hello welcome to chairside live I'm Megan strong and I'm Will Smith registered dental assistant
here at gladwell dental we're so glad you're with us today it's an exciting appointment for dr. mani
Lily's patient because she's going home with the closest representation of the final prosthesis
but this is in a PMMA setup what is that well I tell you what Megan it's the five-dollar wood
of the day polymethyl methacrylate now this is a shatter resistant alternative to glass
that this patient is going to wear for their temporary prosthesis to make sure all that fit
and functionality issues are worked out before we go to our final product sounds like a good
plan let's check it out welcome back to the von Karman operatory today we will be inserting a
poly methyl methacrylate or a PMMA provisional prosthesis I like to think of the PMMA as a test
run of the definitive Brooks our full arch the PMMA will verify both the aesthetics and
the phonetics that were previously established with the wax rim and the full artwork setup as
well as allow us to test the functionality of the tooth arrangement let's take a look at how we did
before we insert the PMMA insert the provided Tryon mu a prosthetic screws when seating the
PMMA provisional hand tighten each screw like the wax setup you should not feel resistance if you
do make sure the top of the multi-unit button is cleaned and the screw channel is free of debris
another reason you may feel resistance can be the soft tissue contours ideally we would like
the contours of the prosthesis to be such that the patient can easily keep their new smile clean this
includes a flange las' buccal contour as well as a convex intaglio surface to check the entire oh
I find the easiest way is with a silicone material such as fit checker this material is placed on the
intaglio surface of the PMMA and then is seated intraoral ii as you can see any areas where the
prosthesis is snug against the soft tissue will show through the silicone I now mark my pressure
spots with a pencil or marker then remove the silicon material and adjust with an acrylic bur
making sure not to create any concave areas that could potentially become a food trap once the
PMMA is seated if you cannot visually confirm the cylinders are flush with the multi-units
radiographic confirmation is recommended after each screw is lightly hand tightened I like to
go back with my torque wrench and tighten each screw to the manufacturers recommendation for
these Han multi-unit abutment prosthetic screws we are tightening 215 Newton centimeters the
heads of the prosthetic screws can be covered with a bacteria resistant material such as PTFE
or Teflon tape and then covered with a light cured composite now that the PMMA is fully
seated let's go ahead and quickly run through our checklist confirm the midline and incisal
edge position evaluate the patient smile lip support the contour of the smile line and the
pink to white ratio you want to sit the patient upright and verify the vertical dimension as well
as the occlusion any noted adjustments to the occlusion can easily be performed in the PMMA
material the biggest benefit of allowing the patient to wear this provisional for two to
four weeks is that they have the opportunity to test the functionality before proceeding to the
definitive Brooks or prosthesis lastly review the oral hygiene instructions with your patient for
home care I personally recommend the use of floss threader as well as a Water Pik it is important to
note that if the PMMA prosthesis was altered in any way the lab will need to know exactly what
changes were made the best and easiest way to communicate this to the lab will be to remove
the altered PMMA after the trial period and send it back to Glidewell from here the laboratory will
copy mail the modified provisional ensuring the definitive Brooks or full arch prosthesis will
include all of your modifications with that we conclude our PMMA appointment thank you
for joining me today in Gladwell's operatory tune into our visit to see the delivery of our
definitive full-arch Brooks or prosthesis well thank you so much for that dr. Manor Lily stay
tuned for the next episode we're going to see the final delivery of the Brooks er full arch
fixed implant prosthesis it's gonna be a great one but hey do you want to earn some free C credit on
the West reduce well then you should head over to gladwell dental calm and take dr. Resnick's
course principles of implant occlusion part 1 will alert implants are not teeth they're not so
I don't overtake the course but on for today's episode well wrapped up on behalf of everyone
here at Global Dental thank you so much for watching we'll meet you right back here next time