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BOOK REVIEWS and encourages the logical progression to an initial differential The significance of the fovea palatini in complete denture prosthodontics. Download the Medical Book: Textbook of Complete Denture Prosthodontics For Free. This Website we Provide Free Medical Books for all Students. Textbook of Prosthodontics - Ebook download as PDF File .pdf), Text File .txt) or read book online.

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Joseph Murphy. D.R.S. thinking and imagery mold, fashion, and create your destiny;.. grow rich—Serve yourself with Anatomy & Physiology. as that branch of dental art and science pertaining to the res- toration and maintenance of oral function by the replacement of missing teeth and structures by. Request PDF on ResearchGate | On Jan 1, , Karthikeyan Ramalingam and others published Textbook of Prosthodontics.

Skip to main content. Log In Sign Up. Ayko Nyush. Vincent Road Kochi , Kerala, Phone: No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: This book has been published in good faith that the material provided by authors is original.

Try-in Procedure in Complete Denture Treatment Laboratory Procedures Following Try-in Procedure Denture Insertion and Patient Education Sequelae of Ill Fitting Dentures Gagging Immediate Complete Denture Overdenture Single Complete Denture Relining, Rebasing and Repair of Complete Dentures Osseointegrated Implants in Complete Denture Prosthodontics It cular system, jawbones, tongue and temporomandibular may also be difficult to completely eliminate the factors joints.

The gradual transition from dentulous to causing wear of teeth. Some of the age-related changes that affect the orofacial structures The periodontium consists of the supporting tissues of might be physiologically normal, however treatment the tooth, comprising the gingiva, periodontal attach- should be rendered to the elderly people with an ment, alveolar bone and cementum.

The structure of awareness of biologic factors since the adaptive mecha- the periodontium becomes more irregular with age and nism and tissue regenerative potentials are usually deposition of cementum, which continues throughout significantly lowered.

Hence, they require a different life. One of the main reasons for complete edentulism is approach, modified treatment planning and knowledge periodontal disease. Periodontitis is a slow progressive of how the tissue changes associated with senescence disease, which results in pocket formation due to loss of affect oral health. This sequence is not a result of age but of chronic disease state within the supporting As age advances, the wear of enamel accentuates giving structure of the tooth.

Early sequential loss of teeth the occlusal surfaces of a flat appearance. The gradual because of periodontal disease may, however, cause change in the quantity and quality of dentine due to irregular resorption of bony ridge, which may compro- formation of secondary dentine result in teeth that are mise the stability of denture.

In addition, gingival recession as age advances, contributes to the discoloration and root caries. Teeth The oral mucosa comprises three broad categories: With increasing keratinized and covers the palatal vault and the attached age the volume of pulp decreases as a result of gingiva. This is associated with comprises the mobile lining tissues within the mouth, fibrosis of the pulp tissue and reduced vascularization. Attrition mucosa which covers the lips and dorsum of the is the gradual loss of tooth substance due to mechanical tongue.

Abrasion is usually as an individual grows older. The oral mucosa of the caused by friction from a foreign body, independent of aged is friable and easily injured.

The mucosa in the occlusion between teeth. Erosion is defined as the loss elderly person is generally thin and tightly stretched and of hard tooth substance due to chemical process not it blanches easily.

Aging produces changes in the blood involving bacteria, for example, the intake of acidic vessels, particularly atherosclerotic changes. Oral beverages. The incidence of stimulates salivary flow. Hence, decreased masticatory oral cancer is associated with aging patients, which function will cause oral dryness and reduced salivary flow accounts for approximately 4 percent of all cancers. Here because of atrophy of salivary glands and reduced the mucosa should be carefully examined and critically synthesis and secretion of saliva.

Thus, appropriate evaluated. When the mucosa lacks adequate kerati- masticatory function is important for proper maintenance nization, the protective capacity provided by the of the salivary flow and overall quality of life for the keratinized layer is reduced and the patient is prone to elderly.

