Remount procedures, occlusal consideration and instruction .pdf

Remount procedures, Occlusal Considerations, Denture Insertion, Instructions to the Patient for Complete Dentures Dr. Piriya Boonsiriphant Department of Prosthodontics Lecture Objectives Given the information for denture insertion appointment including occlusal considerations and remount procedur...

Remount procedures, Occlusal Considerations, Denture Insertion, Instructions to the Patient for Complete Dentures Dr. Piriya Boonsiriphant Department of Prosthodontics Lecture Objectives Given the information for denture insertion appointment including occlusal considerations and remount procedures, the student should be able to accurately • Describe the necessary steps for denture insertion appointment including remounting procedures and occlusal considerations. • Provide the patient with dentures in adequate occlusion for comfort in mastication and function. • Discuss the factors in managing the patient including instructions to patients regarding care of dentures and oral tissues. Processed dentures are returned to you….. Before delivery appointment: • Evaluate the intaglio & cameo surfaces of complete dentures for any sharp areas (acrylic spicules) • Remove sharp surfaces • After examination and adjustment the dentures are now ready to be tried in Instrument and material for denture delivery appointment • Mouth mirror • Straight handpiece • Acrylic burs • Pressure indicating paste (PIP) and brush • Articulating paper • Gauze Checking the dentures in the patient mouth….. Step 1 • Check proper border extensions • Relief of labial and buccal frenums • Border extensions should be contoured to allow spaces for frenum attachments and reflection of tissue Checking the dentures in the patient mouth….. Checking the dentures in the patient mouth….. Checking the dentures in the patient mouth….. • The goal is to have an even layer of PIP on the border with no show though • The borders maintain the seal and consequently the retention, thus adjustment should be done only when needed and should not be done excessively Checking the dentures in the patient mouth….. Step 2 • Check for pressure spots • Pressure Indicating Paste (PIP) is used to locate & relieve the high pressure area or areas with excessive undercut Checking the dentures in the patient mouth….. Paint pressure indicating paste (PIP) on the tissue surface of the denture Checking the dentures in the patient mouth….. The pressure indicating paste (PIP) should be in one direction and thin Checking the dentures in the patient mouth….. Reseat the denture back in the mouth using finger pressure Checking the dentures in the patient mouth….. Take the denture out and locate show through spots on the PIP Checking the dentures in the patient mouth….. Adjust the show through spots by using low speed straight handpiece with appropriate sized acrylic bur extraorally Checking the dentures in the patient mouth….. Repaint PIP and adjust until there is no show through spot Checking the dentures in the patient mouth….. Step 3 Check retention Checking the dentures in the patient mouth….. Step 3 Check stability Checking the dentures in the patient mouth….. Step 4 Check occlusion Adjust occlusion chairside Clinical remount and adjust occlusion on articulator How to adjust occlusion? Rule: deepen fossae, do not flatten cusps! How to adjust occlusion? As you adjust, the teeth will come closer together and eventually make contact How to adjust occlusion? Goal: all posterior teeth contact evenly How to adjust occlusion? Goal: all posterior teeth contact evenly Adjust occlusion chairside How to adjust occlusion chairside….. Check occlusion intraorally with articulating paper How to adjust occlusion chairside….. Adjust occlusion if necessary by using low speed straight handpiece with appropriate sized acrylic bur extraorally How to adjust occlusion chairside….. Adjust occlusion until you achieve even occlusal contacts Clinical remount procedure How to perform clinical remount….. Clinical remount procedure: • Block out undercuts • Lubricate the denture with petroleum jelly • Pour plaster to fabricate the remount casts How to perform clinical remount….. • Remount Cast is formed to mount the processed denture on an articulator How to perform clinical remount….. • Articulate processed maxillary denture to the articulator using the mounting table How to perform clinical remount….. Heat Aluwax Cut short narrow strip Place on posteriors How to perform clinical remount….. Centric record Inspect Mount mandibular remount cast How to perform clinical remount….. • Adjust occlusion on the articulator How to perform clinical remount….. Advantages of clinical remount: • Permits better visualization • Provides a stable working foundation • Absence of saliva allows for more accurate markings with the articulating paper for correcting occlusal discrepancies What should we do? What should we do? What should we do? What should we do? What should we do? Instructions to patient Instructions to patient • Temporary increase in salivary flow • Starting with soft foods and small bites • Speech (6-8 weeks) • Inform the patient about possible sore spots • Patient should not sleep with the dentures Instructions to patient • It may require 6-8 weeks to chew comfortably with your new dentures • Starting with soft foods and small bites • Make sure to chew with both left and right posterior teeth • Once you feel more confident with your dentures, try eating foods that require more chewing Instructions to patient • Rinse your mouth and dentures after meals • Brush the mucosa with a soft toothbrush or to use a washcloth • Denture should be cleaned daily with soap and water using the denture brush • Dentifrice may contain the abrasives Instructions to patient • Continue to see your dentist regularly • If soreness becomes a problem, make an appointment • Whenever you feel any changes in the way your dentures work or feel, make an appointment • NEVER try to make adjustments to dentures yourself Recall appointments • 1 to 3 day adjustment should be made after denture insertion • Immediate denture patients should be seen in 24 hours • 1 week and 1 month after denture insertion • Once the patient is comfortable, a yearly schedule is adequate