Porcelain occlusal surfaces c. Deformation
d. Harmonious occlusion d. Subgingival margins
e. Protection against tooth fracture

Steps of tooth Reduction/Preparation

For molar teeth Anterior teeth
a. Occlusal reduction a. Incisal reduction
b. Functional cusp beveling b. Incisal ½ of labial surface preparation
c. Buccal surface preparation c. Gingival ½ of labial surface preparation
d. Lingual surface preparation d. Cingulam reduction
e. Elimination of proximal contact point e. Incisal ½ of lingual surface preparation
f. Proximal surface preparation f. Gingival ½ of lingual surface preparation

EDUDENT  29
 Quick Bite

g. Providation of finish line g. Elimination of proximal contact

h. Finishing of all surface h. Preparation of proximal surface
i. Polishing i. Providation of finish line
J. Finishing
k. Polishing

Marginal Integrity
The margin of a restoration should be preferably placed supra-gingival because it has the following advantages:
• It can be easily finished.
• Easy to maintain.
• Easy to identify and reproduce during impression making.
• Easy to examine during future visits.

Sub-gingival margins may be required for certain restorations.

The indications for a sub-gingival margin are:
• For teeth with short clinical crowns.
• Teeth affected by sub-gingival caries or cervical erosion where crown lengthening cannot be performed.
• If the contact area is present at or below the gingival crest.
• Where aesthetics is of concern (e.g. gummy smile).
• For cases with unmanageable root sensitivity.
• When the axial contours should be modified.
• When additional retention is required.
• To conceal the metal ceramic margin behind the labio-gingival crest.

Finish Line Configurations

A finish line should have the following characteristics:
• Shallow bevels nearly parallel to the cavosurface should be avoided because the restoration will be too thin at this
area and may chip easily. The discrepancy decreases with the increase in angulation of the bevel.
• The bevel should not produce a very acute margin, which can lead to fracture of the wax pattern during removal.
Over-reduction may lead to the formation of a lip of unsupported enamel lipping.

Chamfer
This finish line possesses a curved slope from the axial wall till the margin. It can be produced using a torpedo
diamond point. The same diamond point when used to reduce more tooth structure will form a deep chamfer finish
line. It is the finish line of choice for cast metal restorations and lingual margins of metal ceramic restorations. It is
not indicated for a res ration where the finish line will be obvious.

Shoulder
This is finish line has a gingival finish wall perpendicular to the axial surfaces of the teeth. If the marginal wall is at
1200 to the axial walls, then it is termed a sloping shoulder. Generally, a shoulder finish line is preferred for all
ceramic restorations where sufficient thickness of the margin is required for structural durability.

Shoulder with a Bevel

It is similar to a shoulder finish line. But an external bevel is created on the gingival margin of the finish line.

Advantages of a finish line bevel

30  EDUDENT
 Prosthodontics

 Aids in contouring the restoration

 Improves burnish ability.
 Minimizes the marginal discrepancy

Preservation of Periodontium
• The placement of finish lines influences the fabrication of the restoration and the final outcome of the treatment.
• The finish lines should be placed in an accessible region so that the margins of the restoration can he easily
finished by the dentist and effectively cleaned by the patient.
• The finish lines should be such that it can be reproduced in the impression
• It should also facilitate the easy removal of the impassion without any tear or deformities.
• The finish line should be in enamel whenever possible.
• Most preferable finish line is a supra-gingival finish line.
• Sub-gingival finish lines predispose to periodontitis.
• A crown lengthening procedure should be done to move the alveolar crest to a location about 3.0 mm away from
the finish line to preserve the periodontal health.

All Ceramic Full Veneer crown

Crowns it provides the best aesthetics. As ceramic is brittle in nature, it is susceptible to fracture. It is mostly used as
a replacement of missing anterior teeth especially incisors. But newer reinforced ceramics are available which make
the material suitable for posterior restorations.
A Half-Moon fracture of an all ceramic crown is the most common form of failure. It usually occurs in:
-Teeth with an edge-to-edge occlusion
-When the opposing teeth occlude on the cervical fifth of the lingual surface.
-Teeth with short crowns
-Teeth with an over shortened preparation

Partial Veneer Crowns

They are preferred over full veneer crowns because they require less tooth reduction. But, they are less retentive
compared to full veneer crowns. Pins can be fabricated to fit pin holes created on the tooth for additional retention.

