A Framework for Setting Realistic Expectations for Water Quality Improvements - Capel
How can I foster realistic patient expectations and ...€¦ · How can I foster realistic patient...
Transcript of How can I foster realistic patient expectations and ...€¦ · How can I foster realistic patient...
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How can I foster realistic patient expectations
and minimize dissatisfaction at the complete denture
delivery appointment?
Ewoldsen N, Point of Care JCDA Dec 2003
From Functional Impressions to Finished Denture;
3 Appointments, Zero Surprises
Ewoldsen N, Collaborative Techniques, Winter 2003
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Assessing Needs & Managing
Expectations
• Motivated patients are more accepting of change
• Adaptation takes time/Adaptability diminishes as we age
• Can we use the existing denture as a blueprint?
• Can the patient ‘approve fit’ before delivery?
Previewing “Smile Makeover” using functionally relined existing
denture
• Communicate benefits of tissue conditioning prior to
impressioning
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Applying plastisols as
a tissue conditioner &
functional impression
material.
Roughening the
denture base improves
adhesion but may
commit you to
treatment!
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Replacement Denture
Candidate:
- severely decreased OVD
- worn teeth
- Class III occlusion
- previously repaired
maxillary denture
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Confirm Occlusal
Plane/Ala-Tragus line
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Plastisols will bond incrementally
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2:1 mix of PermaSoft flowed into denture (no
voids!)
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From this………….
to this in 1 hour
PermaSoft
-conditions tissues
-functionally forms the primary
impression with peripheral seal
-restores lost occlusion and
esthetics
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From this
….to this in 2 days!
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Tone the tissues; no need to remove dentures for 24 hours
prior to impressions
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Use tongue-guided centric
at OVD………
“put the tip of your tongue in
the back of the roof of your mouth,
bite down gently”
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PermaSoft
tissue-conditioning reline
helps restore OVD and
reestablishes posterior
contact
Note: tooth wear is still
evident. Display of teeth
remains deficient,
but improved
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• PermaSoft, a PMMA-plastisol mechanically bonds to most roughened surfaces; avoid irreversible changes to the patients denture initially
• Plastisols functionalize impressioning; aid esthetic blueprint
• Plastisols are auto-adhesive; up to three incremental layers OK
• Trubyte Occlusal Plane Analyzer to locate Fox and Camper’s Planes
• Preserve the inter-dental relationship (bite) with each reline
• Confirm adequate freeway space using phonetics (sibilant sounds are made at “closest speaking space”)
• Confirm maxillary anterior tooth position using fricative (”f”) sounds
• Locate maxillary midline & mount casts w/o facebow
• Recall patient at 3-day intervals, code as D 5850/D 5851
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Vinlypolysiloxane
(Aquasil Ultra, Caulk)
• Rigid
• Heavy
• Monophase
• Low Viscosity
• Ultralow Viscosity
• Regisil Rigid 30-seconds for border-molding
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Appointment #1a; impression mandibular arch
(open-mouth technique) atop the PermaSoft liner
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If necessary, XLV wash impression;
mandibular denture, open-mouth technique
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Appointment #1b; impression maxillary arch, closed-mouth technique
Heavy or Monophase on the borders, LV for raminder
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Coe Soft will functionally extend borders; restore vertical
dimension; re-establish plane of occlusion
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With ‘wash’ technique, progress toward lower viscosity with
each wash; no (tray) adhesive needed between layers
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Aquasil’s lowest viscosity is Aquasil Ultra XLV
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Mount Maxillary Model using Bonwill’s Triangle plate
Craddoch Mounting Craddoch, FW. The Facebow Mounting. J Prosth Dent 1952 43(7) 339-43
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Trace position of maxillary teeth on mounting plate
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Keystone/Darby Labo-mate; magnetic release, mounting table ($55)
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Trace tooth position on mounting table
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Before separating the maxillary denture from model, mount mandibular cast
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Within the allowed incisal pin travel (± 2 mm) OVD can be changed without remounting
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Now your lab knows where you’d like the teeth set!
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Carve clean land areas
Define borders
Draw or carve posterior
palatal seal
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Mount Case in maximum intercusping position (MIP)
which must coincide with tongue-guided centric
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Dental labs’ #1 complaint: “We don’t get good impressions from our doctors”
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Appointment #2: Trial insertion
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Review: Impressioning/casting models
-Hydrophilic vinylpolysiloxane, fast-set (Aquasil Ultra:Mono, LV, XLV)
-Capture mandibular impression, open mouth technique
-Capture maxillary impression, closed-mouth technique
(tongue-acquired ‘centric relation’)
-Confirm final wash doesn’t violate inter-arch relationship (OVD)
-Capture ‘bite’ using fast-set, rigid VPS if needed
-Cast models, peripheral excess permits forming land areas, model
bases parallel to the plane of occlusion
-Index model bases
-Use articulator with mounting plate (Lab-o-Mate, Darby Dental),
maxillary model/plane of occlusion & midline oriented
-Trace desired tooth position on mounting plate
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Immediate Denture
-definitive prosthesis or throwaway?
-surgical guide matching denture intaglia
-communicating tooth position/esthetics
-accommodating swelling, managing shrinkage
-facilitating patient adaptation
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Raise tongue to activate floor of the mouth, fully extend tongue
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Modification of plastictrays is an advantage
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Algin-X Ultra
Dentsply Caulk, alginate Substitute (VPS silicone)
Impression can be stored,shipped remaining accurate for 14 days.
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Is there a benefit to retaining natural teeth during healing of the posterior segment?
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Remember: Brighter always looks BIGGER!
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How do we communicate tooth size when a try-in is not possible?
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Idealize vertical overlap, lingualize tooth placement, document and communicate
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Fully extended, border molded impression, bone level communicated to laboratory
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Pocket depth recordings transferred to master model
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Posterior palatal seal/vibrating line confirmed intraorally and communicated to laboratory
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Undercut areas noted, recorded
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Vacuum formed PVA sheet, clear 0.060” surgical guide
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