The diminished function of the glands also results suffer from chemical, bacterial and mechanical irritations. The mucosa presenting Reduced salivary flow contributes to dry and inelastic heavy layers of thick keratin should be closely and oral mucosa, cracked lips, fissuring of tongue and oral continuously examined.

The level of pain threshold of mucosa, sore spots under the denture, poor retention soft tissue changes markedly after the menopausal period of denture and difficulty in swallowing.

Due to lowered and male climacteric. Hence, denture tolerance as a ptyalin content of saliva, digestion of cooked starch is consequence, is markedly reduced. Xerostomia also affects oral hygiene and adherence of food particles to tissues predisposing it to infection.

In this respect, saliva is particularly important in wearers of removable As age advances there is a decrease in the speed with dentures to protect the oral mucosa from mechanical which muscle tension can be developed and released irritation and infections and to achieve retention in and in the muscle power by which work can be complete dentures. The normal unstimulated salivary performed. There is reduction in the fiber muscle mass.

Impaired salivary Furthermore a slowly progressive degeneration of the secretion or xerostomia is likely, if the unstimulated flow muscles is a feature of the aging process consistent with rate is less than 0. Of the whole unstimulated long contraction of tissues and slowly contracting muscles. The cortical porosity of the mandible also occurs predominantly as progressive infiltration, which increases.

Changes are characterized by altered anatomy increases with age. These adipose cells may gradually with a shift in the origin of mentalis, buccinator, encroach on the parenchyma extending inwards from mylohyoid and genioglossus muscles that assume the periphery of the lobules replacing the entire lobule superior position along with mental foramen in the with adipose tissue.

There is an age-related increase in mandible. The degenerative changes in the blood vessels the amount and density of the fibrous skeletal cause decreased blood supply to the bones.

The component both around the ducts and in the septa which mandibular blood supply becomes merely extra-osseous thus, appears widened intralobularly so that the acini via the plexus of vessel formed by the facial, buccal and becomes more widely spaced.

The masticatory function lingual arteries. This is very common in patients over 60 withstand degenerative changes and shows progressive years of age. These The main risk factors are irreversibility of caries and changes vary from slight fraying of the articular surfaces periodontal diseases which, if not controlled, lead to tooth to cleft formation between the bundles of fibrous tissue loss, resorption of the residual ridge, destabilized occlusal of which the articular surfaces and the disc are composed.

Following The severities of changes are related to advancing age prosthetic treatment acceptable function of the and are more intense.

When there is loss of posterior masticatory apparatus can often be maintained. Define attrition, abrasion and erosion of teeth.

What are the features of periodontitis? Temporoman- 3. What are the ill effects of reduction in keratinized dibular disorders indicate a deviation from normal layer of oral mucosa? What is the normal unstimulated salivary flow rate? What is xerostomia? What are the consequences of xerostomia? What is bald tongue?

What is caviare tongue? What is macroglossia? Taste buds, which are responsible for taste perception, Mention the causes of xerostomia.

Dental Prosthetics— age. Mosby Company ; are atrophic is a common finding in elderly people. These tissues also help the dentures in obtaining their retention and stability. There are certain tissue areas or regions in the maxillary and mandibular edentulous foundations, which are better suited to bear the stresses due to mastication, and are called as stress bearing areas.

While there are other tissue areas which are not quite suited to take up these stresses, either due to their anatomy or due to the structures that lie beneath them and are called stress relief areas.

Textbook of Prosthodontics

Anatomical landmarks in maxillary edentulous complete dentures are called border-limiting areas. The sub-mucosa, which is a connective tissue, attaches the mucosa to the underlying structures. The submucosa varies in compo- sition depending on whether the mucosa is firmly or loosely attached to the bony structure and whether there is muscle tissue between itself and the underlying bone. The blood vessels present in the submucosa supply blood to the edentulous foundation and the nerves innervate it.

