FUNCTIONAL TEST
I Introduction
The functional test represents the moment at which the mechanical precision can be tested, and the aesthetic restoration appreciated.
Its importance is decisive in order to:
-€ to prevent errors, -€ to rectify certain decisions, -€ to reveal the inaccuracy of the limits of the prosthesis and above all -€ to ensure the patient’s cooperation.
Before any functional, it will be necessary to examine the wax models, this examination will concern the intrados of the models.
€€€•€ There must be no roughness or patches of plaster in order to avoid any irritation of the support surface.
€€€•€ The edges must obey the same comfort requirements and they must faithfully reproduce the edges of the anatomy-functional imprint.
€€€•€ The polished surfaces (wax) must respect the principles defined by Fish, namely: be oriented in such a way that the muscles in question tend to apply the prosthesis against the support surface.
This functional test will be methodical. We will start with a static and dynamic examination of each of the 2 models, verification of aesthetics, etc.
II Mechanical test of the lower prosthesis
II.A.Static test
It will start with the verification:
€€€•€ Of the prosthetic occlusal plane€€€•€ of its relationship with the tongue and the orbiculo-buccinator strap€€€•€ The occlusal surface of the teeth must be located at the level of the convexity of the buccinator and the marginal edges of the tongue
The static stability is then checked:
€€€•€ If the model rises slowly while remaining parallel to itself, it is necessary to reduce the
length of the vestibular edges in the region from the masseter to the ….
€€€•€ If the model is elevated only in the posterior region, the length of the submylohyoid lingual edge will be reduced
€€€But in all cases, the lingual edge must cover the internal oblique line and extend at least 2mm above its level.
€€€•€ If the model is pushed from back to front, it is because the retromolar lingual extension is
too large and is not tolerated by the muscles of the palatoglossal arch.
€€€•€ If the model is driven back and forth, one of the following two possibilities may exist:
€€€-€ Either the vestibular edge in the anterior region is too long
€€€-€ Either it is due to an incorrect assembly of the incisors, these must have their implantation
Linguale thus creating a concave space freeing the play of the orbicularis muscle, which
Promotes stabilization.
€€€•€ The model can also move, if its shape or volume are not related
Harmonious with the neutral interference space.
II.B. Dynamic examination
Since the model is stable at rest, it is important to test the design of its base during the
Mandibular movements and muscle contractions accompanying functions.
If the anatomy-functional imprint has been carried out correctly, the support, the
Retention and stabilization must exist.
€€€So during this dynamic examination, it will be appropriate to carry out tests requested at the time
of the secondary imprint namely:
€€€•€ Average opening
€€€•€ Wide opening
€€€•€ Run your tongue over your upper lip from the right corner to the left corner
If the model moves, reducing any extension to the level where it hinders play
of the muscle of the muscular organ.
A second group of stability tests concerning the mounting technique is then addressed, it
This will be done by exerting successively localized digital pressure on a segment of the arch.
II.BaDigital pressure on the free edge of the incisors
If the model moves, it is:
•€ Either from incorrect implantation of the incisors located too far in front of the crests
•€ Either an insufficient peripheral seal at the level of the sublingual region or the retro-molar niches.
€€€-€ Retro molar joints will be improved by lightly scraping the boundary
posterior of the retromolar tubercle, in order to obtain a better adaptation of the base at this level.
€€€-€ The sublingual seal will be made more effective by widening the corresponding groove towards the sublingual fringe
II.BbDigital pressure at the level of the premolars and demolars
If the model moves, it is due to:
€€€•€ Either due to the excessively vestibular (off-crest) situation of the premolar-molar group€€€•€ Or due to an edge that is too thin on the side opposite the pressure€€€•€ Or due to an incorrect orientation of the polished surface, offering no possibility for the buccinator to seat the future prosthesis against the support surface.
The prosthesis is removed in order to proceed to the next step.
III Mechanical testing of the upper prosthesis
III.A. Static tests
In general, the model is stable and retention because the peripheral seal is easy to obtain
If at rest, the prosthesis tends to descend slowly:
-€ The edge is too long in the anterior region.
-€ Or, it is that one of the brakes of the upper lip is limited in its physiological movements.
III.B. Dynamic test
The following movements must be able to occur without compromising stability:
€€€•€ Average mouth opening (vestibular and lateral edges)
€€€•€ Large opening (pretygomaxillary ligaments, paratuberous area)
€€€•€ Pro upper lip traction.
