WHY MY DENTURES (DON'T) SUCK - PART 4
Patients With Terminal Dentitions .........................
How to Avoid Extracting Teeth Before Immediate Denture Fabrication
So, you have a patient in the chair whose teeth move around like a piano player.
Its always a miracle some of the teeth don’t fall out when they sneeze. Your plan is to take an alginate impression to send to the lab for fabrication of immediate denture. Only problem is, there is no assurance that some of the teeth wont come out in the impression. First and foremost, it is not your fault that the patient has waited to seek treatment. Be sure you explain that you will make every effort not to perform unintended oral surgery. That said, sometimes even with best efforts, these teeth will come out during the impression. Please follow on to see how I have been dealing with these cases.
You will need:
A good stock tray. (I like the COE Spacer trays)
Fast Set, Heavy Body PVS impression material
Fast Set Bite Registration material
Its not like you have the luxury of having a custom tray fabricated.
Going in once is stressful enough!
And, it is an immediate denture...
My philosophy is always to capture all the critical anatomy that we discussed a couple of posts back. This can be difficult to achieve if you just cram a tray full of alginate in place. Remember, you only get one shot at this! This technique allows you some control of the process while protecting the vulnerable.
The first step is to fit the stock tray making sure you have sufficient clearance for an alginate pickup. Once fitted, paint some PVS adhesive onto the palate. Take some fast set bite registration and apply to the palate, stack it up to reach the palatal vault. Place in mouth and basically take an impression of the hard palate. This impression will serve as a stop for all other procedures and will also avoid possibly capturing an air void in the impression. Take away any material that extends onto teeth or encroaches on ridge crests with a lab knife.
Once satisfied with the palate. Place some PVS adhesive around the tray periphery (inside and out) At this point, I use fast set, heavy body PVS to border mould. Its very difficult to do this in one shot, particularly if your patient is tight lipped. Typically do this in two steps, getting the anterior in one application and then the posterior with a second. What you are looking for is a good capture of the peripheral roll of soft tissue along with any frenuli. Once you reach the posterior, be sure to capture the hamular notch area. More times than not, it isn’t necessary to border mould the posterior. The alginate will do all that if guided properly with your palatal and peripheral customization.
Apply alginate adhesive (Getz Hold) to all the intaglio surfaces of the tray and cover all the PVS you have added.
Now its a simple matter of mixing alginate (please follow manufacturer’s instructions regarding water powder ratio and water temperature) Load the tray. Remember, you are now using a semi custom tray so the palate is formed, as is the periphery. Fill in the trough created between both with alginate.
Get to the mouth in a timely fashion and seat tray. Remember the palatal stop will give you a confirmation of total seating.
Once in place, border mould periphery, have the patient try to blow air out their nose while pinching off the flow of air by gently pinching their nose. (this will help to form up the hamular notches and posterior palate by hinging the soft palate) Once alginate has set, gently remove the impression. This is not time for any heavy rocking of the tray. You can place a finger over the posterior periphery and gently coax the back free before doing any heavy pressure with the tray handle. The idea is not to tear the alginate or extract teeth.
|As you can see, no extractions,|
and a reasonably detailed impression upon which my Drake technicians
can fabricate an immediate denture
This technique may not solve all potential problems associated with these cases but it is another tool to consider when faced with this relatively common delimma!
Thanks for reading!
'till next time, Larry