A detailed description of the mucosa and the sub- mucosa is beyond the scope of this book. However the microscopic and macroscopic structures of the maxillary and mandibular edentulous foundations relevant to complete denture treatment will be discussed, as it would give a better understanding of the oral anatomy which would act as positive guides to successful complete denture FIGURE 2.

Anatomical landmarks in maxillary edentulous treatment. Edentulous Foundation 1. Supporting structures: Border limiting structures: These are the stratified squamous epithelium, which is keratinized. It is structures that limit the border extent of the maxillary attached to the underlying bone by the sub-mucosal denture. They contain the same epithelium adequate resiliency. The underlying bone has a thick keratinized as the crest of the alveolar ridge. The cortical covering and together with the mucosa and submucosa differs in that it contains adipose tissue.

These submucosa can provide excellent support and withstand tissues can withstand stresses unless they are very flabby. The firm attachment of the mucous They help in the stabilization of the maxillary denture membrane decreases as it passes from the crest to the during function. The maxillary residual foundation. Midpalatine Raphe or Median Raphe Figs 2. The submucosa in this region Significance contains the nasopalatine nerves and vessels. There is, therefore, no resiliency through which the neurovascular bundle emerge and in this region and stress cannot be applied in this lies on the surface of the bone.

Sometimes relation of central incisors, which are about mm there is overgrowth of the bone at the sutural joint anterior to the incisive papilla. Clinical consideration: During the impression procedure, Clinical consideration: During final impression procedure care should be taken not to compress the papilla.

This the raphae is relieved in order to create equilibrium is one of the relief areas of the maxillary edentulous between the resilient and non-resilient tissue supports.

Hence the incisive papilla should be relieved. Compression of blood vessels leads to obliteration of Maxillary Tuberosity Figs 2. Pressure on the and presents the hard tissue landmark. The underlying nerve causes parasthesia in the region of the upper lip.

Palatal Rugae Figs 2. Failure to do so will lead to the the maxillary antrum extends laterally with undercuts denture border being placed on the hard tissue which in the tuberosity region. It is for the retention of the denture. Reflection of the undercut on the preferential chewing side should the mucous membrane superiorly marks the height. The area of mucous membrane reflection has no muscle Fovea Palatinae Figs 2. Due to this, the tissue in this midline. For effective border contact between denture and tissue, the vestibule should be Border Limiting Structures in the Maxillary suitably filled with impression material.

Edentulous Foundation Labial Frenum Figs 2. Close to the ridge. Clinical significance 3. Away from the crest of the ridge. Restricted pterygomandibular raphe movement. It is bounded anteriorly by the buccal frenum, laterally 2. When mouth is wide open, the denture dislodges.

Textbook Of Prosthodontics

Pterygomandibular raphe may be sandwiched below alveolar ridge. The mucosa and submucosa in this region the denture. Posterior Palatal Seal Area Figs 2. It is a narrow cleft of loose connective tissue, which is Supporting Structures of Mandibular approximately 2 mm in extent antero-posteriorly. This Edentulous Foundation structure is bounded by the maxillary tuberosity anteriorly and the pterygoid hamulus posteriorly and The Residual Alveolar Ridge Figs 2.

The The support for the lower denture is provided by the submucosa in this region is thick and made up of loose mandibular residual alveolar ridge and the soft tissue areolar tissue.

A seal can be obtained by utilizing this covering it. In most cases, the type of bone present at area as it can be displaced to a certain extent without the crest of the lower edentulous foundation is cancellous trauma. Clinical considerations: The denture should not extend Buccal Shelf Area Figs 2. It is not advisable to extend the impression beyond the external oblique ridge.

Anatomical landmarks in mandibular edentulous foundation. It should be relieved with a spacer, failure of which leads to ulceration. Anatomical landmarks in mandibular edentulous cast. The submucosa contains fibers of the buccinator muscle. The mucosa in this Significance: It is an area where the masseter muscle in region has a thin and a non-keratinized epithelium and function anterior fibers may push against the distal part the submucosa has loose connective tissue fibers and of the buccinator muscle elastic fibers.

