PEMICU 1

1. Etiologi dan Mekanisme wajah pasien lebih tua?

Etiologi: Vertikal dimensi pasien menurun

Mekanisme:

2. Etiologi dan Mekanisme lengkung RB terlihat lebih besar dari RA?

Consequences on the Bony Structures

Basal bone forms the dental skeletal structure, contains most of the muscle
attachments, and begins to form in the fetus before teeth develop. Alveolar
bone first appears when Hertwigs root sheath of the tooth bud evolves (Fig. 15).44 The alveolar bone does not form in the absence of primary or secondary
tooth development. The close relationship between the tooth and the alveolar
process continues throughout life. Wolffs law states that bone remodels in
relationship to the forces applied.45 Every time the function of bone is
modified, a definite change occurs in the internal architecture and external
configuration.46 Bone needs stimulation to maintain its form and density.
Roberts et al.47 report that a 4% strain to the skeletal system maintains bone
and helps balance the resorption and formation phenomena. Teeth transmit
compressive and tensile forces to the surrounding bone. These forces have
been measured as a piezoelectric effect in the imperfect crystals of durapatite
that compose the inorganic portion of bone.48 When a tooth is lost, the lack of
stimulation to the residual bone causes a decrease in trabeculae and bone
density in the area, with loss in external width and then height of the bone
volume. 49 The width of bone decreases by 25% during the first year after
tooth loss and an overall 4 mm in height during this first year following
extractions for an immediate denture. 50 In a longitudinal, 25-year study of
edentulous patients, lateral cephalograms demonstrated continued bone loss
during this time span; a fourfold greater loss was observed in the mandible
(Figs. 1-6 and 1-7).51 However, because the mandible begins with twice the
bone height of the maxilla, maxillary bone loss is also significant in the
long-term edentulous patient.

TAMBAHAN: JURNAL 2007

Arahkan ke arah resorbsi rahang atas: bukal ke palatal. Alasan: Karena daerah tulang di
daerah bukal kurang compacta, akibat mastikasi lebih cenderung diperankan oleh cusp palatal
Dan sebaliknya untuk rahang bawah rb tampak lebih besar

3. Jelaskan etiologi dan mekanisme terjadinya sakit kepala dan nyeri di sekitar rahang
yang dirasakan oleh pasien tersebut !
The etiology of TMD in clinical dentistry has been considered as one of the most
controversial issues. The concept of mandibular over closure proposed by Dr. James
Costen, an otolaryngologist in 1934 was related to various ear symptoms.4 This was
expanded in the 1970s into mechanical displacement theory. This theory claimed
that deflective occlusal contacts and lack of molar support were directly responsible
for the eccentric positions of condyles in fossa and that these eccentric positions
caused pain and dysfunction. This theory was based on the hypothesis that the
condyles had to be in a central position for proper function. (Gerber, 1971;Weinberg,
1983).
This hypothesis has been disapproved by several investigators, demonstrating
eccentric condylar positions in many asymptomatic patients.20 The proponents of
mechanical displacement theory believed in the diagnostic value of TMJ radiographs
and articulated casts and provided prosthetic reconstruction of patients dentition to
achieve therapeutic condyle repositioning.
The second theory that evolved in 1970s was based on assumption that occlusal
interferences or loss of molar support caused hyperactivity in the masticatory
muscles.19 The altered periodontal receptor input will adversely affect the sensory
feedback mechanism and result in disturbed patterns of muscle contractions.12 The
patients tried to remove the interferences by parafunctional muscular activity or to
stabilize the jaw in cases where occlusal stability was not present. Interferences were
thought to be the direct cause of parafunction leading to jaw muscular pain and joint
overload and dysfunction.22, (Ramfjord & Ash 1966, Dawson 1974). Similar
responses were seen during hyperextension that may occur in yawning, biting or
prolonged dental procedure or an inadvertent injury to medial pterygoid muscle
during administration of local anesthesia in inferior alveolar nerve block procedure.
The spasm and pain may occur in any or in combination of masticatory muscles. Once
it occurs the problem can be self perpetuating and this could account for some cases
of myofacial pain dysfunction.23 This neuromuscular concept was not applicable to

all the TMD patients who resulted in bringing the dental professions attention to the
relationships between different morphological parts of the masticatory system (joints,
occlusion, and muscles) and the psychological and behavioral characteristics of
patient.

