Full Description
Application of the Neutral Zone in Prosthodontics offers a step-by-step guide to successfully designing and placing complete and implant-retained dentures using neutral zone concepts.
Illustrates every technique described with more than 300 color photos
Covers all phases of complete denture therapy
Presents a step-by-step assessment and examination protocol
Details the importance of accurate diagnosis and prognosis prior to committing to treatment
Describes an alternative to traditional impressioning procedures that can be accomplished in a single appointment
Includes access to a companion website with video clips and student handouts, with teaching PowerPoints available for instructors
Contents
Foreword ix
Preface xi
About the Companion Website xiii
1 Assessment of Edentulous Patients 1
Introduction 1
The Patient Interview 1
Patient Interview: Age 2
Patient Interview: Attitude 2
Patient Interview: Expectations 2
Patient Interview: Chief Complaint 3
Patient Interview: General Health 3
Patient Interview: Complete Denture Experience 3
Patient Interview: Denture Remake Frequency 4
Patient Interview: Patient Satisfaction 4
Patient Interview: Photographs, Diagnostic Casts, and Radiographs 4
The Facial Analysis 4
Facial Analysis: Facial Tissue Tone 5
Facial Analysis: Tooth and Denture Base Display 6
Facial Analysis: Midlines 6
Facial Analysis: Lip Mobility 7
Facial Analysis: Lip Dimension 7
Prosthetic Factors 8
Prosthetic Factors: Vertical Dimensions 8
Prosthetic Factors: Existing Dentures 8
Prosthetic Factors: Skeletal Relationship 9
Prosthetic Factors: Saliva 9
Prosthetic Factors: Oral Tolerance 10
Prosthetic Factors: Temporomandibular Joints 10
Prosthetic Factors: Oral Cancer Review 10
Oral Characteristics 11
Oral Characteristics: Palatal Throat Form 11
Oral Characteristics: Arch Size 11
Oral Characteristics: Maxillary Ridge Height 11
Oral Characteristics: The Palate 12
Oral Characteristics: Maxillary Ridge Contour 13
Oral Characteristics: The Maxillary Denture Foundation 13
Oral Characteristics: Mandibular Ridge Height 14
Oral Characteristics: Mandibular Ridge Contour 14
Oral Characteristics: Mandibular Muscle Attachments 14
Oral Characteristics: Mandibular Denture Foundation 15
Oral Characteristics: Maxillary Tuberosity Curve 15
Oral Characteristics: Vestibule 16
Oral Characteristics: Frenula Attachments 16
Oral Characteristics: Pterygomandibular Raphe 16
Oral Characteristics: Denture Bearing Soft Tissues 16
Oral Characteristics: Retromolar Pads 17
Oral Characteristics: Maxillary Ridge Crest to Resting Lip Length (Esthetic Space) 17
Oral Characteristics: Mandibular Ridge Crest to Resting Lip Length (Esthetic Space) 17
Oral Characteristics: Maximal Oral Opening 17
Oral Characteristics: Retromylohyoid Space 18
Oral Characteristics: Tongue Size 19
Oral Characteristics: Tongue Position 19
Oral Characteristics: The Neutral Zone 20
Summary 21
References 21
2 Orthopedic Resolution of Mandibular Posture 25
Introduction 25
Conditioning Abused Tissues and Stabilizing the Existing Prosthesis 26
Materials Properties and Technique 26
Technique 26
Re-establishing Orthopedic Mandibular Position 28
Summary 33
References 33
3 Definitive Impressions 35
Preimpression Considerations 35
Background 35
Impression Fundamentals 35
Impression Materials 36
Edentulous Impression Trays 37
Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures 37
Tray Selection and Tray Adaptation 37
Fabrication of Tray Stops 38
Border Molding the Impression Tray 39
Final (Definitive) Impression 41
Techniques for Making Single Appointment Definitive Impressions for Implant-Assisted Complete Dentures and Immediate Dentures 43
Attachment Selection 43
Implant-Retained Overdentures 43
Tray Selection 43
Impression Technique 44
Implant-Retained and Supported Overdentures 45
Immediate Dentures 46
Master Cast Production 47
Summary 48
References 48
4 Fabricating Record Bases, Occlusal Rims, and Mounting a Central Bearing Device 51
Introduction 51
Fabrication of Record Base and Occlusal Rims 51
Fabrication of Maxillary Wax Occlusal Rim 52
Fabrication of Neutral Zone Mandibular Occlusal Rim 56
Technique 56
Jaw Recorder Device (Central Bearing Device) 59
Jaw Recorder Device Assembly 59
Mounting the Jaw Recorder Device on Record Bases 59
Mounting of the Jaw Recorder for Implant Overdentures 61
Mounting the Jaw Recorder Device on Partially Edentulous Arches 61
Procedure 62
Summary 62
References 64
5 Developing an Esthetic Blueprint 65
Introduction 65
Contouring and Shaping the Maxillary Occlusal Rim 65
Summary 72
References 72
6 Registering the Maxillo-Mandibular Jaw Relationship 75
Introduction 75
Facebow Recording 75
Centric Relation Recording for the Edentulous Patient 76
Centric Relation Recording for the Partially Dentate Patient 83
Summary 86
References 86
7 Neutral-Zone Registration 89
Introduction 89
Recording the Physiologic Neutral Zone for Edentulous Patients 89
Technique 90
Recording the Physiologic Neutral Zone for a Dentate Patient 94
Technique 94
Summary 96
References 96
8 Second Laboratory Procedure: Selection and Arrangement of Prosthetic Teeth 99
Introduction 99
Indexing the Esthetic Blueprint Record 99
Indexing the Neutral Zone Record 100
Selection of Anterior Teeth 101
Maxillary Anterior Teeth Arrangement 102
Mandibular Anterior Teeth Arrangement 103
Selection of Posterior Teeth 105
Mandibular Posterior Teeth Arrangement 106
Maxillary Posterior Tooth Arrangement 108
Tooth Selection and Arrangement for the Partially Edentulous Patient 109
Summary 111
References 111
9 Trial Placement Appointment 113
Trial Placement 113
Evaluation of Esthetics 113
Evaluation of Phonetics 114
Evaluation of Occlusal Vertical Dimension (OVD) 116
Evaluation of Centric Contact Position 116
External Impressions 117
Technique 118
Summary 124
References 125
10 Denture Placement 127
Introduction 127
Placement of Immediate Dentures 127
Placement Procedures 129
Evaluation and Adjustment of Intaglio Surface 129
Technique 129
Evaluation and Adjustment of Denture Borders 131
Evaluating the Cameo Surface 133
Occlusal Evaluation and Correction 133
Subtractive Correction Technique 135
Additive Correction Technique 136
Patient Education and Instructions 137
Technique for Adhesive Application 138
Technique for Adhesive Removal 138
Home Care Instructions for Denture Patients 140
Postplacement Problems with New Dentures 140
Retention Problems 140
Soreness 141
Sore Throat 141
Speech Problems 141
Gagging 141
Summary 142
References 142
11 Use of CAD/CAM Technology for Recording and Fabricating Neutral-Zone Dentures 145
Introduction 145
Registering the Neutral Zone during Impression Making 145
Technique 145
Registering the Neutral Zone during Maxillo-Mandibular Records 147
Technique 147
Registering the Neutral Zone during the Trial Placement 147
Technique 147
Summary 150
References 151
Index 153
