tips and tricks

Recently I spent another day observing at a prosthodontic practice. It was a mixed day with some implant work, fixed pros, composite resin and denture work. Below is a summary of the day with some thoughts and observations: -The first appointment was the jaw registration appointment in the construction of a new full lower over denture retained by a bar. As the old denture suprastructure was made at another practice whose scanner files were lost in a software update, a new suprastructure had to be designed. The impressions were taken in the previous appointment using the layering technique described in his denture course. One issue with impressions around these structures is the material locking in and tearing. This isn't an issue as he flows light body under the bar and lets it set to block it out and uses ultra light body PVS around the bar to take the impression in the final wash which is one reason he doesn't like polyether for these cases due to its stiffness. The suprastru

 Did what I would call my first equilibration recently. Technically in the purest sense of equilibrations I have done a few by building patients up who have lost vertical in a balanced position but this was the first reductive equilibration where the patient had a significant improvement very quickly.  The situation was the boss had done a small restoration on the distal surface of the 28 and the patient said things hadn't felt right after that so I was immediately thinking it was an interference in centric relation bite. I quizzed her more and she explained there was a strange feeling, not a pain but a discomfort that didn't feel right when she chewed sometimes but not all the time. Anytime patients describe this difficult to describe phenomenon, I think of an occlusal imbalance until proven otherwise. She also complained of halitosis that started after the filling which I chalked down to food packing (which I discounted) and mild periodontal disease or sinusitis as a cause.  

 I have an ongoing full over full denture case at my private practice job. Initially I was quite excited as it seemed like a slam dunk case as the patient has the tallest and widest alveolar ridges that I have ever seen. She has a current full upper denture but is looking for a new set as she has lost her full lower denture and her full upper denture is discoloured, has an occlusal cant and has a missing tooth which was her last remaining natural tooth which was recently extracted. Despite the missing tooth and lack of peripheral continuity, the denture is still quite retentive.  At the secondary impression appointment the suction of the impressions were very impressive and I had difficulty removing the lower impression which gave me hope of achieving some level of suction in the final lower denture. Everything was looking quite straightforward due to the patient's favourable anatomy.  At the jaw relation appointment I encountered the difficulty that is inherent in large residual r

 Today I had a difficult and very frustrating restorative appointment. it was restoring a back to back interproximal cavity on an upper canine and premolar. The premolar was rotated to the distal so the cavity was on the palatal surface and there was moderate recession and severe wear with 100% overbite and a vertical parafunction pattern with a horizontal platform worn into the canine and premolar where the opposing teeth occluded.  Difficulties of this appointment was: -The caries was equigingival on teeth with recession. The further down the tooth the lesion is, the more difficult the access, matrixing, wedging and application of restorative materials. Pretty much every aspect of the procedure is more difficult. -When there are well defined wear facets, the occlusion has to be spot on post restoration as the teeth fit together perfectly and any failure to conform will lead to a high spot on a patient with heavy occlusion.  -The rotated premolar put the caries on the palatal root sur

 In my new role the very first patient I met was a difficult denture case. There are upper and lower canine to canines were remaining and the periodontal condition was so severe that the lower teeth are grade 3 mobile and less than 1mm of bone is holding the upper teeth in. In the public system, this would be an open and shut full clearance and delayed denture case as the teeth would clearly come out in the impression but in the private setting, the boss had treatment planned a phased immediate denture and had already extracted the posteriors. I had told him that I enjoy the denture process and mysteriously I have found all of his denture cases have been transferred to me.  So walking into the practice having this case in front of me I was faced with a challenge as I had a situation I had not encountered previously and had time pressure as he wanted the dentures made before his birthday in 3 weeks. It occurs to me that private patient's demands are more reasonable as they are payin