TAMBAHAN: JURNAL 2010

4. Jelaskan kemungkinan penyebab saliva sedikit dan kental dan bagaimana cara
pemeriksaan laju aliran saliva yang sesuai dengan kasus ini !
The diabetes mellitus type 2 (non insulin-dependent) or adult diabetes affects people
aged over 40, frequently overweight or obese. This metabolic variety is characterized
by the partial shortage of insulin that is proved by disturbances in the metabolism of
glucose and therefore the normal assimilation process is affected (1,2). The most
common alterations, at a stomatologic level, include periodontal diseases, caries,
candidiasis, commissural quelitis and sialomegaly. All of the already mentioned are
linked to the xerostomy and glandular hypofunction (1,3-6). Some authors (2,3,7)
state that the decrease of the salivary stream in diabetics is caused by the increase of
diuresis or poliuria, that make the extracellular liquid decrease notoriously, and as a
consequence, the production of saliva.
Diabetes mellitus is one of the etiological causes of sialosis, a pathology generally
characterized by a bilateral enlargement, neither neoplastic nor inflammatory, of the

parotid gland (8-10). Sialosis, however, can have different origins, having been
described as a consequence of hormonal, nutritional or metabolic disturbances,
medicamentosus or neurohumoral alterations (3,11,12). Furthermore, the process is
not exclusive to the parotid, but also affects, to diverse degrees, the other larger and
smaller salivary glands (13-16). Clinically it is said that the swelling of diabetic origin
frequently has a prearicular ubication (1,3,7) different from the alcoholic sialosis is
located at an retromandibular level. In addition, the diabetic sialosis shows a more
pronounced swelling (1,17).
The sialosis generally involves glandular hypertrophy, produced either by adipose
infiltration or by acinar hypertrophy. There are authors who accept the coexistence of
both modifications, while others deny such a possibility (18,19). The fact is that
acinar hypertrophy is not always present in sialosis, as a consequence some authors
centre their attention on the glandular dysfunction. This dysfunction is generally
manifested as salivary hypofunction and xerostomia (12).
This pathology is not considered neither inflamatory nor tumoral, but a degenerative
one. It is also linked to an alteration in the autonomous glandular neuroregulation
(1,7,12) produced by a demielination (or sympatic denervation) and an atrophy of the
mioepithelial cells. This would interfere with the secretion mechanism that is
produced by the stimulation of the alpha and beta adrenergic receptors of the acinar
cells, that phisiologically induce exocytosis (3,5,12).
In previous studies of parotid glands from individuals with alcoholic sialosis we
described heterogeneous accumulations of secretory granules of different sizes,
irregularly distributed throughout the cytoplasm of the acinar cells, unlike the Von
Ebner serosa glands, where the granules were smaller, homogeneous and
preferentially located in the apical region. Likewise, the alterations at the epithelial
level of the ductal system were highly evident. The striate ducts exhibited an
epithelium of pseudostriated appearance, with elongated nuclei of dense chromatin,
together with other nuclei surrounded by loose chromatin. In the excretory ducts, of
note, was the increase in ductal diameter, the stasis of the secretory material with
desquamated cells, and epithelial atrophy, immunohistochemically heterogeneous for
cytokeratins (13,14, 20, 21).
With respect to its function there have been described, other than the flow
disturbances, modifications of the salivary biochemistry in type 2 diabetic patients:
disturbances in the glucose concentration, total protein count, albumin, lisozymes,

