FINLAY’S CASE PRESENTATION

Welcome to my August 2020 Newsletter Case Presentation

This newsletter describes in step by step detail the provision of an upper free end saddle partial denture in a patient with a high smile line and lower implant supported complete denture with suboptimal positioned dental implants.

This 75 year old woman was referred to me from her general dental practiioner.

Dental History and Concerns

An implant supported lower complete lower denture had been provided 4 years previously in the UK. This “no longer fixes to its anchors and is worn”. The upper partial denture was over 12 years old, having been provided in the USA. “Upper partial again worn and a little unreliable.”

Social History

Nil.

Dental wish list

“Good eating teeth – and ones/teeth that I am happy to smile with.”

Diagnoses

  1. The remaining natural upper 8 teeth had reduced but healthy periodontal attachment.
  2. The two dental implants (Astra) in the lower jaw had Locator attachments and appeared healthy. The implants positions were suboptimally positioned being over 30 degress divergant, resulting in poor fixation and increased wear of the Locator components.
  3. The upper and lower dentures exhibited suboptimal extension of the flanges and saddles. They had poor retention, support and stability.
  4. The patient had a high smile line showing the cobablt chromium clasps of the UR4 and UL3 during social interaction.

Apart from providing no treatment we discussed two solutions namely; fixed implant supported teeth versus optimally designed and made removable dentures. The patient chose to have removable partial dentures.

The clinical situation and treatment process is shown in detail below with photographs. I provided the clinical work and Rowan Garstang provided the technical work.

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Figure 1 Pre – treatment. High smile line showing metal clasp.

Figure 2 Pre – treatment. High smile line showing metal clasp. Upper partial denture and lower complete denture.

Figure 3 Pre – treatment. High smile line showing metal clasp. Upper partial denture and lower implant supported complete denture.

Figure 4 The remaining natural upper 8 teeth reduced but healthy periodontal attachment. Upper denture with suboptimal extensions.

Figure 5 Pre-treatment lower implant supported complete denture. Under-extended in retromolar area and overextended labially, indicating a lack of border moulding during impression taking.

Figure 6 Divergent implants – over 30 degrees

Figure 7 Green locator attachments (without male insert) work better on divergent dental implants

Figure 8 Food (particularly seeds) get pushed into the abutment centre resulting in the denture attachment not seating

Figure 9 This results in deformation damage to the attachments

Figure 10 A superb tip Prof Frauke Muller taught me. A temporary filling material placed into the top of the abutment prevents food from collecting

Figure 11 The attachment inserts were then changed from pink to green to allow the denture to seat

Figure 12 treatment planning card containing sequenced treatment plan and quotation. This is how I plan all of my patients treatments

Figure 13 Lower primary impression with two viscosities using Zhermack Tropcalgin (base) and Neocolloid (Syringe). This allows full extension to record the sulcui

Figure 14 Upper primary impression – 2 stages compound first to record the free end saddles and alginate medium wash

Figure 15 Custom tray for lower working impression. This is adjusted so that the impression pick ups for the locators do not touch the inside of the tray when this is seated in the mouth – ensures correct seating of the tray

Figure 16 Lower working impression. Border moulded in greenstick followed by Impregum impression with full border moulding

Figure 17 Upper working impression. Border moulded in greenstick followed by alginate impression with full border moulding

Figure 18 Registration visit with central bearing apparatus (gothic arch tracing) for CR recording

Figure 19 Registration visit with central bearing apparatus (gothic arch tracing) for CR recording

Figure 20 Registration visit with central bearing apparatus (gothic arch tracing) for CR recording moving to the patient’s left

Figure 21 Registration visit with central bearing apparatus (gothic arch tracing) for CR recording moving to the patient’s right

Figure 22 Inter-maxillary registration with central bearing apparatus. Maxillary plate with china graph pencil marking with arrow head scribed showing precise CR

Figure 23 Inter-maxillary registration with central bearing apparatus. Maxillary plate with plastic disc with countersunk hole placed over CR arrow head. This allows the mandibular pin to fit into the hole to enable accurate recording of this inter-maxillary relation.

Figure 24 Inter-maxillary registration with central bearing apparatus in the mouth with the maxillary and mandibular parts “locked” together in CR by the pin in the hole

Figure 25 Inter-maxillary registration with central bearing apparatus in the mouth with the maxillary and mandibular parts registered together with futar D bite registration material

Figure 26 Mounted casts with finished dentures on the articulator. Schottlander Enigmalife denture teeth and Dental D clasps

Figure 27 Before and after changes in shape of the denture fitting surfaces. Optimal extensions from border moulding. New denture metal reinforced too

Figure 28 Before and after changes in shape of the denture fitting surfaces. Optimal extensions from border moulding. New denture metal reinforced too

Figure 29 Upper denture cobalt chromium base and finished denture. Optimal extension of saddles and palatal strap for maximum support. Dental bar gives additional support and should teeth be lost in the future this can be added to

Figure 30 Finished upper denture. Optimal extension of saddles and palatal strap for maximum support. Dental bar gives additional support and should teeth be lost in the future this can be added to

Figure 31 Finished denture mimicking the natural teeth. Schottlander Enigmalife denture teeth and Dental D clasps

Figure 32 Finished denture mimicking the natural teeth. Schottlander Enigmalife denture teeth and Dental D clasps

Figure 33 Finished denture mimicking the natural teeth. Schottlander Enigmalife denture teeth and Dental D clasps

REFERENCE MATERIAL

Full access PDF to my published scientific papers which explain my philosophy and clinical techniques. Please click on the link below and scoll down this page to find lots of useful clinical techniques, reference material and previous lectures:

https://www.finlaysutton.co.uk/speaking
Dr Finlay Sutton

BDS, DGDP (UK), MSc, MFDS RCS Ed, MRD RCS Ed, PhD, FDS (Rest Dent) RCS Ed

Finlay is a GDC registered specialist in restorative dentistry, prosthodontics, periodontics and endodontics and takes private referrals in prosthodontics.

He has particular expertise in conventional and implanty supported:

Complete dentures Removable partial dentures Combined fixed and removable prosthodontics Removable prosthodontics education/mentorship partial, complete and implant supported dentures

Garstang Dental Referral Practice
Weind House, Park Hill Road, Garstang, Lancashire PR3 1EL
07858 054139
education@finlaysutton.co.uk