FIXED FIXED PARTIAL DENTURES

The term denotes fixed partial dentures with rigid connectors. The design of these dentures is more conventional.
Since the connectors an' rigid, there can be no movement between the connected components. These are the most
commonly used fixed partial denture designs.

Advantages Disadvantages
The major advantages of these partial dentures include: • Since the connectors are rigid, unwanted stress and
• Easy to fabricate lever forces are directly transferred to the abutment
• Economical design producing considerable damage.
• Strong • Requires excessive tooth preparation to achieve a single
• Easy to maintain pith of placement.
• Robust design provides maximum retention and • Difficult to cement on multiple abutments
strength • Contraindicated for pier abutments.
• Helps to splint mobile abutments
• Can be used for long bridges along with periodontally
weak abutments.

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Metal-Ceramic Fixed partial Dentures/ Porcelain veneer Crown

Advantages Disadvantages
• Aesthetically pleasing • Significant tooth -preparation necessary not
• Stronger metal substructure conservative.
• Characterization possible internal and external stains. •To achieve better aesthetics, the facial margin of an
anterior restoration is often placed subgingivally, this
increases potential for gingival destruction.
•Slightly inferior in aesthetics compared to all ceramic
restorations.
•Brittle fracture can occur due to failure at the metal
ceramic junction.
•More expensive.

Porcelain Jacket Crown

A jacket crown is a full porcelain ceramic covered crown which is used to protect the entire surface of a tooth.
Crowns are an ideal way to rebuild teeth which have been broken or weakened by decay or large fillings. Crowns are
fitted over the remaining part of the tooth to make it strong and give it the shape and contour of a natural tooth.
Crowns may also be used to help whiten, reshape and realign existing teeth. Jacket crowns have the translucency of a
natural tooth and are often recommended for anterior teeth.

When Is A Jacket Crown Used?

Jacket crown is a tooth shaped protective cap which is used as a covering over a tooth that is chipped, broken or
otherwise damaged to create a permanently restored, functional and aesthetic natural look to teeth.

Advantages of Jacket Crowns

These crowns and bridgework will not corrode, and the normal black gum line that you might see around a porcelain
fused metal crown will not occur, because of the strong ceramic material which is used. Also the hot and cold
sensations you might feel with other crowns normally do not occur because of the lack of electrical conductivity

All ceramic fixed partial denture

Advantages
 Superior aesthetics.
 Excellent translucency.
 Requires slightly more preparation of the facial surface.
 The appearance can be influenced and modified by selecting different colors of luting agent.

Disadvantages
• Reduced strength due to lack of reinforcement with metal
• It is very difficult to obtain a well-finished margin because the ceramic edges tend to chip easily.
• These crowns cannot be used on extensively damaged teeth because they cannot support these restorations.
• Due to porcelain's brittle nature, large connectors have to be used, which usually leads to impingement of the
inter-dental papilla. This increases the potential for periodontal disease.
• Wear of opposing natural teeth.

32  EDUDENT
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Mechanical Methods of Gingival Retraction

Commonly used mechanical methods for gingival retraction are:
• Copper band
• Retraction cord
• Rubber dam
Retraction cords Pressure packing the retraction cord into the gingival sulcus provides sufficient gingival retraction.

Healthy / Ideal abutment

Characteristics:
a. Ideal crown root ratio
b. Adequate thickness of enamel & dentin
c. Adequate bone support
d. Absence of periodontal disease
e. Proper gingival contour

Type of abutment:
•Normal/ideal abutment
•Cantilever abutment
•Pier abutment
•Mesially tilted abutment
-Mesial half crown
-Telescopic crown
•Endodontically treated abutment(depending on the amount of remaining tooth structure)

Types of Retainers
Retainers in fixed partial dentures can be broadly classified as: Based on tooth coverage:
• Full veneer crowns
• Partial veneer crowns
• Conservative (minimal preparation) retainers

Based on the Material Being Used

• All metal retainers
• Metal ceramic retainers
• All ceramic retainers
• All acrylic retainers

Types of connectors:
a. Rigid connector
b. Non rigid connector
•Tenon mortise connector
•Loop connector
•Split pontic connector
•Cross pin and wing