€€€•€ Simulation of a whistle.
A second group of tests is then approached, it will be carried out by exerting digital pressure:
€€€•€ On the free edge of the upper incisors
€€€•€ At the level of the premolars and molars
III.BaPressure at the free edge of the upper incisors
If the model tilts, it is because the rear seal is insufficient or poorly located.
€€€•€ Either the edge is too short, so it is unable to ensure the hermeticity of the posterior seal€€€•€ Or the posterior edge is too long and this therefore creates instability
The posterior seal should extend 2 to 3 mm beyond the palatal fossae, it will be improved by scraping the reflection line of the veil, according to a ??Barley (gutter) 3 mm wide and 1 mm deep, thus ensuring a seal of the posterior seal.
At this stage, saliva plays an important role in the adhesion between the intrados of the prosthesis and the palatal vault.
The position of the upper incisors can also affect the interference of the whole.
III.BbDigital pressure at the level of the premolars and demolars
This pressure should not cause any movement on the opposite side, if the movement exists, it is due to:
€€€•€ Either due to a very vestibular assembly€€€•€ Or due to a lack of contact between the model and the limits of the neutral space to be systematically filled, that is to say that the edge of the opposite side is not thick enough, and is not sufficiently wedged between the vestibular slope of the crest and the internal face of the cheek.
IV Verification of the inter-arch relationship
The lower prosthesis is inserted first, then the upper prosthesis is inserted.
€€€The patient is asked to remain in the maximum opening position for a few seconds in order to cause fatigue of the elevator muscles; simultaneous propulsion may be required in certain cases in order to obtain the same fatigue of the external pterygoid muscles.
€€€The patient is then asked to slowly and gently let his mandible go to the resting position, then into centric relation.
The labial corners are gently separated in order to monitor how the first dento-dental contact will be made; it is essential that from the outset this contact is general and without hesitation over the entire extent of the arch (there will be a maximum of intercuspidation).
-€ The coincidence between the upper and lower incisors will be checked. -€ It will be verified that the existing meshing in the mouth is the same on the articulator. -€ It will be checked that there is no premature contact in the posterior regions. -€ The vertical dimension will be checked, for this the tests carried out at the stage of its evaluation will be repeated.
€€€Any imperfection in the inter-arcade relationship requires us to re-record the inter-arcade relationship.
V Control of the aesthetic value of our prosthesis
This control is the one to which we must pay the most attention, a patient will make a lot of efforts to integrate an aesthetic prosthesis that flatters him, but he will reject another prosthesis of less pleasant appearance.
-€ The most natural contours of the lips must be restored
-€ Any excess wax above the upper incisors will be removed
-€ The position of the free edge of the upper incisors will be checked in relation to the mucosal edge of the upper lip in the resting position.
-€ The incisal edges should touch the upper edge of the lower lip when smiling.
-€ We will also check the smile line which will correspond to the line of the necks of the teeth.
VI Control of the aesthetic value of our restoration
-€ The position of the free edge of the upper central incisors will be tested phonetically during the emission of the labiodentals Fe and Ve, this must be done without suffocation, we then feel that the mucous edges of the lower lip graze the free edge of the upper central incisors.
-€ The relative position of the upper and lower anterior teeth is then checked during the dento-dental emissions: I and Che, the anterior teeth must confront each other without colliding, without clicking and without whistling.
€€€Any clicking noise indicates an overestimated vertical dimension and insufficient free space.
of innoclusion also called Thomson space.
-€ The emission of the stomals is then checked: SE and SI.
-€ If the lower incisors are too lingual, a lisp occurs, creating too much overjet.
– A whistling sound is heard if the overhang is insufficient or if the clearance is too small.
€€€If the interdental relationship is correct but a whistling sound exists, it is because in the upper retro-incisal region, an abnormal gap exists which must therefore be filled.
-€ On the other hand, an excess of material in this region results in a lisp.
-€ The emission of the bi-labials Be and PE allows to check the vertical dimension , so if it is overestimated, there is a chattering of the teeth.
-€ If the posterior edge of the upper prosthesis is too long or not in sufficient contact with the soft palate, the emission of K is disturbed.
VII Conclusion
At the end of the functional test, when it proves satisfactory from a mechanical, aesthetic and phonetic point of view, a mirror can be held up to the patient in order to obtain his approval or comments.
FUNCTIONAL TEST
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental x-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.