hello and welcome to chair side lies I'm your host Megan strong thanks for joining us today got
a great show for you in this episode dr. bi has a fully adventurous patient in this chair and he's
discussing his clinical protocol for replacing an ill-fitting existing denture he's discussing how
to fine-tune form and function when fabricating a complete denture and he's also highlighting
how important it is for clinicians to maintain the ability to deliver complete dentures for
certain clinical indications or patients financial limitations so dr. by let's see what you've got
welcome everybody back to another episode of chairside live my name is dr. avi and I want
to take you through a complete denture case and this is an interesting case because the patient
came in with an existing set of dentures as you can see here and they're not a bad-looking set of
dentures they're functional and you know the patient can have them for quite a while like
this but we wanted to take the next step and maybe transition this patient into some form of implant
supported prosthetics and in order to do that I wanted to make him a new set of dentures now
you can see here in this picture where I'm fairly happy with the amount of of two that he's showing
when he's smiling however he does have some dark areas in the corners of his of his mouth so we
want to fill those in with with some teeth so he has a little bit of a more of a natural smile
while he's smiling and also I wanted to improve on the function of these dentures so they look
good but the fit is a little bit off and they're moving around especially the mandibular denture
and I'm sure you can all relate to that and your practices so we brought the patient in
and I took them through a visit of diagnosis and treatment planning and this picture is important
for diagnosis especially if we do take the next step and go with implant supported prosthetics
especially for the for the maxillary arch and you can see here as a patient's going through a little
bit of a smile on the on the left picture and then a very big smile on the right picture I'm looking
to diagnose where the transition zone is in the transition zone what I mean by that is when the
patient smiles am I going to see the transition between a fixed prosthesis and the soft tissue and
the bone or am I not going to see it and the good news here is that I'm not going to see it so if
we do decide to place implants for this patient in the future we're not going to have to remove a lot
of bone in order to do that for the maxillary arch the bone removal in the maxillary arch would be to
hide that transition zone that I just mentioned so we take the patient through the diagnosis and
you can see here in the maxillary arch we have a nice Ridge and I want to take my preliminary
impressions I do this utilizing a denture Lestrade's GC America sells some nice ones they're
called Co trays Co e I tried those in they come in three different sizes and I want to measure
and make sure I have something that resembles the arch that I'm going to be taking the impression of
so I try those in and load them with impression material and once I have the impression set I
can remove those from the mouth and the closer I am with my preliminary impression the better
it is because we're going to fabricate some custom trays that fit well and we're going to take final
impression so here are my preliminary impressions and I'm happy with those I can send those into
Glidewell and they fabricate custom impression trays for me and we all know the rule where we
want to be a few millimeters shy of the depth of the vestibule let me try these in and the reason
for that is because we want a boarder mold so that we can capture the depths of the anatomy for the
patient so we have some well fitting dentures and there is such a thing as overextension
and we don't want to over extend further into the vestibule and displace tissue and that will cause
a denture to be painful and also to be displaced itself so here I am utilizing the border molding
technique and we all went through this in dental school I want to make sure that I do extend the
tray into the borders and usually when I do this and I go all the way around the custom tray I'll
have a pretty good seal even with it with the compound material that I'm using here so once I
get to this point and I've gone all the way around I actually have pretty good suction especially
with my maxillary custom tray so that's a telltale sign that the tray fit very well now we're done
with the fabrication of the border molding and I'll place holes inside my custom tray because
I don't want to take a Miko compressive impression so we want to do Miko static and once I'm ready I
will load polyvinyl siloxane material into my tray I usually take the impression for the maxillary
arch with medium body and the mandibular arch with heavy body you could do a combination of the two
as you prefer in your practices now here you see a sequence of different products so that the lab
can provide for you you can get a traditional wax room with a couple of teeth already set in there
so that you can call relate the midline better to the laboratory or on the right hand side of the
screen you can have a combination of different products such as a printed tooth set up now
whether it's completely printed or the posteriors are printed and the anteriors are in waxed so that
you can work out the aesthetics a little bit better that'll be up to the clinician so those