Pontic

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A pontic is a suspended member of FPD that replaces the lost natural tooth, restores function and occupies the space
for the missing tooth.
The artificial tooth that replaces a missing tooth in a fixed partial denture is called a pontic. Pontics are attached to
the retainers. All forces acting on the pontic are transferred to the abutment through the retainers.
It is the connection that exists between the pontic and retainer. They may be rigid or non-rigid)

Pontic Design
The success of a fixed partial denture depends on the proper design of the pontic. If the pontic is not designed to
restore function and aesthetics, the chances of failure are dramatically increased. The objective of designing a pontic
includes the construction of a substitute that favorably compares with the tooth it replaces. Each surface of the pontic
should be designed carefully to fulfil this objective. There are three important factors that control the design of the
pontic.

Factors Affecting the Design of a Pontic

The major factors that determine the design of a pontic are:
 Space available for the placement of the pontic.
 The contour of the alveolar ridge.
 Amount of occlusal load that is anticipated for that patient.

Classification of Pontics
Pontics can be classified in the following ways:
• Mucosal contact.
• Type of material used.
• Method of fabrication
Classification of pontics
Mucosal Contact Based on the amount of mucosal contact, pontics can be classified as:
•With mucosal contract
-Saddle Pontic
-Ridge Lap Pontic
-Modified Ridge Lap Pontic
-Ovate Pontic
•Without mucosal contact
-Bullet Pontic
-Hygienic or Sanitary Pontic

Type of Material Used

Based on the type of material used, pontics can be classified as:
• Metal and Porcelain Veneered Pontic
•Metal and Resin Veneered Pontic
•All Metal Pontic
• All ceramic pontic

Method of Fabrication
Based on the method of fabrication pontics can be classified as:
• Custom made pontic
• Prefabricated pontic

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 Prosthodontics

— True pontic
— Interchangeable facing
— Sanitary Pontic
— Pin-facing Pontic
— Modified Pin-facing Pontic
—Reverse Pin-facing Pontic
—Harmony Pontic
— Porcelain Fused to Metal Pontic
• Prefabricated Custom Modified pontic
• Rigid connectors
• Non-rigid connectors
— Tenon-Mortise connectors
— Loop connectors
— Split pontic connectors
— Cross pin and wing connectors

Abutment selection
The most important factor to be considered in the design of a fixed prosthesis is the location and the characteristics of
the abutment.
The major criteria for choosing an abutment have been discussed below. The factors influencing the choice of
abutment are:
1. Location, Position and Condition of the Tooth
2. Root Configuration
3. Crown Root Ratio
4. Root Support
5. Periodontal Ligament Area
6. Assessment of Pulpal Health

An ideal abutment should have the following characteristics:

• Ideal crown root ratio.
• Adequate thickness of enamel and dentin.
• Adequate bone support
• Absence of periodontal disease
• Proper gingival contour

Bridge
―A restoration or replacement which is attached by a cementing medium to natural teeth, roots, implants.‖–GPT.
These dentures are often termed as Bridges
Parts of a bridge
a. Retainer
b. connector
c. Pontic
d. Abutment
Advantages of Bridge Disadvantages of bridges
• Easy to use • Large amount of bone loss as in trauma.
• Aesthetically good • Very young patients where teeth have large pulp chambers.

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• Functionally sound • Presence of periodontally compromised abutments.

•Patient's preference • Long span edentulous spaces.
• Mentally compromised and physically • Mentally sensitive patients who cannot co-operate with
handicapped patients who cannot maintain the invasive treatment procedures.
removable prosthesis) • Medically compromised patients (e.g. leukemia, hypertension).
• Very old patients.