peroxidase, electrolytes (sodium, potassium, chloride, phosphorus, magnesium,

calcium), amylase, IgA, and in its buffer capability. Although these findings have not
been related by all the studies. Therefore Ben-Aryeh et al. (22) studied 35 type 2
diabetics and they compared them with a control group. The results of this study
found increased levels of glucose, total protein, and potassium, normal levels of
amylase, IgA and sodium and a reduced salivary flow, not finding any correlation
between blood and salivary glucose levels.
Dodds et al. (23) studied the effects of metabolic control in salivary flow, protein
concentration, and salivary amylase activity in type 2 diabetics, finding a reduced
salivary amylase activity, but no significant difference in the protein concentration or
in the salivary flow. Reuterving et al. (24) studied the influence of the degree of
severity of diabetes in the salivary flow and in the glucose concentration in 11 patients
with type 1 and 2 diabetes, not finding any significant difference in pH, buffer
capacity, total proteins, electrolytes, lysozymes, peroxidases, or metabolic control.
They concluded that the degree of metabolic control doesnt have a great influence in
salivary composition, except in the salivary concentration of glucose. Forbat et al.
(25) measured the concentration of blood and salivary glucose in 31 patients with type
2 diabetes mellitus. They concluded that salivary glucose levels dont reflect blood
glucose levels.
In type 1 and 2 diabetic patients it has also been tried to correlate salivary
composition with the presence of oral pathology, finding dental caries in 100% of
diabetic patients and an overall increase in periodontal disease (26-28).
The objectives of our study were: to compare the biochemical findings in the saliva in
a sample group of diabetics against the saliva of a control group; to establish if the
salivary biochemical disturbances are related with metabolic control; to determine if
the variables of the oral and periodontal findings are related with the salivary
biochemical disturbances; and to establish the usefulness of measuring the salivary
biochemistry of type 2 diabetes mellitus patients, as an optional parameter to evaluate
the metabolic state.
Cara pemeriksaan laju aliran saliva?

5. Kemungkinan penyebab mukosa yang tipis?

As bone loses width, then height, then width, and then height again, the attached
gingiva gradually decreases. A thin attached tissue usually lies over the advanced
atrophic mandible or is absent entirely. The gingiva is prone to abrasions caused by
the overlaying prosthesis. In addition, unfavorable high muscle attachments and
hypermobile tissue often complicate the situation. The thickness of the mucosa
on the atrophic ridge also is related to the presence of systemic disease and
physiologic changes accompanying aging. Conditions such as hypertension, diabetes,
anemia, and nutritional disorders have a deleterious effect on the vascular supply and
soft tissue quality under removable prostheses. These disorders result in a decreased
oxygen tension to the basal cells of the epithelium. Surface cell loss occurs at the
same rate, but the cell formation at the basal layer is slowed. As a result, thickness of
the surface tissues gradually decreases. Therefore sore spots and uncomfortable
removable prostheses result.
6. Jelaskan penyebab lidah yang berukuran relative lebih besar!

The tongue of the patient with edentulous ridges often enlarges to accommodate the
increase in space formerly occupied by teeth. At the same time, the tongue is used to
limit the movements of the removable prostheses and takes a more active role in the
mastication process. As a result, the removable prosthesis decreases in stability. The
decrease in neuromuscular control, often associated with aging, further compounds
the problems of traditional removable prosthodontics. The ability to wear a denture
successfully may be largely a learned, skilled performance. The aged patient who
recently became edentulous may lack the motor skills needed to accommodate to the
new conditions.

7. Jelaskan pengaruh saliva yang sedikit dan kental terhadap pemakaian GTP!
Saliva & Complete Denture Prosthodontics
The role of saliva in maintaining the overall wellbeing of the oral cavity in dentate
individuals is well documented. In edentulous subjects, who have lost all their teeth
and are dependent upon artificial prosthesis to carry out the basic oral functions of
mastication, the presence of appropriate quantity and quality of saliva becomes even
more critical.
Optimal salivary flow and consistency plays an important role not only in the denture
fabrication process but also in the maintenance of integrity of the prosthesis. In
patients who present with an excessive secretion of saliva, proper impression making
becomes difficult. Also, the minor palatal glands are known to secrete saliva rich in
mucins. The presence of such highly mucous saliva may distort the impression
material and prevent the ideal reproduction of posterior portion of the palate in the
impression.9
Saliva also plays a very important role in preserving denture integrity by keeping the
denture surfaces clean and in maintaining proper oral hygiene by physically washing

