Australasian Dentist Magazine Sept-Oct 2021

Category 98 Australasian Dentist T his 49 year old female patient was referred to my practice, unhappy with her smile and performance of her implant bridges which had regularly loosened and broken requiring repair, and also were the cause of foul odour and bad breath. She had a full clearance, ten implants (maxilla 6/mandible 4) under general anaesthesia by another dentist, whom also inserted fixed bridges supported by the implants later that day. Two key options for treatment of each arch were presented: a. Fixed dental prosthesis. b. Removal dental prosthesis. The patient chose this option due to her unfavourable result with her fixed treatment. The final design we agreed to was a bar-retained, mucosal and implant supported overdenture for each arch. The aim of primary impressions for conventional complete dental prostheses is to achieve an overextended impression of the area, and to get this, stock trays are modified with periphery wax. Wax stops are also used to help relocate the arch within the tray. For primary impressions, a putty-like consistency is critical to allow an overextension of the peripheries. By increasing the powder: water ratio, you get a consistency thick enough to enable rolling the alginate into a sausage. Anatomical landmarks to be captured for the maxilla are the post dam and hamular notches, whilst the mandibular arch impression should impress the submandibular fossae and retromolar pads. Fixture level impressions were taken with open tray impression copings. (Figure 5). These copings are splinted with GC Pattern Resin in the laboratory, and then sectioned to be reluted again intra orally. The fixture level impression is taken with polyvinyl siloxane or poly ether material with a custom tray. In this particular case, I have utilised Edentulous management – fastidious or fast? It’s all in the detail By Dr Tuan Dao BDS (Hons), MDSc (Pros), FPFA Prosthodontist and Specialist Clinical Educator clinical Figure 1. Her initial presentation. Figure 2. Her initial presentation. Figures 3 and 4. Attention to detail for primary impressions for complete edentulous arches. Figure 5. Fixture level impressions Figure 6 Figure 7 Figure 8