Model Question

1. Types of Resin based fixed dentures does not C Chamber D. Feather edge
include – Ans: C.
a) Rochtte bridge
b) Maryland bridge 7. The time taken for deposition of secondary
c) Virgini bridge dentin is:
d) None of these A. 4-6 weeks
Ans: D B. 7-8 weeks
C . 8- 12 weeks
2. To increase durability we usually don’t do D. None of the above
during tooth preparation in case axial reduction- Ans: C.
a) Isthmus
b) Occlusal shoulder 8. The objectives of tooth preparation are:
c) On set A. Reduction of the tooth to provide retainer support
d) Proximal box B. Preservation of healthy tooth structure
Ans: C C. Provision for acceptable finish line
D. All of the above
3. In case of shoulder finish line we produce-angle Ans: D.
from gingival wall to axial wall?
a) 120O b) 900 9. The occlusal clearance required for all metal
o
c) 180 d) 360o crown is:
Ans: A A. 2mm
B. 5mm
4. Proximal flare during tooth preparation is done
C. 1-15 mm
for giving-
D. None of the above
a) Retention
Ans: C.
b) Resistance
c) Marginal integrity
10. For the occlusal surface coverage of teeth. The
d) structural durability
best material is:
Ans: C
A. Metal
5. Acceptable crown root ratio is (minimum): B. Porcelain
A. 1:1.5 B. 1:1 C. Acrylic
C.2:1 D. 1:2 D. Composite
Ans: A Ans: A.
Explanation: Metal is the best material for occlusal
6. Which finish line is most preferred in fixed coverage since it does not cause attrition of the
prosthodontics: opposing tooth surface. Porcelain will cause attrition
A. Knife edge B. Shoulder of the upper tooth surface.

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 Prosthodontics

A. Children below 15
11. The pontic for the maxillary posterior region B. For teeth with wide pulp spaces
should be: C. Opposing a tooth with attrition
A. Sanitary D. All of the above
B. Point contact Ans: D.
C. Bullet nose Explanation: Ceramic crowns should not be
D. Saddle considered in any of the cases.
Ans: B.
Explanation: The pontic for the maxillary area 16. A full cast crown covers the tooth:
(posterior region should be of the modified saddle A. Partially
type with the point contact on the aspect of the ridge B. Only on one surface.
for aesthetic and the lingual embrasure should be C. Completely
completely open. D. None of the above
Ans: A
12. The pontic for the mandibular posterior region
should be: 17. The most suitable margin design for cast metal
A. Point contact crown is: .
B. Bullet A. Feather edge
C Sanitary B. Shoulder
D. Saddle type C. Shoulder with bevel
Ans: C. D. Chamfer
Explanation: Sanitary for the mandibular posterior Ans: D.
region the pontic should be sanitary with a gap of Explanation: Chamfer is easily made with a diamond
about 3 mm between the pontic and tissue for ease of with a rounded tip, the margin formed is an exact
cleaning. image of the instrument.

13. The tissue side of the pontic should be:

A. Rough 18. Margin for all ceramic crowns should be:
B. Smooth A. Feather edge
C. Corrugated B. Shoulder
D. Compressive on tissues C. Chamfer
Ans: B. D. Shoulder with bevel
Explanation: The tissue side of the pontic should be Ans: B.
smooth and highly polished so that food material and Explanation: This is specially important when
other debris cannot stick and produce inflammation. porcelain margin technique is used the margin should
form a 90° angle with the tooth surface.
14. The best material for a pontic tissue side is:
A. Metal 19. The taper that should be present in a prepared
B. Ceramic tooth should be:
C. Acrylic A. 10°
D. Composite B. 6°
Ans: B. C. 2°
Explanation: Ceramic can be glazed so that D. Is not important
microporosities do not exist. This forms a smooth Ans: B.
surface on which food does not stick. Explanation: Too small a taper will lead to unwanted
undercuts. Too large will be no longer retentive.
15. Ceramic crowns should not be considered for

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20. The ideal occlusal clearance for a complete cast functional cusps can be protected with less metal, i.e. 1 mm
crown is: clearance.
A. 2.5 mm
B. 1.5 mm
C. 2 mm
D. 0.5 mm
Ans: B.
Explanation: 1.5 mm. A minimum of alloy thickness
about 1.5 mm over centric cusps and the less stressed non

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Chapter 04 Cleft Palate & Oro-facial prosthesis

Maxillofacial prosthodontia is the art and science of functional, or cosmetic reconstruction by means of non-living
substitutes for those regions in the maxilla, mandible, and face that are missing or defective because of surgical
intervention, trauma, pathology, or developmental or congenital malformation.