away food and other debris from the soft tissues and from the polished surface of the
prosthesis. The lubrication provided by saliva in dentate subjects is equally important
in the edentulous as this makes the surface of the dentures more compatible with the
movements of the lips, cheek and tongue. Salivary glycoproteins facilitate the
movement of soft tissues during speech, mastication and swallowing of food.
Denture retention is also to a large extent dependent upon saliva. Retention in
complete denture prosthodontics is defined as the quality inherent in the prosthesis
which resists the forces of dislodgement along the path of insertion.10 Successful
rehabilitation of edentulous patients with complete dentures is largely contributed to
by satisfactory denture retention. Two important factors that contribute to retention of
complete dentures include the establishment of an accurate and intimate fit of the
denture base to the mucosa and the achievement of a proper peripheral seal. 11 The
physical factors that contribute to denture retention include Adhesion, Cohesion,
Interfacial surface tension, Atmospheric pressure, Capillary attraction and Gravity. An
optimal flow, consistency and volume of saliva is considered to be a major factor in
enabling these physical factors to act in unison and aid in denture retention. 11 -13
The adhesive action of the thin film of saliva between the denture base and the
underlying soft tissues is considered to be one of the principal factors that aids in
denture retention. Such adhesive action of saliva is achieved through ionic forces
between charged salivary glycoproteins and surface epithelium on one side and
denture base acrylic resin on the other.13 This thin film of saliva also acts as a
lubricant and cushion between the denture base and oral tissues and tends to reduce
friction. Also, the cohesive forces within the
layers of saliva present between the denture base and mucosa aid in maintaining the
integrity of interposed fluids and aids in retention. The presence of a thin film of
saliva also provides interfacial surface tension and resists the separation between the
denture surface and the mucosa.
Not just the quantity, but also the flow rate, quality & consistency of saliva influence
denture stability and tolerance. The presence of thick ropey saliva may compromise
maxillary denture retention by creating a negative hydrostatic pressure in the area
anterior to the posterior palatal seal leading to downward dislodgement of the denture.
The normal salivary flow rate is about 1ml/min. Optimum quantity of saliva of
medium viscosity at this rate lubricates the mucosa and assists in denture retention.

An inadequate salivary flow may have a profound effect on denture retention and
stability and also tends to make mastication and deglutition difficult. Loss of the
mechanical protective influence of saliva on the denture supporting tissues would
predispose them to irritation. Also, the antibacterial action provided by saliva would
be proportionally reduced making the denture bearing oral tissues more susceptible to
infection.14
Considering the highly significant role played by saliva in successful complete
denture rehabilitation, it is imperative for the prosthodontist to give due attention to
the quantity and quality of saliva during the fabrication of complete dentures. Hyposalivation and associated xerostomia is a common finding in the elderly. The effect of
age on salivary secretion and flow has been a matter of great debate. However, it is
now believed that aging does not directly reduce salivary flow per se; a number of
factors associated with aging may however do so. 5, 15 The geriatric prosthodontic
patient may be under some sort of medications that tend to affect salivary function.
These include drugs such as sedatives, anti-hypertensives, anti-depressants and antihistaminics. Any systemic factors such as alcoholism, depression and the presence of
diseases such as uncontrolled diabetes, pernicious anaemia, rheumatoid arthritis,
Vitamin A & Vitamin-B deficiency and Sjogrens syndrome are also known to have a
profoundly negative influence on salivary secretion. Patients who have undergone
radiotherapy in the head and neck region also present with xerostomia due to the
associated destruction of salivary glands.15-16 Any such systemic diseases must be
identified prior to denture fabrication and due consultation should be sought from the
physician. If the patient is under any medication that tends to cause hypo-salivation,
consultation should also be sought to substitute these drugs with others that have
lesser adverse effects.17
In patients with xerostomia in whom some residual salivary capacity remains,
stimulation of salivary glands may be induced by the by the frequent snacking and by
the use of lemonades, lozenges and sugar free gums like xylitol. 17 Sialogogues such
as pilocarpine may also be prescribed in an attempt to stimulate salivary secretion.18
In severe cases where the salivary glands cannot be stimulated to produce sufficient
saliva, salivary substitutes 12,13,17 may be used. These substitutes range from readily
available compounds such as milk to the commercially available substitutes such as
artificial saliva (which may be mucin or carboxymethyl cellulose based), Salinum
(containing Linseed oil), Luborant (based on lactose peroxidase) and others.

