Sequence of Complete Denture Fabrication and Implant Overdentures Planning-2022.pdf

Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Ira E. Klein Professor & Chair Department of Prosthodontics 1. Describe the clinical steps and sequence 2. Review laboratory and clinical procedures 3. Discuss systemic conditions that affect CD associated with the elderly patien...

Advanced Prosthodontics L. Jahangiri Leila Jahangiri, BDS, DMD, MMSc Ira E. Klein Professor & Chair Department of Prosthodontics 1. Describe the clinical steps and sequence 2. Review laboratory and clinical procedures 3. Discuss systemic conditions that affect CD associated with the elderly patients 4. Importance of regular recall schedules 1 Advanced Prosthodontics L. Jahangiri Average Age 90 100 75 80 60 40 38 47 Average Age 20 0 1800 1900 1996 2050 Year Elderly patients require special considerations due to their compromised oral anatomy, medical & nutritional status, reduced physiologic reserves and adaptive capacity. • • • • • • Denture support area Neuromuscular control Chewing force Salivary flow due to medication(s) Healing capacity Quality of denture bearing tissues 2 Advanced Prosthodontics L. Jahangiri 1 Intraoral & prosthesis examination Preliminary impressions Pour preliminary impression Fabricate custom tray 2 Secondary / final impressions Send out for pouring bite registration 3 Jaw registration and teeth selection Set anterior teeth 4 Anterior teeth try in Send out for posterior teeth set up 5 Posterior teeth try in verification of occlusion Locate PPS Send out for processing 6 Adjustments and delivery Remount if necessary 7 Recall and follow up 1         Lips and cheeks Lateral border of the tongue Base of tongue Floor of the mouth Tonsillar region & soft palate Oropharynx Neck TMJ 3 Advanced Prosthodontics L. Jahangiri 1 Bidigital 1 Examine the denture bearing surfaces, the soft palate, tonsillar region, the vestibules and the buccal mucosa Note the hamular notch and definition of tuberosities 4 Advanced Prosthodontics L. Jahangiri 1 Inflammatory Fibrous Hyperplasia Fibrous hyperplasia begins as a traumatic ulcer secondary to an ill-fitted denture flange. 1 Inflammatory Papillary Hyperplasia Papillary hyperplasia is secondary to ill-fitting maxillary dentures and is sometimes complicated by chronic candidiasis. 5 Advanced Prosthodontics L. Jahangiri 1 Keratinized attached mucosa Mucogingival junction Keratinized attached mucosa is the remnant of attached gingiva. The more keratinized attached mucosa available on the denture bearing surfaces, the better the support. 1 Lingual frenum Buccal frenum 6 Advanced Prosthodontics L. Jahangiri 1 The mucosa overlying this region is poorly keratinized and prone to perforation secondary to trauma from complete dentures. Note the sharp mylohyoid ridge Resorption patterns in the edentulous patients (Zarb et al., 1983) 7 Advanced Prosthodontics L. Jahangiri 1 Moderate resorption Dentate Mandible - No resorption The size and position of the buccal shelf vary relative to the degree of alveolar ridge resorption. Severe resorption 1 Mental Foramen - the anterior exit of the mandibular canal and the inferior alveolar nerve. In cases of severe residual ridge resorption, the foramen occupies a more superior position. 8 Advanced Prosthodontics L. Jahangiri 1 Dentate Mandible-No resorption Moderate resorption Note the position of the mylohyoid ridge as it varies relative to the degree of alveolar ridge resorption. Severe resorption 1 Testing maxillary denture retention Apply a tipping force to the incisors in an attempt to break seal. 9 Advanced Prosthodontics L. Jahangiri 1 Testing maxillary denture retention Apply a tipping force to the incisors in an attempt to break seal. 1 Testing maxillary denture stability Apply unilateral force to posterior occlusal surface of denture. 10 Advanced Prosthodontics L. Jahangiri 1 Testing stability and retention of mandibular denture Alternately apply unilateral force to posterior occlusal surfaces. 1 11 Advanced Prosthodontics L. Jahangiri 1 2 Space for border molding 12 Advanced Prosthodontics L. Jahangiri 2 2 Impressions and dentures made for patients with favorable floor of mouth posture and favorable (anterior) tongue position. Note length of lingual flange are impression. This will greatly enhance stability and retention. 13 Advanced Prosthodontics L. Jahangiri 2 3 14 Advanced Prosthodontics L. Jahangiri 3 3 Maxillary wax rim check list: Posterior region • The occlusal portion of the rim thickness a) Molar region - 8 mm b) Premolar region - 6 mm c) Anterior region - 3 mm • As viewed from the lateral perspective the rim should project anteriorly to just beyond the outer edge of the land of the cast. Anterior region • Lingual contours must not impinge on the tongue space. 15 Advanced Prosthodontics L. Jahangiri 3 3 Before adjustment After adjustment With the lips at rest the wax rim should project 1-2 mm below the lip line. 16 Advanced Prosthodontics L. Jahangiri 3 Adjust the plane of the wax rim so that it is parallel to Camper’s plane. Adjust the plane of the wax rim so that it is parallel to the interpupillary line. 3 Mark the midline on the wax rim 17 Advanced Prosthodontics L. Jahangiri 3 “VDR” 3 “VDO” “VDR” Interocclusal Rest Space 18 Advanced Prosthodontics L. Jahangiri 3 3 19 Advanced Prosthodontics L. Jahangiri 4 4 20 Advanced Prosthodontics L. Jahangiri 5 Different occlusal schemes are acceptable 5 Posterior palatal seal Patient and articulation should be identical 21 Advanced Prosthodontics L. Jahangiri 5 Posterior palatal seal Greatly enhances retention and the shrinkage of acrylic resin during processing is compensated for by scoring the cast in the postdam area. 6 22 Advanced Prosthodontics L. Jahangiri 7 Dissatisfied 7.7 % Moderately Satisfied 25.6 % Fully Satisfied 66.7 % 7 Removable - Implant retained Fixed - Implant supported Out of 33 million edentulous patients only 2-4% have received implant treatment. 23 Advanced Prosthodontics L. Jahangiri 1. Diabetes 2. Dehydration 3. Xerostomia causing medications 1 Intraoral & prosthesis examination Preliminary impressions 2 Secondary / final impressions 3 Jaw registration and teeth selection 4 Anterior teeth try in 5 Posterior teeth try in verification of occlusion 6 Adjustments and delivery 7 Recall and follow up 24 Advanced Prosthodontics L. Jahangiri 1 Denture fabrication Implant placement 2 Abutment selection 3 Abutment connection and torque 4 Pick up of attachments 5 Occlusion 6 Recall and follow up 25 Advanced Prosthodontics L. Jahangiri Implant Assessment 26