Clinical consideration Clinical considerations: It may be single or multiple. Over extension of the denture causes: Dislodgement of the denture. The depressor anguli oris muscle underlines 2. During the impression procedure Retromolar Pad Figs 2. It is also known as the retromolar triangle. Significance Buccal Vestibule Figs 2. Fibers of temporalis ridge and laterally by buccal mucosa. The mucosa of 2.

Fibers of masseter the buccal vestibule is the same as the labial vestibule 3. Fibers of buccinator with the submucosa containing loose connective tissue 4. Fibers of the superior constrictor muscles of fibers mixed with elastic fibers. Even in the poorer of the poor extending it to the land area of the cast, which is conditions, this has to be recorded very critically for called the mean crestal line.

The central fossa of stability of mandibular denture.

It is imperative that apart dislodging factor with the forces being inclined from the knowledge of all the factors of anatomical and anteriorly. Thus, the diagnosis and clinical acumen of to the tongue.

It overlies the genioglossus muscle, which application of above knowledge. Mention the anatomical landmarks of significance of the frenum. Which are the primary and secondary stress bearing areas in the maxillary edentulous foundation?

Sublingual Crescent Area Figs 2. What is the significance of posterior palatal seal The anterior portion of the lingual sulcus is commonly area? It is the part of the 6. What is the consequence of bilateral severe floor of the mouth covering the sublingual gland.

It has specialized innervations. Why should an allowance be created in the Clinical consideration: Over extension of the denture in complete denture at the labial and buccal frenum this area causes burning sensation. Which muscle underlies the buccal frenum?

Retromylohyoid Space Figs 2. Is it necessary to relieve the greater palatine foramen It is located posterior to the mylohyoid ridge and area? Why is buccal shelf area referred to as the primary constrictor of pharynx. Significance What are the contents of the retromolar pad? What is the procedure to record the maxillary and by the glossopalatine and superior constrictor muscle. Syllabus of Complete Dentures.

Why is crest of the mandibular edentulous ridge 4th edn. Mention the clinical significance of retromolar pad. Winkler S. Essentials of Complete Denture Prosthodontics. What is mean crestal line? Describe the anatomy of posterior palatal seal area. What is the significance of fovea palatine? Prosthodontic Treatment for Edentulous Patients. Harcourt India Private Ltd ;, Beneath Residual ridge is the term used to describe the clinical the compact bone is the spongy bone.

The spaces alveolar ridge after healing of bone and soft tissues between the trabeculae communicate throughout the following extractions.

Residual ridge resorption is a term spongy bone. Bone is constantly undergoing changes in used for the diminishing quantity and quality of residual response to replacement and functional demands. In , When we clinically examine a completely edentulous Atwood postulated that there are four major etiologic foundation, we tend to gauge the residual ridge on the factors that cause residual ridge resorption: Although the this chapter will be based on these four factors.

The structural elements of bone are: These are cells responsible for metabolic resorbed per unit of time. Calcified cementing substance: The calcified Metabolic Factors cementing substance consists mainly of polymerized Metabolic disturbance is attributed to both nutritional glycoprotein.

Mineral salts namely calcium carbonate disturbances and hormonal causative factors. General and phosphates are bound to these protein sub- body metabolism is the net sum of all building up stances. Osteoblasts, by their function of on in the body. Anabolism exceeds catabolism during forming and calcifying the intercellular substance, are growth and convalescence, levels off during most of the the active bone forming cells.

The osteoblasts adult life and is exceeded by catabolism during disease surround the bone in a continuous layer. In the course and senescence.

Hormonal Factors d. Osteoclasts are the cellular Pituitary Glands and Hypophysis components of bone that are responsible for bone The hypophysis is the master gland of the endocrine resorption. Bone resorption always requires the system. The control of the hypophysis over the endo- simultaneous elimination of the organic and inorganic crine system is complex and problems of dysfunction components of the intercellular substance. Such findings Alveolar bone has two structural characteristics.

