DELIVERY OF COMPLETE DENTURES Clinical Insertion

Transcription

DELIVERY OF COMPLETE DENTURES
Clinical Insertion Appointment
(1)Final psychological evaluation and
education of the patient
DELIVERY OF COMPLETE
DENTURES
(2)Final adjustment of the prosthesis
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Psychological - Education
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Many hours, much effort , and money !
50% of the work has been done
High expectations !
Adjustment appointments are expected
Prepare for post-insertion problems !
Caution that a new denture is just THAT -
Enough time must be devoted !
NEW
Pessimistic must be encouraged !
Overly optimistic must be counseled !
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You are an individual
Review and explain the clinic document for
post-insertion
Sore areas with New Dentures
Speaking with New Dentures
Chewing with New Dentures
In detail
Increased saliva with New Dentures
Longevity of Dentures
Limitations of Dentures
How to care for Dentures
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ADJUSTMENT
Tissue Surface Adjustment
INITIAL PLACEMENT
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ADJUSTMENT
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INITIAL PLACEMENT
Be careful to follow the correct path of
insertion.
ADJUSTMENT
INITIAL PLACEMENT
Disclose with PIP
We’re looking for resistance to the path -
tissue undercuts.
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ADJUSTMENT
ADJUSTMENT
INITIAL PLACEMENT
(pressure indicating
paste) and
MIZZY Spray
(surface tension
releasing agent)
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ADJUSTMENT
INITIAL PLACEMENT
Pressure Indicator Paste
sequence (PIP)
1. Dry denture surface
2. Brush a thin even layer of PIP onto
the surface of the denture
3. Seat the denture gently - when
resistance is felt, remove and
inspect.
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2
ADJUSTMENT
INITIAL PLACEMENT
ADJUSTMENT
INITIAL PLACEMENT
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ADJUSTMENT
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INITIAL PLACEMENT
ADJUSTMENT
INITIAL PLACEMENT
Now, remove the PIP (alcohol wipe)
Do this for both the
maxillary and mandibular until each will insert
passively
(without resistance)
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ADJUSTMENT
INITIAL PLACEMENT
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ADJUSTMENT
INITIAL PLACEMENT
Place both dentures and position a
cotton role over both posterior
segments - ask the patient to close
with light force.
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3
ADJUSTMENT
INITIAL PLACEMENT
ADJUSTMENT
INITIAL PLACEMENT
If this hurts 1. Remove the denture (the one
producing the discomfort)
2. Coat the tissue surface with PIP and replace - with the cotton roles
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ADJUSTMENT
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INITIAL PLACEMENT
ADJUSTMENT
INITIAL PLACEMENT
Continue until both max and mand
dentures are comfortable when biting
with light force - with the cotton roles in
place.
Ask your patient to hold for
approx. 10 minutes.
Carefully adjust with an acrylic bur
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ADJUSTMENT
INITIAL PLACEMENT
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ADJUSTMENT
INITIAL PLACEMENT
The patient is holding in order
to allow the mucosa to adapt to
the inside surface of the
denture.
The dentures should not have
any PIP left inside while the
patient is holding the bite with
the cotton roles.
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ADJUSTMENT
INITIAL PLACEMENT
After the 10 minutes,
ADJUSTMENT
INITIAL PLACEMENT
Re-insert this denture - place the
cotton roles - and have the patient bite
with more pressure.
Remove one of the dentures usually the maxillary - and coat
with PIP again.
The cotton roles prevent the prosthetic
occlusal contact from influencing the
pressures exerted on the tissues.
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ADJUSTMENT
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INITIAL PLACEMENT
Relate any report of soreness to
the pattern of pressure indicated
by the PIP.
Remove small amounts of acrylic at a time
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ADJUSTMENT
INITIAL PLACEMENT
ADJUSTMENT
INITIAL PLACEMENT
Each time
• Clean the internal surface of denture
• Coat with a thin, even thickness of PIP
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ADJUSTMENT
INITIAL PLACEMENT
Repeat this process until the brush
marks are almost gone - the paste is
smooth throughout - and the patient is
tolerating the bite pressure.
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ADJUSTMENT
INITIAL PLACEMENT
Common Areas to
Adjust
ADJUSTMENT
INITIAL PLACEMENT
• Median raphe
• Incisive papilla
• Distal buccal flange of the
max denture
• Zygomatic process
• Frenum areas
BORDERS
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Common Areas to
Adjust
ADJUSTMENT
INITIAL PLACEMENT
