Denture Treatment Planning & Improvement PDF

Taking History, Treatment planning, and improving denture-bearing areas TREATMENT PLANNING: o Synthesis of Key Information to facilitate choice of Treatment Options o History: The Patient's Story o Tx planning Includes: § Social and behavioral information § Psychological considerations § Systemic he...

Taking History, Treatment planning, and improving denture-bearing areas TREATMENT PLANNING: o Synthesis of Key Information to facilitate choice of Treatment Options o History: The Patient's Story o Tx planning Includes: § Social and behavioral information § Psychological considerations § Systemic health status Dentist’s observation o Extraoral evaluation § TMJ § Lips and cheeks § Neck posture o Intraoral examination § Mucosa § Tongue § Saliva § Residual ridge morphology and ridge relations § Tori § Undercuts § Enlarged tuberosities § Teeth (when present) § Existing prostheses occlusal relationship § Radiographic imaging § Study casts How patients approach to their tx o With enthusiastic optimism or o Merely resigned to it as a necessity o Cooperative and keen to participate in the decision making and continuing care or o Will want to defer to the dentist and avoid accepting responsibility for their own well-being o With reasonable care and effort in patient management, most patients can be successfully treated. o However, there are some who have significant psychological problems that require professional help TMJ o TMJs should be healthy before new dentures are made o Explore other structures associated with the TMJs § Lymph node palpation § Masticatory muscles - Pain and tenderness in the muscles of mastication - Pain and tenderness in TMJ - Joint sounds during condylar movements - Limitations of mandibular movement o Unhealthy TMJs complicate the registration of jaw relation records since centric relation depends on the structural and functional harmony of: § Osseous structures § Intraarticular tissue § Capsular ligaments o The patient may be unable to position the mandible in a correct and repeatable centric relation o The routine evaluation of TMJ function is an integral part of complete denture treatment Have a basic knowledge of speech o Articulation is the modification of speech sounds by structures of the throat, mouth, and nose o Fortunately, the neuromuscular activity that produces speech can adapt to structural change o An assessment should be made during the diagnosis appointment to identify existing problems and determine the potential for improvement A Primer on tx options o Adjunctive Care § Elimination of infection § Elimination of pathoses § Surgical improvement of denture support and space § Tissue conditioning § Nutritional counseling o Prosthodontic Care § If patient destined to become edentulous - Removable partial denture - Conventional or - Interim § Hybrid complete denture/removable partial denture require interim or transitional treatment § Complete dentures may be - Immediate or conventional - Definitive or interim - Tooth, implant, or soft tissue support - Fixed or Removable Advanced anterior mandibular residual ridge reduction (RRR) leads to the mentalis muscle's origin ending up close to the ridge crest Sulcus deepening procedure Requires surgical detachment of labial and buccal muscle attachments followed by placement of a mucosal or skin graft Displacement of the mentalis muscle and adjacent muscle slips allows the production of: o a looser lower lip with a o a low wound margin down in the sulcus o and an increase in both stability and extension of the labial flange Classifications of Residual Ridge Morphology Class I: o This classification level describes the stage of edentulism that is most likely to be successfully treated by conventional prosthodontic techniques with complete denture prosthesis. o Defined by: § Residual bone height of ≥ 21 mm measured at the least vertical height of the mandible § Class I maxillomandibular relationship Class II o This classification level is distinguished by the continuation of physical degradation of the denturesupporting structures and in addition is characterized by localized soft tissue factors and patient management/lifestyle considerations o Defined by: § Residual bone height of 16 to 20 mm measured at the least vertical height of the mandible § Class I maxillomandibular relationship § Residual ridge morphology resists horizontal and vertical movement of the denture base Class III: o Is characterized by the need for surgical intervention (implant therapy or pre-prosthetic surgery) to allow for adequate prosthodontic function o Defined by: § Residual bone height of 11 to 15 mm measured at the least vertical height of the mandible § Class I, II, and III maxillomandibular relationship § Residual ridge morphology has minimum influence to resist horizontal or vertical movement of the denture base § Location of muscle attachments have moderate influence on denture-base stability and retention Class IV: o The most debilitated edentulous condition with surgical reconstruction almost always indicated, but cannot always be accomplished due to patient's health, desires, dental history, and financial considerations o Defined by: § Residual bone height of least vertical height of the mandible § Class I, II, and III maxillomandibular relationships § Residual ridge offers no resistance to horizontal or vertical movement (it’s just flat) § Location of muscle attachments have significant influence on denture-base stability and retention Class Bone Height Class I Class II Class III Description ≥ 21 mm Maxillomandibular Relationship Class I 16 to 20 mm Class I Residual ridge morphology resists horizontal/vertical movement of the denture Class I, II, III Continued degradation of denture-support characterized by soft tissue factors and pt management/lifestyle Needs surgical intervention for prosthodontic function 11 to 15 mm Most likely to be successfully treated by conventional techniques Residual ridge morphology has low resistance to horizontal/vertical movement of denture Location of muscle attachments have moderate influence on denture-base stability, retention Class IV Lowest Class I, II, III Most debilitated edentulous condition Sx required but cannot be completed due to pt condition No resistance to horizontal/vertical denture base movement Reseat tray and border mold again Hold tray in place with one hand and border mold with the other Review for all anatomic landmarks BEADING, BOXING AND POURING OF FINAL IMPRESSIONS FOR COMPLETE DENTURES Measure 3mm down from the borders of the final impressions and mark these measurements with a ball point pen. There is no need to measure along the posterior portion of the maxillary final impression (see diagram). Connect the dots to form an outline (see diagram). Paint a thin coat of tacky liquid just beneath the outline. The tacky liquid will hold the rope wax in position until you can securely attach it with sticky wax. Place a strip of rope wax along the outline drawn on the tray. Place the top edge of the rope wax at the line. As you go along the perimeter of the outline, attach the rope wax to the tray with some sticky wax. Review: Measure 3mm down from the borders of the final impressions and mark these measurements with a ball point pen. There is no need to measure along posterior portion of the maxillary final impression (see diagram). Connect the dots to form an outline (see diagram). Paint a thin coat of tacky liquid just beneath the outline. The tacky liquid will hold the rope wax in position until you can securely attach it with sticky wax. On the maxillary impression, carry the rope wax posteriorly so that the top edge of the wax is even with posterior edge of the tray as shown in the diagram. In the mandibular tray, the rope wax should be 3mm shy of the borders of the impression all the way around the tray. If one strip of rope wax is not long enough to finish the beading of the tray, use a second strip. Place the second strip adjacent to the first and continue the beading process Place a strip of rope wax along the outline drawn on the tray. Place the top edge of the rope wax at the line. As you go along the perimeter of the outline, attach the rope wax to the tray with some sticky wax. On the maxillary impression, carry the rope wax posteriorly so that the top edge of the wax is even with posterior edge of the tray as shown in the diagram. In the mandibular tray, the rope wax should be 3mm shy of the borders of the impression all the way around the tray. If one strip of rope wax is not long enough to finish the beading of the tray, use a second strip. Place the second strip adjacent to the first and continue the beading process