The Complete Denture Taller Mapa Conceptual (2).docx

Tomado de The Complete Denture: A Careful Pathway

Michael I. MacEntee, Quintessence

The Complete Denture: A Step-byStep Summary Appointment One: Consultation, Examination, and Preliminary Impressions Preparation • All necessary documents for recording a medical and dental history • Selection of maxillary and mandibular trays for edentulous jaws • Irreversible hydrocolloid (alginate) impression material • Soft beading wax • Indelible marker

Patient interview and information record • Complaints (including impact, source, and development) • Dental history • Medical history

Other diagnostic tests • Radiographs • Biopsies • Microbiologic tests

Finish • Disinfect the impressions. • Pour impressions and prepare the casts for the articulator. • Render diagnosis, treatment plan, and prognosis. • Estimate costs and fees. • Make acrylic trays.

Appointment Two: Treatment Plan, Impressions, and Selection of Anterior Teeth Preparation

• Acrylic tray • Impression compound • Portable flame and Bunsen burner • Hot water bath • Lubricant • Low-viscosity impression material • Scalpel handle and no. 11 blade (Bard Parker, Becton-Dickinson) • Egg-shaped carbide bur (Buffalo Dental) • Indelible marker • Mouth mirror • Shade and mold guides for acrylic resin • Spatula and rubber bowl

Actions • Review the treatment plan, prognosis, and fees with the patient. • Adjust the trays. • Mold the periphery of the trays with wax compound. • Make an impression of each residual ridge with low-viscosity impression material. • Select the anterior denture teeth.

Finish • Disinfect the impressions. • Box and pour the impressions.

Appointment Three: Jaw Relations and Arrangement of Anterior Teeth Preparation • Record bases with occlusal rims • Portable flame and Bunsen burner • Reinforced brittle wax • Wax spatula • Wax knife • Indelible marker • Six maxillary anterior teeth • Articulator • Stone • Slurry water • Spatula and rubber bowl

Actions • Record the resting vertical dimension of the lower third of the face and the VDO with the patient wearing the old dentures. • Adjust the occlusal rim to the preferred VDO.

• Arrange the maxillary anterior teeth on the occlusal rim with the patient’s approval. • Remove approximately 3 mm of wax bilaterally from the posterior part of the mandibular rim and place notches in the wax. • Record with the reinforced wax the position of the mandible in centric relation. • If desired, record the orientation of the maxillary occlusal rim and anterior teeth with a facebow.

Finish 1. Disinfect record bases and occlusal rims. 2. Attach the maxillary cast to the articulator. 3. Mount the mandibular cast on the articulator. 4. Select the posterior teeth. 5. Arrange the mandibular anterior and all of the posterior teeth.

Appointment Four: Clinical Trial of Teeth and Orientation of the Condylar Guides Preparation • Teeth arranged in wax on the record bases • Articulator • Portable flame and Bunsen burner • No. 7 spatula • Wax knife • Reinforced brittle wax • Stone • Slurry water • Spatula and rubber bowl

Actions • Assess the tooth arrangement on the articulated casts. • Insert the teeth into the patient’s mouth. • Remount the mandibular cast if articulator mounting is incorrect. • Adjust the condyles on the articulator to reproduce the eccentric movements of the patient’s mandible. • Obtain the patient’s approval of the tooth arrangement.

Finish • Disinfect the baseplates with the teeth. • Adjust the posterior teeth to establish as many simultaneous anterior and posterior occlusal contacts as possible. • Provide a detailed prescription for the dental technician to process the dentures.

Appointment Five: Remount and Insertion of the Dentures Prepare • Processed dentures on casts • Round bur with a straight handpiece • Slurry water • Stone • Spatula • Rubber bowl • Wax knife • Plaster knife • Pressure indicator paste (PIP) • Articulating ribbon • Carbide burs for trimming acrylic resin

Actions • Examine the base of the dentures for defects and irritants. • Evaluate the maxillary denture in the mouth, using PIP if necessary, and adjust the bases. • Assess the comfort and stability of the mandibular denture and adjust. • Identify the occlusal contacts, record the jaw relationship in centric relation, and remount the casts on the articulator. • Adjust the occlusal contacts. • Polish and insert the dentures. • Instruct the patient on the management of problems with the dentures. • Review with the patient the informational pamphlet and add special recommendations. • Establish further appointments to adjust the dentures until the patient is as comfortable as possible. • Estimate expected changes to the fit and comfort of the dentures in the future.

Finish • Establish an appropriote recall schedule.