Classification
A. Intraoral
a. Maxillary b. Mandibular
• Congenital • Congenital
– Cleft lip – Cleft lip
– Cleft palate – Early feeding devices
– Surgical
• Acquired
– Orthodontic
– Total maxillectomy – Prosthodontic
•Complete dentures – Fixed partial dentures
• Partial dentures – Complete dentures
• Obturators – Implants
• Speech aids
• Implants • Acquired
– Complete dentures
– For partial maxillectomy
– Partial dentures
• Complete dentures – Flange prosthesis
• Partial dentures – Mandibular exercisers
– Implants

B. Extraoral
— Auricular prosthesis
— Ocular prosthesis
— Orbital prosthesis
— Nasal prosthesis
— Composite prosthesis
— Lip and cheek prosthesis

Treatment supplements:
• Radiotherapy supplements
— Stents
— Splints
— Shields
— Carriers
— Positioners
— Radiation appliance
• Surgical supplements
— Prosthetic dressings
— Surgical splints
— Surgical obturation
• Chemotherapeutic supplements.

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Types of Maxillary Defects Maxillary defects can be broadly classified as follows:

–– Congenital
–– Cleft lip
–– Cleft palate
–– Acquired
–– Total maxillectomy
–– Partial maxillectomy
Cleft lip
Class I: U/L notching of vermillion border, not extending into the lip.
Class II: cleft extending into the lip, but not including the floor of the nose.
Class III: extending into the floor of the nose.
Class IV: any b/I cleft of the lip, whether incomplete or complete.

Veau’s Classification of Cleft Palate

Veau (1922) classified cleft palate into four types mainly,
• Class I: Cleft involving the soft palate. It can also be a
sub-mucous cleft, which appears normal
• Class II: A midline cleft involving the bone, present
only on the posterior part of the palate
• Class III: A unilateral cleft extending along the mid-
palatine suture and a suture between premaxilla and
palatine shelf
• Class IV: A unilateral cleft extending along the mid-
palatine suture and both the sutures between pre-maxilla
and palatine shelf

Types of Acquired Maxillary Defects

Aramany proposed a classification of partial maxillary defects based on their extent.
• Class I: It is a unilateral defect involving one half of the arch and the adjacent palatine shelf. The defect extends to
the midline (all the teeth in that side of the arch are missing)
• Class II: It is a unilateral defect involving one side of the arch posterior to the canine (teeth posterior to the canine
are absent)
• Class III: It is a defect involving the centre of the palatine shelves (all the teeth are present)
• Class IV: It is a bilateral defect involving one side of the arch along with the entire premaxilla (all anteriors along
with the posteriors of one side are missing)
• Class V: It is a bilateral posterior defect (teeth anterior to the second premolar are present)
• Class VI: It is a bilateral anterior defect (teeth anterior to the second premolar are absent).

Types of Acquired Mandibular Defects

Cantor and Curtis classification of acquired mandibular defects:
Class I: Marginal resection Continuity defect (Lower border of the mandible is preserved
Class II: Segmental free end resection (discontinuity defect) that does not cross the midline.
Modification a: Bilateral resection posterior to the second premolar
Modification b: Unilateral resection posterior to the lateral incisor
Modification c: Bilateral resection posterior to the lateral incisor on one side and the second premolaron the
other
Class III: Segmental free end resection upto or crosses the midline.

40  EDUDENT
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Class IV: Class III + resection of the temporomandibular joint.

Class V: Anterior bounded resection (Fig. 36.17h).
Management of patient with alveolar cleft:
a. Temporary management-
- The condition can be managed by removable partial denture temporarily.
b. Definitive management-
- Definitive management of the alveolar cleft patent is surgical intervention.
- Bone grafting in the defective area followed by fixed implant prosthesis.

Obturators and velo-pharyngeal Prosthesis Obturators

An obturator can be defined as, ―A prosthesis used to close a congenital or acquired tissue opening, primarily of the
hard palate and/or contiguous alveolar structures. Prosthetic restoration of the defect often includes use of a surgical
obturator, interim obturator, and definitive obturator‖

Types of Obturators
Obturators can be classified:
Based on the phase of treatment Based on the material used Based on the area of restoration
a. Surgical obturator a. Metal obturators a. Palatal obturator
b. Interim obturators b. Resin obturators b. Meatal obturator
c. Definitive obturators c. Silicone obturators

Materials Used in maxillofacial prosthesis

a. Acrylic Resin
b. Acrylic Copolymers
c. Polyvinyl Chloride and Copolymers
d. Chlorinated Polyethylene
e. Polyurethane Elastomers
f. Silicones
g. Polyphosphazines
h. Adhesives
i. Metal
Uses
• Provides a stable matrix for surgical packing
• Reduces oral contamination
• Speech will be effective post-operatively
• Permits deglutition
• Reduces the psychological impact of the 'cursory
• May reduce 11w period or hospitalization.