Glandosane is a salivary substitute with an acid pH indicated specifically in denture

wearers.
Another approach to providing optimal lubrication in complete denture patients is the
use of saliva delivery systems in the form of oral lubricating devices or reservoir
dentures. The clinician may either fabricate new reservoir dentures for the patient or
may add reservoirs to the existing dentures. An important concern is the size, shape
and location of the reservoir. The commonly preferred sites for adding reservoir is the
palate in the maxillary denture and interior of the mandibular complete denture.
13,19-20
The prosthodontists role does not end just at denture fabrication and delivery. An
important concern for prosthodontic patients who have recently received new dentures
is the discomfort associated with a significant increase in salivary secretion. The
prosthodontist should explain to the patient that the new dentures are perceived as
foreign objects, stimulating the salivary glands to produce excessive saliva, which
necessitates frequent deglutition. Such an increase in salivary flow is however a
transient natural response of the oral tissues and tends to diminish over time. During
this period, the patient should also be advised to avoid compulsive rinsing & spitting
as it is unsettles the denture. Also, following the delivery of complete dentures in
patients with xerostomia, it is important to advise the patient to use the dentures for
shorter periods of time and to consume soft and moist foods which would be tolerated
better by the oral mucosa.8 Such patients should also be advised to have frequent sips
of water17 and should be followed up regularly to assess and suitably treat any form
of mucosal ulceration or denture stomatitis.

8. Jelaskan pengaruh mukosa yang tipis terhadap pemakaian GTP!

The dentures are surrounded by the cheeks and lips, which are covered by lining
mucosa. This mucosa moves in intimate contact with the dentures during the
functioning of the related facial and masticatory muscles. The lining mucosa of the
lips and cheeks and floor of the mouth is relatively thin and easily traumatized. It is
also the site of a variety of pathoses. The lingual and palatal surfaces of the dentures
are in intimate contact with the tongue and its specialized mucosa. The specialized
mucosa covering the tongue is often regarded as a possible window on systemic
disordersarguably an overstatement, but still a relevant consideration. All these
tissues must be examined in detail for individual anatomy and for abnormalities,
irregularities, and pathoses. The term masticatory mucosa has been applied to the
mucosa covering the residual alveolar ridges and palate. It is usually attached to the
underlying periosteum; however, when it is not, denture instability can be a problem.
The area of attachment diminishes with ridge resorption, which is more severe in the
mandible. A total loss of attachment is often first seen above the mandibular
symphysis and can be demonstrated by tensing the lower lip, which causes the floor
of the mouth to move.
Diagnosis of abnormalities of the mucosa requires the recall of the normal
appearance. Shape, color, and texture are significant characteristics. Some variations
occur frequently with no significance and are therefore accepted as normal. These include
Fordyces granules in the buccal fat pads and varicosities in the floor of the mouth of
elderly patients. Initially, knowledge of normal appearance is learned from anatomy
texts and the study of surface anatomy. However, the required mental picture becomes
well developed only through careful examination of many healthy mouths.
The color of the mucosa reveals much about its health. The differences in appearance
between a healthy, pink mucosa and red, inflamed tissue will be apparent. The
cause of any inflammation must be determined.
Abrasions, cuts, or other sore spots may be found in any location under the basal seats
of the existing dentures or at the borders. They may be the result of overextended or
even underextended borders (Fig. 5-4). Incorrect occlusion is also a major source of
tissue trauma. Sharp or overextended denture borders produce red lines of inflammation or ulcerations. Evidence of cheek biting appears at the level of the occlusal plane
and often presents as a white scar tissue line indicating a mucosa that has been
traumatized and is now healing. Sometimes soreness results from something as simple

