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

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

Applying plastisols as

a tissue conditioner &

functional impression

material.

Roughening the

denture base improves

adhesion but may

commit you to

treatment!

Replacement Denture

Candidate:

- severely decreased OVD

- worn teeth

- Class III occlusion

- previously repaired

maxillary denture

Confirm Occlusal

Plane/Ala-Tragus line

Plastisols will bond incrementally

2:1 mix of PermaSoft flowed into denture (no

voids!)

From this………….

to this in 1 hour

PermaSoft

-conditions tissues

-functionally forms the primary

impression with peripheral seal

-restores lost occlusion and

esthetics

From this

….to this in 2 days!

Tone the tissues; no need to remove dentures for 24 hours

prior to impressions

Use tongue-guided centric

at OVD………

“put the tip of your tongue in

the back of the roof of your mouth,

bite down gently”

PermaSoft

tissue-conditioning reline

helps restore OVD and

reestablishes posterior

contact

Note: tooth wear is still

evident. Display of teeth

remains deficient,

but improved

• 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

Vinlypolysiloxane

(Aquasil Ultra, Caulk)

• Rigid

• Heavy

• Monophase

• Low Viscosity

• Ultralow Viscosity

• Regisil Rigid 30-seconds for border-molding

Appointment #1a; impression mandibular arch

(open-mouth technique) atop the PermaSoft liner

If necessary, XLV wash impression;

mandibular denture, open-mouth technique

Appointment #1b; impression maxillary arch, closed-mouth technique

Heavy or Monophase on the borders, LV for raminder

Coe Soft will functionally extend borders; restore vertical

dimension; re-establish plane of occlusion

With ‘wash’ technique, progress toward lower viscosity with

each wash; no (tray) adhesive needed between layers

Aquasil’s lowest viscosity is Aquasil Ultra XLV

Mount Maxillary Model using Bonwill’s Triangle plate

Craddoch Mounting Craddoch, FW. The Facebow Mounting. J Prosth Dent 1952 43(7) 339-43

Trace position of maxillary teeth on mounting plate

Keystone/Darby Labo-mate; magnetic release, mounting table ($55)

Trace tooth position on mounting table

Before separating the maxillary denture from model, mount mandibular cast

Within the allowed incisal pin travel (± 2 mm) OVD can be changed without remounting

Now your lab knows where you’d like the teeth set!

Carve clean land areas

Define borders

Draw or carve posterior

palatal seal

Mount Case in maximum intercusping position (MIP)

which must coincide with tongue-guided centric

Dental labs’ #1 complaint: “We don’t get good impressions from our doctors”

Appointment #2: Trial insertion

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

Immediate Denture

-definitive prosthesis or throwaway?

-surgical guide matching denture intaglia

-communicating tooth position/esthetics

-accommodating swelling, managing shrinkage

-facilitating patient adaptation

Raise tongue to activate floor of the mouth, fully extend tongue

Modification of plastictrays is an advantage

Algin-X Ultra

Dentsply Caulk, alginate Substitute (VPS silicone)

Impression can be stored,shipped remaining accurate for 14 days.

Is there a benefit to retaining natural teeth during healing of the posterior segment?

Remember: Brighter always looks BIGGER!

How do we communicate tooth size when a try-in is not possible?

Idealize vertical overlap, lingualize tooth placement, document and communicate

Fully extended, border molded impression, bone level communicated to laboratory

Pocket depth recordings transferred to master model

Posterior palatal seal/vibrating line confirmed intraorally and communicated to laboratory

Undercut areas noted, recorded

Vacuum formed PVA sheet, clear 0.060” surgical guide