Complete DenturesComplete DenturesPatient EvaluationPatient Evaluation

Clinical ExaminationClinical ExaminationExtraoralExtraoral

Linda YenLinda Yen

ExtraoralExtraoral

Facial – form + featuresFacial – form + features Muscle – Tone + devMuscle – Tone + dev ComplexionComplexion LipLip TMJTMJ Neuromuscular – speech + Neuromuscular – speech +

coordinationcoordination

FacialFacial Form Form

– What’s the outline of face? What’s the outline of face? teeth selection teeth selection SquareSquare TaperTaper Square taperSquare taper ovoidovoid

ProfileProfile jaw relation + occlusion I, II, IIIjaw relation + occlusion I, II, III

Lower facial Height (VD) Lower facial Height (VD) vertical jaw relationvertical jaw relation FeaturesFeatures

shade, shape, arrangement of teethshade, shape, arrangement of teeth– Lips: length, fullness, supportLips: length, fullness, support– Philtrum, nasolabial fold, labiomental groovePhiltrum, nasolabial fold, labiomental groove– Width of vermillion border Width of vermillion border tooth display tooth display– Size of oral opening Size of oral opening tooth display tooth display– Skin texture Skin texture teeth selection teeth selection

Muscle (House Muscle (House classification)classification)

ToneTone stabilitystability

I: no degeneration. Normal. Common in immediate denture I: no degeneration. Normal. Common in immediate denture pts.pts.

II: normal function but ↓ toneII: normal function but ↓ tone III: ↓ function, ↓ toneIII: ↓ function, ↓ tone

– Denture ill fitting, ↓ VD Denture ill fitting, ↓ VD wrinkles, dropping commissures, ↓ wrinkles, dropping commissures, ↓ biting force, biting force,

DevelopmentDevelopment– More dev, ↑ biting force More dev, ↑ biting force – House: I (heavy)House: I (heavy) II (medium)II (medium) III (light)III (light)

ComplexionComplexion

Colour (eye, hair, skin)Colour (eye, hair, skin) teeth selectionteeth selection

Lip Lip teeth selection teeth selection

SupportSupport MobilityMobility ThicknessThickness

– Thicker, need ↓ support from artificial teeth + labial Thicker, need ↓ support from artificial teeth + labial flange, so can place teeth freely whereas thin lips need flange, so can place teeth freely whereas thin lips need appropriate labiolingual teeth positionappropriate labiolingual teeth position

LengthLength– Shorter, reveal more tooth + denture baseShorter, reveal more tooth + denture base

HealthHealth– Ulcers, cracks, fissure Ulcers, cracks, fissure candidiasis, B def, ↓VD candidiasis, B def, ↓VD

TMJTMJ

MvtsMvts Muscles of mast.Muscles of mast. SoundsSounds PainPain

– If severe, indicates ↓ or ↑ VDIf severe, indicates ↓ or ↑ VD

Neuromuscular: Neuromuscular: can they accommodate new CD?can they accommodate new CD?

SpeechSpeech– Normal: can articulate with existing CD Normal: can articulate with existing CD will accommodate will accommodate

new CDnew CD– Affected: special attnetion for ant. Teeth arrangementAffected: special attnetion for ant. Teeth arrangement

If speech altered by bad CD, need more time to adapt to proper If speech altered by bad CD, need more time to adapt to proper speech in new CDspeech in new CD

CoordinationCoordination– Parkinsons, hemiplegia, cerebellar diseases, psychotropic Parkinsons, hemiplegia, cerebellar diseases, psychotropic

drugsdrugs– How? How?

Observe gait + facial + bodily mvtsObserve gait + facial + bodily mvts– Why? Why?

Manifestations on faceManifestations on face Good neuromuscular coordination Good neuromuscular coordination learn to manipulate CD learn to manipulate CD Abnormal mvts: lip smacking, tongue tremors, uncontrollable Abnormal mvts: lip smacking, tongue tremors, uncontrollable

chewing mvts influence CD performance chewing mvts influence CD performance