as a small fruit seed lodged under the denture. At the time of the examination, the
causes should be determined to allow correction before impressions are recorded.
9. Jelaskan pengaruh lidah yang besar terhadap pemakaian GTP !
The tongue plays an important role in determining denture success or failure, with its
size and activity being the main concerns. The tongue will expand into any edentulous
space(s) by a reorientation of its intrinsic musculature and become habitually active
within its extended boundaries. The introduction of a new denture will then be met
with dislodging competition from the tongue. An edentulous patient who has not been
wearing a mandibular denture often uses the tongue as an antagonist for the maxillary
arch during mastication. In these situations, the tongue can become enlarged (see Figs.
5-2 and 5-3) and also very strong, making prosthetic treatment and subsequent
denture use challenging for the dentist and the patient, respectively.
Examination of the floor of the mouth includes examination of deep sublingual
structures. The surface contours are important but can change as a result of underlying
activity. Contraction of the mylohyoid muscles raises the floor of the mouth. This will
dislodge a complete denture made from an impression that did not record the position
of the floor of the mouth with the mylohyoid muscles in a contracted state. The visual
examination also requires that the depths of mucosal folds be exposed to make sure
that hidden lesions are not missed
Tongue position and coordination are significant in functioning with a mandibular
denture. Normally, the tongue should be expected to rest in a relaxed position on
the lingual flanges, which, if properly contoured, will allow the tongue to help retain
the denture. A retruded tongue position deprives the patient of a border seal for the
lingual flange in the sublingual crescent; it also may produce dislodging forces on the
distal regions of the lingual flanges. On the other hand, a habit of protruding the
tongue tends to dislodge a lower complete denture by raising the floor of the mouth
and, in so doing, lifting the lingual flanges. Attempts at tongue retraining may not be
very successful but will at least make patients aware of the problem and help them to
understand encountered adverse effects.
10. Jelaskan biomekanik dukungan gigitiruan penuh berdasarkan hasil pemeriksaan intra
oral pada pasien tersebut!

The basic challenge in the treatment of edentulous patients lies in the differences
between the ways natural teeth and their artificial replacements are supported. The
previous section emphasized the superbly evolved quantitative and
qualitative aspects of periodontal ligament support for a functioning dentition. This
has an approximate area of 45 cm 2 in each arch, viscoelastic properties, sophisticated
sensory mechanisms, and the potential for bone remodeling to cope with the diverse
directions, magnitudes, and frequencies of occlusal loading. In contradistinction, the
tissues pressed into service to support complete dentures are inherently unsuited to
this role.
MUCOSAL SUPPORT AND
MASTICATORY LOADS
The mean area of mucosa available for denture support has been calculated to be
22.96 cm 2 in the edentulous maxillae and approximately 12.25 cm 2 in an edentulous
mandible. These figures, particularly in the mandible, are in dramatic contrast to the
45-cm 2 area of periodontal ligament available in each dental arch (see Fig. 1-3). It
also must be remembered that the denture-bearing area (basal seat) becomes
progressively smaller as the residual ridges resorb.
Furthermore, the mucosa itself demonstrates little tolerance or adaptability to denture
wearing, a disadvantage worsened by the presence of systemic diseases such as
anemia, hypertension, or diabetes, as well as nutritional deficiencies.
Indeed, any disturbance of the normal metabolic processes may lower the upper limit
of mucosal tolerance and initiate inflammation. Reported masticatory forces using
complete dentures are much smaller than those produced by the natural dentition,
which is of the order of 200 N. Although maximum forces of 60 to 80 N have been
reported for complete dentures, the average loads are probably much less than these.
Indeed maximal bite forces appear to be five to six times less for complete denture
wearers than for persons with natural teeth. Moreover, the forces required for
mastication vary with the type of food being chewed. Patients with prostheses
frequently limit the loading of supporting tissues by selecting foods that do not
require masticatory effort that exceeds their tissue tolerance.
THE RESIDUAL RIDGES