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Common Areas to
Adjust
ADJUSTMENT
INITIAL PLACEMENT
• Frenum areas
• Genial tubercle
• Mylohyoid ridges
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ADJUSTMENT
INITIAL PLACEMENT
To this point - the
prosthetic teeth still
have not occluded.
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ADJUSTMENT
INITIAL PLACEMENT
OCCLUSION
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DELIVERY
DELIVERY OF
OF COMPLETE
COMPLETE DENTURES
DENTURES
ADJUSTMENT
ADJUSTMENT
Errors in Occlusion
•
•
•
•
Inaccurate JRRs
Inaccurate mounting of JRRs
Ill fitting record bases
Incorrect arrangement not detected
at try in
• Processing changes
• Warping of C/C by overheating
during polishing
• Why does denture resin shrink?
– High coefficient of thermal expansion
– Cooling after polymerization
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ADJUSTMENT
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ADJUSTMENT
Clinical Remount
Purpose of the Clinical Remount is to
correct for the fact that:
Clinical Remount
• Adjusted denture bases seat
more accurately than record
bases
• Accommodate for errors made
during the making of centric
relation records
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• Maxillary is
remounted
with the
facebow
preservation
record
ADJUSTMENT
Clinical Remount
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• Mandibular
must be
remounted
with a new
CR Record
ADJUSTMENT
Clinical Remount
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• 4 little cones
of Alu Wax
• Soften
(temper) in a
warm water
bath
ADJUSTMENT
Clinical Remount
• Record
in the
CR
position
ADJUSTMENT
Clinical Remount
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ADJUSTMENT
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Clinical Remount
• Secure mandibular to maxillary
with sticky wax
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• Secure cast to cast with tongue blades
luted to cast with hot glue gun
Clinical Remount
Adjust CO then eccentric positions
Light even contacts around arch
• Adjust the occlusion...light even contacts
across the arch…keep anatomy
ADJUSTMENT
Clinical Remount
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ADJUSTMENT
Clinical Remount
Remove any deflective contacts
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ADJUSTMENT
Clinical Remount
Check Vertical Dimensions
Review esthetic concerns
Verify phonetics
Maintain centric stops
Maintain anatomy 49
Patient education-oral and written instructions
• At the end of the appointment, polish borders +
flanges (not inside)
• Ask patient to use the denture as much as possible
(adaptation element) especially speech (read
newspaper aloud).
• If significant discomfort - soreness - the denture
should be removed - but try to replace at least
6hrs before the next appointment - to observe
tissue response
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• Diet recommendation, cut food and place on
back teeth - up and down motion (a new skill
to be acquired)
• Caution - may feel some fullness early on and
excessive salivation in the first few weeks should resolve
• Use brush to clean denture under water after
soaking it in a cleaning solution (1/2 tsp
bleach + 1tsp Calgon softner + 4oz water)
• Cleaning to remove plaque, prevent stains,
calculus, odor. Avoid wearing the denture for
sleep - to maintain tissue health.
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24 hour follow-up
Next appointment in
24 hours
(next-day post-insertion check)
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• Inquire about the patient’s problems and
conduct a thorough oral examination
• Check the denture for pressure areas with PIP
and adjust the denture as needed
• Check borders for overextension with
disclosing wax and adjust as needed
• Evaluate occlusion, refine equilibration as
necessary, and recheck finish and polish.
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24 hour follow-up
24 hour follow-up
• Note the lesions associated with the anterior
mandibular denture border. They correspond
to the PIP pattern.
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24 hour follow-up
24 hour follow-up
Inspect the frenum areas. This is the anterior
maxillary frenum. It is the most common frenum
to become irritated from denture overextension.
Open contact
If you observe change repeat the clinical remount procedure
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24 hour follow-up
Common Problems
Mandibular denture
• Discomfort
• Poor retention and stability
• Lack of support
Maxillary denture
• Poor retention and stability
• Esthetics
• Phonetics
• Gagging
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Next
In one week Then two weeks Then according to need.
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Last precaution -
DO NOT adjust
the dentures
yourself
Recall
6 months,
then 1 year
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DELIVERY OF COMPLETE DENTURES Clinical Insertion

Transcription

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