Edentulous Custom Tray for PVS Impression Fabrication

Note: Trays should be fabricated at lease 24 hours in advance to ensure triad shrinkage is minimal during the impression.
 
Maxillary PVS Custom Tray Fabrication Sequence

Identify location in which over-extended alginate impression tissue appears to begin to fold and mark with a blue pencil.  Then mark about 1 mm superior to the blue line a red line.

Adapt one layer of base plate wax to intimately cover the tissue surface of the maxillary arch.  Cut the pink wax back to the previously scribed red line.  Cut three tissue stops into the pink base plate wax; one in the anterior and one in each posterior segment.

 

Apply separating medium over the wax and then adapt triad tray material over the entire wax relieved area.  Cut the excess triad about 2 mm from the pink base plate wax extension.  Using a wax spatula curl the excess triad material back against the pink base plate wax until the blue line is at the same level as the triad extension.  Then add a handle that won't interfere with the patients lips.  Cure for 2 minutes and remove the wax.  Then cure for 6 minutes intaglio surface up.

 Mandibular PVS Custom Tray Fabrication Sequence
Fallow the same steps as described above with the mandibular custom tray.

 

Maxillary Teeth and Mandibular Semi-precision Removable Partial Dentures with Distal Extension Implant

Patient presented with a partial edentulous mandibular arch with the very strong request "I do not want anything removable."  We investigated the possibility of implants with a diagnostic wax up and subsequent cone beam CT scan.  It was very evident that there was insufficient bone for implant restorations for fixed prostheses.  The patient was presented with the option of survey crowns with semi-precision attachments and an small implant supporting the unilateral distal extension, as well as restoring her maxillary teeth to a more ideal esthetic and occlusal relationship.  After reviewing the option in detail and considering the patient's finances, the patient elected to restore the mandibular arch with two survey crowns with semi-precision attachments and on implant supporting the distal extension on the left side.  The patient was somewhat apprehensive about the idea of having something removable right up to the day of insertion.  Once it was in the patient's mouth and taken home and used for a while I received this note in an e-mail...

"I love my partial!!  Thank you for doing such a great job; believe it or not, I don't want to remove it.  It is just that comfortable."

Maxillary Complete Denture / Mandibular Complete Denture - Small Maxilla

This patient presented with 20+ year old complete dentures in the maxilla and mandible.  All the patient really wanted was "white" teeth.  The patient's maxilla and mandibular relationship is very class III and the patient's maxilla is very small in comparison to the mandible.

Original Prostheses in the Mouth

Intra-oral photo of pre-treatment edentulous jaws

Smile with old Prostheses in the mouth

Smile with New Prostheses in the mouth

Profile smile with the prostheses in the mouth

Average man's thumb as a reference for size of patients maxilla

Maxillary Complete Denture / Mandibular 5 Implant Hybrid (CAD/CAM Frame)

Patient presented with generalized advanced periodontal disease.  He elected to receive a maxillary complete denture and a mandibular 5 implant hybrid prosthesis. 

Maxillary Complete Denture / Mandibular Overdenture Metal re-enforced

Initial Prosthesis and oral condition.

Final Maxillary Complete Denture / Mandibular 2 Implant Overdenture

Initial Profile Photos with old Proshesis.

Lateral Profile with final prostheses.

Initial smile photo with old prosthesis.

Final smile photo with new prostheses.

Mandibular 2 implants with locator abutments.

New Prostheses.

Mandibular Implant Overdenture Surgical Guide

Patient presented with severely worn maxillary complete denture opposing a partially dentate mandible with advance chronic periodontal disease.  The patient wanted to keep his teeth if possible.  The teeth were deemed non-restorable and the patient then elected to proceed with a two implant overdenture.  The following describes the basic fundamentals of preparing an adequate surgical guide for a two implant overdenture

Intial presentation with adjustments made to his existing maxillary denture to establish a better occlusal plane.  Acrylic was added to the posterior segments to help restore OVD and better articulation with his existng dentition and for a future interim prosthesis.  Another option might be to fabricate an interim maxillary complete denture.

Interocclusal record obtained to properly mount the patients teeth to aid in fabrication of the interim mandibular denture.

Interim mandibular denture tooth set up in wax.

Processed interim mandibular denture ready for insertion at surgery.

Inserted mandibular interim denture day of surgery

Clear duplicate of mandibular interim denture to be used as a surgical guide.  If implant surgery is to be performed the day of extractions duplicate the interim as soon as it's processed.  If there will be a delay between tooth extraction and implant surgery do not duplicate the interim denture until it has been adequately relined with a soft liner close to the surgical date.

It's important to provide guidelines for your implant surgeon.  This picture depicts removing the lingual flange and lingual portions of the anterior sextant of teeth.  This provides buccal/facial limitation to the implant placement.  Implants directed out the facial or buccal of a prosthesis is not desirable. 

The guide can and should be modified to illustrate the amount of boney reduction required to ensure proper inter-arch space for the prosthesis.   It is recommended that 12 mm of space from the implant platform to the incisal edge be available for proper ovedenture fabrication.  Note: if the patient so desires to progress to a fixed implant prosthesis in the future a minimum of 16 mm of space is required.  This can be accomplished by measuring the proper distance down from the incisal edge of the denture teeth and marking the labial flange of the duplicate denture.  The flange can the be reduced to the measured line.  This allows the surgeon to place the guide in the patients mouth and visually see the amount of required bone reduction required.

Maxillary Complete Denture / Mandibular Complete Denture

This particular patient just wanted new teeth.  She reported the set of dentures with which she initially presented were 20 years old and amazingly enough in relatively good condition.  Her reason for seeking treatment was "I just felt like it was time to get some new teeth."  She requested to have new teeth that looked just like the old ones.

Profile with New Prostheses in place.

New Prostheses in Maximum Intecuspation.

New Prostheses - Smile

Old Prostheses - Smile

Old Prostheses Maximum Intercuspation

Old Prostheses Profile