A are of importance to the dentist because they involve hard compact outer layer is superimposed on a spongy the general health of the patient, which is reflected in somewhat resilient substructure. A healthy and the oral cavity. A moderate amount of osteoporosis They are responsible for the regulation of the rate of accompanies senescence because of the increased metabolism.

Hyperthyroidism increases the metabolic catabolic action reflected by atrophic and degenerative rate leading to negative nitrogen balance. Such a balance changes throughout the body.

The ageing person is equivalent to protein deficiency, which can be a direct produces decreased amount of androgens and estrogens, cause of osteoporosis. Thyroxin also has a direct influence which results in faulty protein metabolism for tissue repair. This depletion of calcium and be compensated.

Dietary Factors Food is classified as proteins, carbohydrates, fats, vitamins Parathyroid Glands and inorganic elements. Parathormone maintains blood calcium by mobilizing it from the bones through osteoclastic activity. Protein Protein is necessary to build and maintain tissue and to Islets of Langerhans supply energy. The synthesis of osteoid tissue in protein- The failure of these glands to produce sufficient insulin starved people is compromised and calcification is for proper utilization of glucose causes diabetes mellitus.

The syndrome of poor healing, low tissue tolerance and Protein may not be available because of inadequate rapid resorption of bone is associated with the diabetic intake, improper assimilation or excessive loss as in patient. Bone apposition affected by this mechanism. Since perfect control is rarely cannot keep up with normal osteoclastic activity and a possible, a word of caution and explanation to diabetic negative bone factor exists. Vitamins The action of vitamins in many respects is said to be Suprarenal Glands same as that of hormones.

The relationship of vitamins The adrenal cortex produces steroid hormones called and hormones can be explained on the basis that the corticoids. Cortisone and related steroids are antianabolic. A deficiency of vitamin A may result in poor effect on calcium excretion. The prolonged use and development and calcification of bone. Prolonged defi- administration of such steroids are considered very ciency of vitamin A causes renal damage by hornification dangerous to bone tissue.

However, one of the beneficial of tubules, which then lose the capacity to reabsorb effects of corticoids is to control the defense mechanism phosphorus. The imbalance of the calcium: Gonads Vitamin B complex: The total effect of vitamin B complex In general, the sex hormone androgens and estrogens is of a regulatory nature.

The total well being of the individual Calcium salts calcium carbonate and calcium phosphate is impaired. Phosphorus in the form of calcium and magnesium phosphate, gives Vitamin C: Lack of vitamin causes decalcification of the hardness to bone. Abnormalities of the calcium bone and has been held responsible for diffuse alveolar phosphorus elements of the blood stream may be atrophy.

The apposition of new bone slows down associated with alveolar resorption or rarefaction. The The body requires 0. Other sources of deficiency.

The periosteum thickness and the cells appear calcium are dairy products, spinach, oranges, celery, immature and resemble fibroblasts. This condition may chard, carrots and lettuce.

The phosphorus need is about make the periosteum easily prone to injury by the 1. Dry beans, denture base. Osteophytes appear as a result of milk, cheese, leafy vegetables, celery and carrots may avitaminosis C. The rapid loss of bone and the increased fulfill these requirements. This diet should be low in carbohydrates and high in protein intake.

The diet should include at least a Vitamin D: It is necessary for the calcium phosphorus quart of milk or substitute dairy products, vegetables, balance to remain within tolerable limits.

Vitamin D fruits and a multiple vitamin supplement. Functional When bone loses its ability to calcify the matrix, Bone is generally thought of as a hard substance because administration of vitamin D will cause calcification and of its rigidity, when in reality it is one of the most plastic denser bone.

Moderate overdosage causes excessively tissues of the body, e. Bone is constantly undergoing resorption. Many drugs act as vitamin antagonists. These changes in response to replacements and functional drugs act largely on vitamin C and B complex and their demands.

Forces within physiologic limits of alcohol, barbiturates, morphine, some of the sulfa drugs bone are beneficial in their massaging effect. On the other and some of the antibiotics such as streptomycin and hand, increased or sustained pressure, through its penicillin.

