What needs to be evaluated in a clinical exam before I begin a full denture for a patient?

ANSWER

The following are the essential elements of a good clinical pre-treatment evaluation for each denture patient:

1)	Muscle Tone a) good b) fair c) poor
2)	Mouth Shape a) size b) mouth curvature c) upper lip thinning d) signs of angular cheiliosis
3)	Jaw Size a) large - favorable b) medium c) small
4)	Ridge Form a) normal U-shaped b) difficult V-shaped c) abnormal - bulbous
5)	Ridge Relation a) normal class I b) retrognathic c) prognathic
6)	Ridge Parallelism a) parallel - favorable b) divergent - causes shifting
7)	Intermaxillary Space a) wide b) close - difficult
8)	Vault Form a) square - favorable b) arched - favorable c) taporing - unfavorable d) flat - favorable retention, unfavorable stability
9)	Tori a) small b) medium c) large
10)	Soft Tissue a) normal - 1 mm. uniform thickness over ridge b) thin c) heavy
11)	Border Tissue Attachments a) high - decreases support b) low - well extended flanges possible
12)	Throat Form Upper: a) class I - 6 mm. soft tissue from hard palate to vibrating line of soft palate b) class II - 3 mm. soft tissue from hard palate to vibrating line of soft palate c) class III - no soft tissue from hard palate to vibrating line of soft palate Lower: a) class I - 90 degrees to retromolar pad b) class II - 60 degrees to retromolar pad c) class III - 45 degrees to retromolar pad
13)	Tongue Form and Position a) normal - tongue apex slightly below incisal edges of mandibular incisors b) subnormal - flat, broad c) abnormal - retractive tongue
14)	Saliva a) normal b) thin, watery c) thick, ropey
14)	Mental Attitude a) philisophical b) exacting c) nervous d) indifferent

QUESTION

What do I need to check on a custom tray to achieve a good tray and thus a good impression?

ANSWER

When the custom tray is returned from the lab (or after construction in your office), try it in the patient's mouth. For a maxillary custom tray, check to make sure that the tray border has 2 mm. of space between the periphery and the height of the buccal vestibule. Also, be sure the labial and buccal frenae clear in all directions. The tray should have inherent suction and the coronoid processes of the mandible should clear at the disto-buccal corners of the tray when the mandible moves right and left. For the mandibular custom tray, the peripheries must also be reduced 2 mm. for a good peripheral roll of impression material, the frenae must clear freely, and the tray should be stable. In addition, remember to check the mylohyoid muscle attachment on the disto-lingual border. The muscle should clear freely when the patient sticks their tongue out.