Treatment prosthesis
A treatment prosthesis can be defined as ―A prosthetic appliance used for the purpose of treating or conditioning the
tissues that are called on to support and retain it.‖

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Total dental management of children with cleft lip and palate

Age General dental & Pediatric dental Orthodontic care. Surgical care.
care.
Birth Initial contact and interview with Construction of presurgical Initial assessment.
parents. Case discussion with orthopaedic appliance if
surgical and orthodontic teams. required.
3-6 Introduce dental care plan. Study Primary surgical repair of lip
months models at time of lip repair
12 months to Review. Surgical repair of Palate.
2 years.
2-6 years 6 monthly reviews for assessment of Possible revision of lip
growth and development, preventive repair. Pharyngoplasty if
advise. Topical fluoride applications required.
and fissure sealing. Myringotomy and grommets
by ENT.
6-7 years Fissure sealing of first permanent Myringotomy and grommets
molars. Composite resin restoration by ENT as required.
of hypoplastic teeth adjacent to cleft.
Preventive advice.
8-10 years Case discussion with surgical and Assessment for maxillary Bone grafting at one-half to
orthodontic teams for bone grafting. expansion prior to bone two-thirds root development
Possible extraction of supernumerary grafting. Skeletal age of canine.
teeth. Interim bridge or partial assessment.
denture.
11-15 years Retention of palatal expansion. 6 Full fixed appliance therapy. Review and possible
monthly review. Fissure sealing of Minor tooth irregularities surgical revision if required.
bicuspids and second molars. may be corrected by
removable appliance.
16-17 Restoration 9f teeth in the cleft by Retention following Assessment of the need for
years crowns, bridges, implants, dentures orthodontic therapy. Orthognathic surgery.
etc.

Dental Implantology

Advantages of Using Implants

•Presentation ethane: The implant stimulates the bone like a natural tooth thereby preventing the progress of residual
ridge resorption.
• Improved fraction: Implants can be designed such that the effect of harmful forces can be minimized. The chewing
efficiency is greater than other prosthetic replacements.
• Aesthetics: Implants provide a natural emergence profile (appearance of the tooth as if it emerges directly from the
soft tissues).
• Stability & retention: Implants are more stable and retentive due to osseo-integration.
• Comfort Implants are more comfortable as the extent of flanges of the final prosthesis can he be reduced.

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Disadvantages of Implants
• It is very expensive: Patient affordability is the primary concern in the use of implants.
• Cannot be used in medically compromised patients who cannot undergo surgery.
• Many patients do not accept longer duration of treatment and tedious fabrication procedures.
• It requires a lot of patient cooperation because repeated recall visits for after care is essential.
• It cannot be universally placed due to the presence of anatomical limitations.

Implants can be classified under five categories namely:

• Depending on the placement within the tissues
• Depending on the materials used
• Depending on their reaction with bone
• Depending on the classification of edentulous spaces
• Depending on the treatment options
• Depending on the placement within the tissues:

Depending on their placement within the tissues, implants can be classified into
1. epiosteal.
2. endosteal and
3. transosteal implants.
Epiosteal Implants
It is a dental implant that receives its primary bone support by resting on it. E.g. Sub-periosteal implants
Transosteal Implants It is a dental implant that penetrates both cortical plates and passes through the entire
thickness of the alveolar bone
Endosteal Implants It is a dental implant that extends into the basal bone for support. It transects only one cortical
plate. It can be further classified into root form and plate form implant
Endosteal Implants
1. Root form Implants
2. Plate form Implants

Biocompatibility Materials available at present are co Ti (commercially pure Titanium) Ti-6Al-4V (Titanium-6
Aluminium-4 Vanadium) cp Niobium and Hydrooxyapatite (HA). cpTi is the most biocompatible material.

Metals
Stainless steel
Cobalt-Chromium-Molybdenum alloys
Titanium and its alloys
Surface coated Titanium
Gold
Tantalum

Ceramics
Hydroxyapatite
Bio-glass
Aluminium oxide

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Titanium and its Alloys

Titanium is a highly reactive metal. It is the material of choice because of its predictable interaction with the
biological environment.