The amount and frequency of stress and its Carbohydrates Starch and Sugars distribution and direction are important factors in treatment planning. Although the total amount of the They provide the chief source of energy.

The frequency of stress application modifies the reaction of alveolar bone to external forces. Constant pressure Fats and Organic Substances on bone causes resorption, while intermittent forces They are those, which yield heat and energy and only favor bone formation. For this reason, the patient should be warned controlled, so that pressure remains within tissue that gum chewing has a destructive effect on the bone.

If the action of the base is favorably manifests itself as gnashing, grinding or clenching of the controlled in its adaptation to the tissues and its directed teeth while the patient is asleep or awake. Since most force, it could provide stimuli that retard resorptive denture patients do grind their teeth in sleep, the processes. Often, a new technique, a new impression dentures should not be worn during this period. Thus material, new denture base or a new form of teeth has the supporting structures are afforded the rest period been heralded as the answer to the problem of ridge essential to the maintenance of the alveolar bone.

While resorption. Excessive stress resulting from artificial environ- The principal concern should be in the pattern and ment. There are two mandibular 2. Abuse of the tissue from lack of rest. Long, continued use of ill-fitting dentures. A sharp 4. Reduced area of coverage of the foundation cusp will penetrate a bolus of food with less force than a resulting in increased load per unit area.

However, a law of physics explains 5. Faulty impression procedures, employing compres- that forces applied to an inclined plane produce a sive forces. Error in relating maxillae to cranial landmarks. Applying this principle to occlusal form, the 7. Lack of freeway space due to increased vertical resultant force of the steep incline of high cusps would dimension of occlusion.

Incorrect centric relation record. Faults in selection and placement of posterior teeth. Stress distribution favorable to healthy alveolar bone Lack of balance in posterior occlusion. Non-correction of occlusal errors caused due to balanced occlusion. Balanced occlusion is that processing technique and factor of tissue resiliency. Use of non-rigid material with high flexure for mandibular movements with out tending to dislodge the denture base.

Non-observance of biological principles of stress reduction. Prosthetic Factors Patients with dysfunction state of TMJ resulting in Prosthetic factors are extremely difficult to evaluate instability of dentures. Age changes in senility. If the 1. Thorough clinical examination mechanical factors designed into the denture by the 2. Improving stress potential— systematic and local movements and vertical movements under control to 4.

Proprioceptive exercise facilitate jaw relation recording procedures. This will be 5. Clinical procedures referred to as including patient in the treatment. Impressions b. Jaw relations Clinical Procedures c. Selection and arrangement Minimal pressure impression should be made in order 6. Laboratory procedure to reduce the stress on the underlying ridge. The impression should cover maximum denture bearing Thorough Clinical Examination surface within physiologic limits.

Rigid denture base material should be used. The jaw relation should be It should be done on the basis of the general information accurately recorded with special emphasis on creating regarding the medical health status, previous denture adequate freeway space mm.

Teeth with shallow treatment, temporomandibular joint status and cuspal inclines should be selected. The teeth should be evaluation of supporting and surrounding tissue. There Communication should be simultaneous contact of maxillary and It involves prosthodontic service of giving complete mandibular teeth both in centric and eccentric relations.

Conditions complicating the treatment with geriatric problems need greater understanding. Prosthodontic management problems are mostly considered from physiological, psychological, social and Systematic approach: Enquiry into food habit and functional needs of a geriatric edentulous patient. Stability dietary intake will reveal the nutritional status of the and retention qualities suffer greatly in these patients.

Essentials of complete denture prosthodontics

When combined with clinical findings, it will help The problem becomes much worse when the patients dentist in prescribing the nutritional regime which may expectations run high because of lack of patient include prescriptions on vitamin products, hematinics in education and motivation.

The patient fails to realize that therapeutic dose, proteins to improve, repair and a dentist does not create the problem of his foundation maintenance of tissues, neurotropic agents to improve but the patient himself has created the same out of neuromuscular co-ordination, dietary calcium for neglect.

