When we have patients with an existing maxillary denture who want to transition to some type of implant prosthesis, there are many things to consider when we are treatment planning these types of cases. Number of implants, A/P spread, and vertical space are a few important clinical decisions that must be made. The decision to do a fixed or removable prosthesis, however, can be patient driven, meaning, most patients will want a fixed prosthesis if given the choice.
I think about orthodontists being, in a way, like restorative dentists. They are moving teeth and they're facilitating occlusions. And because of this, I believe it's very important for them to have a strong understanding and working knowledge of centric relation.
There are three main areas that need attention when designing complete denture prostheses. When these three things are not accomplished, it can lead to misfits and patient dissatisfaction. I see it all the time.
Having a unified practice vision is essential for implementing complete dentistry. As doctors, we need to have a clear picture or vision of the type of practice we want to have. What type of dentistry do we want to offer? What level of service do we want to deliver to our patients? What does the office look and feel like? What is the reputation we want to have? And what is the personality or culture of our practice?
Occlusal equilibration is a treatment modality that we can use to increase patient satisfaction and comfort. Prior to my training and education at The Dawson Academy, equilibration was the least understood and therefore the most underutilized procedure of all the things that I did.
When patients come to us with existing maxillary dentures and want to transition to afixed implant supported prosthesis, sometimes the treatment planning process can be a little confusing and a little challenging.
And we tend to maybe let the patient drive that decision and we end up doing a fixed prosthesis. But really the question is, is that the best prosthesis for them?
Performing a complete exam on a new patient is our greatest opportunity to differentiate our practice, and if done the way Pete teaches us, it can be a huge practice builder. However, getting our team on board and getting them trained in the concepts of complete dentistry can often be our greatest barrier to implementation. There are three steps that I recommend for getting our team trained.
Mandibular denture stability is often times a difficult challenge for us and also for patients.
For them to feel that a lower denture is stable and comfortable is very challenging, especially with ridges that are severely atrophic. One of the things that I have learned over my career is using HydroCast, which is a functional impression material. It is made by Sultan.
Cement-retained implant crowns are very, very popular and have been for the past 10 or 15 years.
But one of the challenges we see with cement-retained implant crowns is the lack of retrievability, especially since most of these have been put on with permanent cement.
Even the temporary cement sometimes is very difficult to remove.
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When we are restoring patients with complete dentures, and they come in with, sometimes, a bag of many sets of dentures that have not been functional, we often wonder why would our set be any different.
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