are a couple products that are available for you that can make your life a little bit easier when
you're going through the setup trying stage with the patient once the wax rims are are set and you
take a bite registration you can have a complete tooth setup for the patient at that point so I'm
just doing the the measurements right now for the vertical dimension and comparing them to
what patient had previously and once I'm happy with that vertical dimension I can take a buy
registration as well and relay that information back to the laboratory so here you see a picture
of the maxillary by so with the different products that the lab provided me I can either try in the
base plate and wax trims with the teeth already set in there or I can go to traditional route if
that's what I choose to do and here you can see that I'm going more with the traditional route
and I'm trying in the base plates I can set my midline with the two teeth that are provided
and measure my vertical dimension and once we're happy with what the way things look and I'm also
checking the high smile line here I also want to match the occlusal plane for the patient
with the aloe tragus line utilizing a fox plane so once all the measurements are taken I can go
ahead and place a couple of indentations into the wax rims for the bite registration and this part
is a little bit tricky and a little bit more challenging because we want to stabilize these
base plates in the patient's mouth and at the same time take the bite registration so we go through
this procedure several times with the patient so that he understands what we're trying to do and
what we trying to achieve and with the help of my assistant holding the maxillary baseplate in place
I can manipulate the mandibular arch into centric relation and eventually centric occlusion once the
teeth are set into the base plate so the patient comes back the following visit and we go through
the setup trying and I want to make sure at this visit that patients are happy with the way things
look and again the product that the lab can that can provide you is a set up with a combination of
printed denture which will fit very well into the patient's arch and ridges and the esthetic
setup in the anterior the fit is going to be very important because that way you can keep the teeth
in place as you're going through your esthetic evaluation and the base plates aren't going to
be moving around while you're trying them in so we like our setup and here you can see that
I want to do it traditionally as well just to show you the two different techniques and this
is the same visit as the previous setup trying with the printed denture and you can tell that
these are moving around a little bit more than the printed denture did and the reason for that
is because the printed denture fits a little bit better because the stone casts are scanned and the
denture is printed to fit like a final denture so once the patient's happy with the the results and
we can send the setup back to the laboratory for processing and bring the patient back the
following visit and now we're going to try in the final product the patient already checked off on
the aesthetics at the previous visit so we're not going to have any surprises and he approved
everything and we make sure that that's the case and once we process we let the patient know that
there is no going back so for the final delivery stage I want to try in my denture with pressure
indicating pace and again this will probably take you back to the dental school days and I
want to check the intaglio surface of my denture to make sure that it's not going to be catching
on any areas and make sure that there weren't any imperfections in the processing stage each of the
denture and if there are any high areas I can remove those carefully and make sure that these
dentures are comfortable for the patient once that is completed I can take the patient through the
occlusion and make sure that we have the proper occlusion for this patient so that we don't have
dislodging of the denture as a patient is eating now you can see here that there are a little bit
of discrepancy during the processing stage where I will have to do a clinical adjustment of the
occlusion chairside and their different techniques that you can utilize for the adjustments basically
what I use is a u-shaped or a horseshoe shaped articulating paper and I will check the occlusion
several times and make my adjustments chairside during the delivery stage of the visit this is
usually repeated after the one week and the two week follow-ups and what you see here is
the completion of the complete dentures maxillary and mandibular and the patient is quite happy with
the results and we tried to keep the vertical dimension and the tooth length the same but we
worked out some of the kinks that were wrong or we're not quite acceptable to the patient
from the previous denture and we incorporated that into this denture so if we do decide to
place implants for this patient in the future we can utilize the tooth position and in the tooth
shape of these dentures to help guide us to where those implants are going to go and we'll have a
more predictable outcome that way well I want to thank you for joining me again for this episode
of chairside live and hope to see you here back in the near future thank you thank you for that
doctor bye well that about wraps it up for this episode of terrified live on behalf of everyone
here at glial laboratory thank you for watching and I'll meet you right back here next time
you