Composition
• Commercially pure Titanium (99.999% Pure
Titanium) is available for the use in dental
implants
• Commonly used Titanium alloys contra by
weight Titanium, 6% by weight of
Aluminum and 4% by weight of Vanadium.

Surface Coated Titanium

It is new implant design where the titanium
implant is coated with a plasma spray of
hydroxyapatite, which improves the rate and
quality of osseointegration. Hann and Palich
developed it.

Model Question

1. Factors not affecting Osseo-integration of 3. Ceramic used as Implant material –

implant? a) Gold
a) Occlusal load b) surface coated materials
b) Implant bed c) Bio-glass
c) Infection d) Carbon
d) Bio-availability of the material Ans: C
Ans: D
4. Following which is not a part of an implant?
2. Porous compact bone is known as – a) Fixture
a) D1 bone b) Healing screw
b) D2 bone c) Gold crown
c) D3 bone d) Healing caps
d) D4 bone Ans: C
Ans: B

44  EDUDENT
 Prosthodontics

5. Anatomical problem associated with edentulism 12. What should the distance between the implant
is: and the post ligament of the adjacent teeth be?
A. Width of supporting bone A. 2 mm
B. Height of supporting bone B. 1 mm
C. Thinning of mucosa and sensitivity or abrasion C. 5 mm
D. All of the above D. 3 mm
Ans: D. Ans: B

6. An endosteal implant is an implant inserted in: 13. Time taken for integration of implants in the
A. Periosteum maxilla is:
B. Bone A. 4 months
C Root canal B. 2 months
D. None of the above C. 6 months
Ans: B. Ans: C.
Explanation: A minimum of 6 months is needed for
7. Endosteal implant can be: adequate integration of implant on the maxilla since it
A. Root form implant only has larger marrow spaces and thinner cortex.
B. Plate form implant only
C. Can be either root form or plate form 14. With respect to anatomic limitation the most
D. Combination of both straightforward area for implant placement is:
Ans: C A. Anterior mandible
B. Posterior mandible
8. The most common types of implant in use today C. Anterior maxilla
are: D. Posterior maxilla
A. Subperiosteal implant Ans: A.
B. Transosteal implants Explanation: The anterior mandible has adequate
C. Endosteal implants height and width for implant placement and the bone
D. All of the above quality is normally excellent.
Ans: C.
15. The recommended time interval between
9. The minimum space between implant should be: surgery and placing load in the posterior mandible
A. 2 mm is:
B. 5 mm A. 2 months
C. 3 mm B. 3 months
D. 4 mm C. 4 months
Ans: C. D. 6 months
Ans: C.
10. This distance between the implant and the
superior aspect of the inferior alveolar canal 16. The recommended interval for the maxilla is:
should be: A. 2 months
A. 1 mm B. 3 months
B. 3 mm C. 4 months
C. 2 mm D. 6 months
D. 4 mm Ans: D.
Ans: C
17. The new generation of bonding material avai-
11. The distance between the implant and the lable can bond:
mental foramen should be: A. Composite to metal
A. 2 mm B. Composite to tooth
B. 3 mm. C. Composite to ceramic
C. 1 mm D. All of the above
D. 5 mm Ans: D.
Ans: B.
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18. When bonding porcelain veneers to the

enamel. The preferred luting cement should be: 21. Impression of margins of abutment level
A. Polycarboxylate should be taken with:
B. Composite resin A. Reversible hydrocolloid
C. Zinc phosphate B. Irreversible hydrocolloid
D. Dual cure resin C. Elastomeric materials
Ans: D. D. Any of the above
Ans: C.
19. Pontic designed for fixed restoration should:
A. Have no mucosa contact 22. Based on the area of restoration – obturator is
B. Be sanitary known as-
C By self cleansable a) Surgical obturator
D. All of the above b) Meatal obturator
Ans: D. c) Definitive obturator
d) Resin obturator
20. While selecting a post and core system Ans: B
preferably the post should be:
A. Tapered 23. Intra oral maxillofacial prosthesis-
B. Parallel a) Lip & cheek prosthesis
C. Threaded b) Nasal prosthesis
D. Non threaded c) Early feeding devices
Ans: B. d) Ocular prosthesis
Explanation: Paralleled posts are thought to be better Ans: C
than the rest because they do not cause stress on the
tooth unlike tapered and threaded post system.