Patient should not expect miracles from balancing osteoporotic changes, drugs to correct anaemic prosthodontic treatment. For above reasons the conditions and vitamins with hormonal inclusions to treat treatment should be guided by understanding various geriatric problems.

Local approach: This consists of warm saline mouth rinses, application of astringent lotions and gum massage. Define residual ridge. Proprioception 2. What is residual ridge resorption? Proprioception has a reference to learning to effect 3.

Textbook Of Prosthodontics by Nallaswamy

Mention the four major etiologic factors that cause relaxation of facial muscles and perform the horizontal residual ridge resorption. Atwood DA. Some clinical factors related to rate of resorption 5. How is hyperthyroidism a contributing factor in of residual ridges. J Prosthet Dent ; Current 6. What is the need to provide rest to bone tissue? A review. Ortman HR. Factors of bone resorption of the residual ridge.

How can residual ridge resorption be managed by J Prosthet Dent ; Sobolik CF. Alveolar bone resorption. J Prosthet Dent 9. What role does nutritional deficiency play in ; The Essentials of Complete Denture Prostho- residual ridge resorption? Above the age of 40, osteoporotic changes are also a Evaluating the patient for proper diagnosis, prognosis common finding. It is, therefore, very important for Relevance of the Sex Factor of the Patient the student to know the meaning of these terms before Cosmetics and esthetics would be much more important evaluating the patient: Younger males though would be conscious, 1.

It is an enquiry, scrutiny or they may grow indifferent to looks as they age and are investigation carried out for the purpose of diagnosis. Also during menopausal state, It is the critical or scientific evaluation of existing there would be intolerance to treatment and burning of conditions, which is made towards the end of the mouth, vague pains and psychological disturbances. BOOK REVIEWS and encourages the logical progression to an initial differential diagnosis based on radiographic evidence, followed by a more definitive diagnosis using the additional evidence provided.

Also included in the presentation of each case are two or three relevant questions, often slanted to test the knowledge of the reader on points such as alternative views or other investigations which may be indicated. Not unnaturally one is tempted to turn rather too rapidly to the Answers towards the end of the book and this must be resisted.

The answers are extensive and in many cases include a fairly comprehensive discussion on points of differential diagnosis. In a book of this nature and in which a large number of radiographs are reproduced it is inevitable that one or two at first sight fail to demonstrate a point clearly. By Toronto: Saunders, , pp.

The approach to the subject is divided into the pre-treatment, constructional and maintenance phases of complete denture prosthodontics, and is followed by a section dealing with special techniques. The opening section includes oral anatomy and physiology with specific reference to complete denture treatment, together with some selected systemic diseases likely to occur in the complete denture age group.

The latter, however, devotes a disproportionate amount of space to neoplastic conditions and the chapter is interspersed with several unnecessary case reports.

The construction of complete dentures includes the surgical approach, treatment planning, clinical stages, and laboratory procedures. Although extensive, the section suffers from some lack of continuity and considerable repetition, which is only partly relieved by the cross references present.

A large amount of attention has been given to laboratory techniques which are the province of the technician, and appear out of place in a modern text on clinical prosthodontics. Mani rated it it was amazing Jun 20, Karthika Shanmugam rated it liked it Jan 24, Praneshkumar rated it liked it Sep 26, Athulya rated it really liked it Jan 12, Ismi Anugrah rated it it was amazing Apr 08, Nirmal rated it it was amazing Nov 18, Rubaid Ahmed rated it really liked it Apr 20, Riya rated it it was amazing Jul 27, Abdul rated it it was amazing Mar 05, Kiran Bagwan rated it really liked it Jan 14, Manan Shah rated it really liked it Sep 27, SG rated it did not like it Sep 21, Kalyanee Deshpande rated it it was ok Sep 07, Bushra rated it really liked it Oct 20, There are no discussion topics on this book yet.

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