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Dental Articles on Occlusion, Centric Relation, Restorative Dentistry & More

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Rehabilitating the Completely Edentulous Patient

Rehabilitating the completely edentulous patient is one of the most challenging tasks we face in restorative dentistry, and for me, the most rewarding. The majority of the patients I see with an existing set of complete dentures are suffering from pain under the denture bases, poor retention, difficulty with mastication and unnatural esthetics (Figure 1). I feel our society has come to accept the fact that this is what you get when you lose all of your teeth, that this is how dentures are supposed to feel because they are dentures! The psychological effects that accompany the loss of teeth often lead patients to insecurities, social isolation, and even depression. The physical effects of pain, weight loss, and poor nutrition can be even more debilitating.

Creating comfortable dentures

Combining what we have learned from Pete’s Concept of Complete DentistrySM, classic removable prosthodontic principles, and the latest technologies in implant dentistry, we have the ability to impact our patients’ lives in a way they never knew was possible.

The key to successful denture-implant dentistry is knowing where the teeth need to be functionally, esthetically and phonetically. We begin chairside with setting the maxillary anterior teeth on a wax rim, to establish appropriate lip support, esthetics and phonetics, in the same way we work out our tooth-borne provisionals. A centric relation bite registration is critical to making sure there are no interferences which may dislodge the denture bases. I have found that almost all “loose” dentures have interference to CR (Figure 2).  A lingualized occlusal scheme will provide stable centric contacts, helping to increase retention of the denture bases. Hydrocast material is used to get proper extension of the denture bases and to create a functional impression for maximum fit and comfort (Figure 3).

Dentures with Centric Relation(Figure 2: Upper denture with CR interference)Dentures with Hydrocast(Figure 3: Denture without and with Hydrocast)

Once the dentures are fabricated in this manner and the patient has been able to wear them successfully, appropriate implant therapy can be determined. In all honesty, some patients who come in wanting implants because of loose dentures have realized now they really don’t need them! But for the rest of the patients, implant therapy is necessary for adequate stabilization or perhaps they want to go to a fixed treatment option.

For cone beam analysis, the dentures are duplicated using a radiopaque material to evaluate the bone to tooth relationship (Figure 4). At this point, treatment planning with the surgeon and the laboratory technician is critical. Sequencing and phasing the treatment, knowing how much chair time is needed, and laboratory fees all need to be determined ahead of time. A treatment plan which is in harmony with the patient’s expectations and desires can then be presented.

 Dentures with Radiopaque Markers

(Figure 4: Duplicate dentures with radiopaque markers)
Happy Denture Patient
(Figure 5: Happy and satisfied patient)

Sometimes the road is long for these patients, but the light at the end of the tunnel ultimately leads them to a better quality of life and that is what it is all about (Figure 5)!

How to Avoid Mistakes During Dental Treatment Planning

Dr. Daxon is a native of Fort Pierce, Florida and attended John Carroll High School. She received her Bachelor of Science degree in Chemistry from Stetson University in 1989 where she met her future husband, Patrick. Dr. Daxon graduated from the University of North Carolina School of Dentistry in Chapel Hill in 1993. Following graduation, she served a one-year general practice residency at Brigham and Women's Hospital in Boston and a two-year Prosthodontic residency at Harvard School of Dental Medicine and the Veterans Administration. Prior to starting Daxon and Grundset Dentistry, Dr. Daxon was a partner with the International Center for Complete Dentistry for 12 years. She is a Prosthodontist specializing in complex occlusal disorders, complete dentures, implants, and dermal fillers. She is a faculty member at The Dawson Academy in St. Petersburg. She holds awards from the International College of Dentists and the Academy of Oral Medicine. Dr. Daxon is also a member of the International College of Dentists, the Florida Academy of Dental Practice Administration, the American Dental Association, the Florida Dental Association, the American College of Prosthodontists, the Florida Prosthodontic Association, the West Coast Dental Association and the Pinellas County Dental Association. Dr. Daxon is an active member in her church and community. Her husband, Patrick, is Vice President of the Financial Planning Department at Raymond James. They enjoy spending time with their three girls, Claire, Grace, and Lilly. Her interests include cooking, gardening, water-skiing, exercising and fishing.