Self-Assessment (Prosthodontics)

1. Minimum occlusal clearance on centric cusp for 4. Pontic design not indicated in anterior region:
cast metal is: a. Ovate pontic
A. 0.5 mm b. Verified ridge lap pontic
B. 1 mm c. Stem pontic
C. 1.5 mm d. Spheroidal pontic
D. 2 mm
5. The posterior tooth that gives a better support
2. For a patient with missing canine what type of is:
prosthesis will we prefer: a) With convergent roots
A. Three unit FPD b. Divergent roots
B. Resin retained FPD C. Conical roots "'.
C. Implant retained crown Curved roots
D. It will depend on patient choice
6. The most suitable margin design for porcelain
3. A pier abutment is: crown is:
A. Periodontal weak abutment A. Shoulder
B. With an edentulous space on both side of the B. Chamfer.
abutment C. Shoulder with bevel
C. Edentulous space on one side of the abutment D. Depends upon operators choice
D. Abutment adjacent to space

46  EDUDENT
 Prosthodontics

7. Only pure hinge movements of mandible occur at: 14. In the concept of biological width, the value of
A. Centric occlusion biological width is:
B. Centric relation A. 1 mm
C. Lateral excursion B. 2 mm
D. Terminal hinge position C. 3 mm
D. 4 mm
8. To replace a missing canine, the best pontic
design is: - 15. The I-Bar RPD was introduced by:
A. Modified ridge lap A. Berg and caputo
B. Ridge lap B. Kratochvil
C. Ovoid C. McDowell
D. Sanitary D. Krol

9. Impression material of choice in patients with 16. Thickness of the die spacer should be:
submucous fibrosis is: A. 10-20 µn
A. Zinc oxide eugenol B. 20-40 µn
B. Addition silicon C. 40-60 µn
C. Condensation silicon D. 60-80 µn
D. Plaster of Paris.
17. Anatomic teeth should have a cusp angle of:
10. Anterior vibrating line is located on: A. 30 degree
A. Soft palatal tissue B. 3.1 degree
B. Hard palatal tissue C. 32 degree
C. Either on the soft or hard palatal tissue D. 33 degree
D. Posterior to fovea palatini
18. The most common trigger factor for bruxism
11. The terminal end of retentive arm of extra- is:
coronal retainer is placed at: A. TMJ dysfunction
A. Gingival third B. Pericoronitis
B. Occlusal third C. Discrepancy between centric occlusion and
C. Middle third centric
D. Junction of middle and gingival third relation
D. Acute periodontal disease
12. The superior border of lingual bar major
19. Chamfer finish line is used in:
connector should be located below the gingival
A. Labial side of all ceramic crown
margin by a minimum of:
B. Lingual of All crown
A. 2 mm
C Lingual of PFM
B. 4 mm
D. Labial of PFM
C. 5 mm
D. 1 mm
20. All of the following are major factors that
affect the design of a FPD except one
13. Vibrating line is present on:
a. abutment selection
A. Hard palate
b. arch curvature
B. Junction of hard and soft palate
c. length of the edentulous span
C. Soft palate
d. age of the patient
D. Junction of muscularis mucosae and palatine
muscle

EDUDENT  47
 Quick Bite

21. Which is a functional requirement of a clasp? 24. Ovate pontics are used in
a. passivity a. well rounded ridge
b. retention b. knife edged ridge
c. reciprocation c. flat ridge
d. all of the above d. recently extracted tooth sockets

22. Which of the following statement is not true 25. Non anatomic teeth are indicated primarily in:
about onlay? A. Flat ridge
a. is a intracoronal restoration B. Sharp ridge
b. it covers more than two cusps of a tooth C. Poor muscular control
c. both facial & lingual reduction is done before D. All of the above
placement of an onlay
d. unaesthetic

23. To replace a missing canine, the best pontic

design is
a. modified ridge lap
b. ridge lap
c. ovoid
d. sanitary
Answer
1. C 5. B 9. B 13. C 17. D
2. C 6. B 10. A 14. B 18. C
3. B 7. D 11. A 15. B 19.C
4. D 8. A 12. B 16. B 20.A
21. D 22. D 23. D 24. A 25. C

48  EDUDENT