The residual ridge consists of denture-bearing mucosa, the submucosa and

periosteum, and the underlying bone. When the alveolar process is made edentulous,
the alveoli that contained the roots of the teeth become filled with new bone, forming
the residual alveolar processes. These become the residual ridges and are the
foundation for dentures, a role for which they are ill-suited.
The loss of teeth and their periodontal support results in the removal of an important
sensory mechanism and a change in the loading pattern of the alveolar bone
from tensile to compressive with forces being predominantly vertical as well as
horizontal. The edentulous ridge also has a considerably smaller surface area than that
of the preceding periodontal ligaments, and the denture supporting tissues
demonstrate very little adaptation to their new functional requirements. This is in
marked contrast to the frequently remarkable adaptive range of the dentate
masticatory system. Following teeth loss, the alveolar ridge is subject to
ongoing resorption, which results in its gradual reduction and virtual disappearance
(Fig. 1-4). This process apparently occurs at an exponentially reducing rate and is
typically most rapid in the anterior mandible. The loss of bone does not occur evenly
over the surface of the ridges, and so with time, their shapes and size become altered.
The rate of bone resorption also varies markedly from person to person and is not
predictable at an individual level. Little is known about which factors are most
important for the observed variations Two concepts have been advanced concerning
the inevitable loss of residual bone: one contends that as a direct consequence of loss
of the periodontal structures, the latters organizational influence on adjacent bone is
altered and variable progressive bone reduction occurs. The other maintains that
residual bone loss is not an inevitable consequence of tooth removal but depends on a
series of poorly understood factors.
Clinical experience strongly suggests a definite relationship between the presence of a
healthy periodontal ligament and the maintained integrity of alveolar bone (Fig. 1-5).
This accounts for a strong professional commitment to the preservation and protection
of any remaining teeth to minimize or avoid advanced residual ridge reduction. The
tissue support for complete dentures is conspicuously limited in both its adaptive
ability and inherent capability of simulating the roles of the periodontium. These
disadvantages are compounded by the movement of complete dentures in relation to
the underlying bone during function. This is related to the resiliency of the supporting
mucosa and the inherent instability of the dentures during functional and

parafunctional movements. Because these recurrent movements and the forces that
produce them can cause damage to the supporting tissues, almost all principles of
complete denture construction have been formulated so as to minimize them.
Although unproven, it is tempting to conclude that the recurrent functional
movements of removable prostheses may be a major factor contributing to residual
ridge reduction.
Two physical factors are involved in denture retention that are under the control of the
dentist and are technique driven. One is the optimal extension of the denture base;
the other is the maximally intimate contact of the denture base to its basal seat.
Muscular factors can be used to increase the retention (and stability) of dentures. The
actions of the buccinator, the orbicularis oris, and the intrinsic and extrinsic muscles
of the tongue can be harnessed by the dentist to achieve this with appropriate
impression techniques. Furthermore, the design of the labial, buccal, and lingual
polished surfaces of the dentures and the forms of the dental arches must be
considered when balancing the forces generated by the tongue and the perioral
musculature. As the form and size of the denture-supporting tissues (the basal seat)
change, harnessing muscular forces in complete denture design becomes particularly
important for denture retention.
Wearing dentures may have an adverse psychological effect on some patients, and the
nervous stimuli that result may influence salivary secretions and thereby adversely
affect retention. Eventually, most patients seem to acquire an ability to retain their
dentures by means of oral muscle control. This muscular stabilization of the
prostheses is probably also accompanied by a reduction in the physical
forces used in retaining the dentures. Clearly, the physical forces of retention can be
improved and reestablished, up to a point, by careful and frequent attention to the
status of the dentures. Periodic inspection, including relining procedures, will help
prolong the usefulness of the prostheses.
11. Bagaimana prognosa perawatan prostodonsia pada pasien tersebut berdasarkan
karakter pasien?

Dari riwayat diketahui bahwa pasien bukanlah sosok yang patuh, hal ini
terbukti dari:
o Seluruh gigi telah dicabut

Mukosa tipis

o Saliva sedikit
o Lidah relative besar
Tanda-tanda tersebut menunjukkan bahwa pasien tidak dalam kondisi
mengontrol kadar gula dalam darah tidak kooperatif
Pasien tidak kooperatif + keadaan intraoral yang tidak baik untuk stabilitas
GT

Prognosis kurang baik

12. Bagaimana teknik komunikasi yang tepat untuk pasien tersebut?

Interpretive
-D & P berdiskusi alternatif penanganan

Seni mendengar dan mendengar aktif komunikasi 2 arah

Empati umpan balik untuk memastikan bahwa pasien sudah paham

Langkah-langkah:
o GATHER

Greet
Memberi salam ramah

Ask
Nada yang menunjukkan minat dan keramahan
Kata yang dapat dimengerti
Ajukan pertanyaan dan tunggu responnya
Gunakan open question

Tell
Memberi informasi secara jelas pasien mengerti

Help
Bantuan ketika pasien sulit menentukan keputusan

Explain

Penjelasan atas keputusan yang dipilih pasien

Return
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