Professional Documents
Culture Documents
Dr. Bob Loney, DMD, MS Dr. Mark Vallee, DDS, MSc, FRCDC
Course Objectives
Identify patients who can be successfully rehabilitated Five-step method to diagnose & treat problems Select & use indicating media correctly Minimize problems with relines Denture esthetics & occlusion Implant overdentures & Locator attachments
Successful Treatment
Selecting cases that can be successful !
Avoid: No ridge Ridge mucosa moves when tongue/cheek active Floor of mouth above mand. ridge LOOK during Function!
Avoid: Cheek or frena attach to top of ridge Vestibuloplasty (relative) LOOK during Function!
Caution: Severe wear, loss OVD Severe undercuts/tori & don dont want surgery
Caution: No dentures for many years Patient who doesn doesnt want dentures Patient who doesn doesnt need dentures
Inform of consequences, costs, options Don Don t talk patient into treatment Shortened Dental Arch (SDA)
Patient Satisfaction
Patient Satisfaction
Difcult to quantify, unpredictable
More than good anatomy More than well constructed denture Includes expectations
Not directly correlated with quality Small percentage never satised Low quality results in lower satisfaction Patients more satised with dentures than eyeglasses and hearing aids
Patient Characteristics
Not correlated with satisfaction: Personality Age Attitude toward aging Reduced salivary ow & reduced ridge negatively correlated
Fabrication Variables
Patient Expectations
High expectations if currently dissatised Unrealistic expectations negatively correlate with satisfaction Pre-treatment interview can help determine expectations
Related to satisfaction: clinical remounts accurate impressions & occlusal records patient involvement in denture esthetics
Matching Expectations
Iatrosedative Interview
1. Recognize & acknowledge problem
Critical for success If patient & dentist dont expect the same result - failure Helps determine need for referral
2. Explore & identify problem 3. Interpret & explain problem 4. Offer a solution
Iatrosedative Interview
1. Recognize & acknowledge problem
Patient: My problem is .... Id like.... Theyre too... Dentist: So your dentures feel..., I can see they are... That must be difcult ...
Iatrosedative Interview
2. Explore & identify problem
Dentist: History - You say the dentures loosen only when you are chewing on the left side? Exam - Visual intraoral check. Look for variations from normal in denture & tissue. Use indicating media. Have patient demonstrate the problem. Palpate.
Iatrosedative Interview
3. Interpret & explain problem
It appears that the denture teeth may be too far away from your bone. There is not much bone to support them. Look here in the mirror... The denture will always be looser than normal unless...
Iatrosedative Interview
4. Offer a solution
Dentist: So to review, you have 3 things you want changed.. You dont want these 2 things changed... I can change/improve ... but not....because... Do you understand...Do you have any questions What would you like to do?
Conclusions
Small percentage never satised, even with highest quality Comprehensive interview can help identify patients with high expectations Low clinical quality related to reduced patient satisfaction
Principles of Diagnosis
Don Don t limit list too early in diagnosis Keep an open mind Revisit possible causes
Information Gathering
Gathering Information
Often inadequately investigated Spend more time talking to narrow possibilities
Chief Complaint
History of C.C.
History
Medical Dental
Not
Clinical Exam
Where?
Have patient point to problem Partially ignore patient patients position Dentist locate with stick, instrument or paste
Chewing only - Occlusion Gets worse throughout day - Occlusion When rst insert dentures Denture Base
Details
How long?
After adjustment
0%-100%
0% Still Same, Can Can t Tell
Insufcient Amount
Prior to Placement
Ensure damp mucosa Spray surface of PIP with air/water
Reading PIP
Burn-through (No paste left)
- Acceptable contact
Non-retentive Denture
What Whats Wrong?
Peripheries
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Alter Phonetics
Paste Removal
Gauze, cotton rolls, toothbrushes Alcohol for stubborn areas Cheap steamer Cement, debris
Secrets of Impressions
Polyvinyl Siloxanes
Dimensional Stability Detail Use for all procedures
Secrets of Impressions
Final Impressions
Load quickly - viscosity Material brought over periphery
Everything Dry
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Secrets of Impressions
Two Mirror Technique
Secrets of Impressions
Seat anterior of tray rst Cotton swabs on tray - remove excess posterior
- everything visible
Secrets of Impressions
Flange thickness
Secrets of Impressions
Tray not overextended
Secrets of Impressions
Why remake?
Relines
This denture needs a reline!
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Materials
Tissue Conditioners PVS Light Body Self/Light Cure? undercuts distortion porosity
Improperly Placed!
Relieve Denture
Remove undercuts Shorten anges Create space for material
Relieve Denture
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Video Clip
Mullick et al. J Prosthet Dent 1981;46:304 Ockert-Eriksson et al, Int J Prosthodont 2000 Millstein & Hsu, J Prosthet Dent 1994 Breeding et al, J Prosthet Dent 1994
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No contacts on inclines
Removable partial dentures B caused unseating Central loading better than distal loading
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Step 1
Check Denture base with PIP Moisten with air water syringe No peripheries
Avoid cheeks
Laboratory Prescription
Fabricate: Remount index Remount casts Remount maxillary denture
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Adjust Occlusion
Extraoral adjustment more efcient Eliminates continual removal & replacement of dentures Avoids reex avoidance
Step 5 Check Esthetics & Phonetics If large change, warn a head of time
6 Step Delivery
Step 1 Adjust Denture base with PIP Step 2 Denture peripheries with PIP Step 3 Occlusal Adjustment Step 4 Chewing Test Step 5 Check Esthetics & Phonetics Step 6 Polish
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