The flexible denture - Presentation of my graduating thesis.
TITU MAIORESCU UNIVERSITY OF BUCHAREST FACULTY OF MEDICINE AND DENTAL MEDICINEThe Flexible DentureSupervisor: Author :Univ.Assist PhD. Smătrea Oana Ursu Mihaela Catalina
Agenda✓ 1 Introduction 2 Partially edentulous 3 Materials used in obtaining the flexible partial denture 4 Clinical stages in obtaining the partial denture 5 Clinical cases 6 Conclusionss
1 Introduction Purpose of the paper • This paper is about partial edentations, presenting treatment options with advantages and disadvantages. •The paper is far from exhaustive because on one hand the technology is relatively new in Romania, and on the other hand considerable financial effort is needed to acquire and implement. • For this reason we believe that there is room for improvement in many of the concepts presented here.
2 The partial edentulous. Definition Partial edentulous is a pathological condition arising from the loss of one or more teeth in an arch.
2.1 Causes for partial edentations • decay and its complications; • marginal periodontitis; • vertical and horizontal migrations exaggerated;; • excessive abrasion; • iatrogenic causes; • occlusal dysfunction.
2.2 Classification of the edentulous jaws - I CLASS II - CLASS I - Unilateral Bilateral Posterior Posterior Edentulous Area Edentulous Areas ; CLASS III - CLASS IV - Single Unilateral or Edentulous Area Bilateral Anterior to Edentulou Remaining Teeth Area(s) and Crossing the Bounded by Midline In 1923. E.Kennedy published a simple Remaining Tooth/Teeth and practical classification, reducing the number of clinical forms to only four groups, according to topography :
2.2 Classification of the edentulous jaws - II Costa proposed a simple terminology that names partial edentations, terminology applied in our country: • edentulous frontal • edentulous subtotal - 1-2 remaining teeth on arch;; • the lateral edentulous • edentulous stretched - the missing teeth in • terminal edentulous edentulous a hole more than three teeth .. Based on this classification of Costa Ionita made some changes in 1998: • extended edentulous - in the same gap are missing teeth from two different areas (frontal and lateral); • reading is in order of the edentulous quadrants, while the Costa classification reading is from right to left on both jaws..
2.4 Indications for the flexible denture class I class II class III class IV combined edentations
3 Materials used in obtaining flexible partial denture - I ✓ Thermopress 400 injection unit The injection moulding technique or the proper term of injection moulding describes a procedure in which a heated high-performance plastic (resin) material is injected into a hollow mould under very high pressure. The materials used in the injection moulding technique - so- called thermoplastic resins - enable dental technicians to fabricate Thermopress 400 injection unit restorations for sensitive personswithout the use of chemical additives or catalysts.Four underlying factors sync procedure: temperature - time - speed – power.
3 Materials used in obtaining flexible partial denture - II ✓ Bio Dentaplast ,the semi-crystalline thermoplastic material with a linear structure characterized by high crystallinity . The exceptional physiological behavior and the wide range of mechanical characteristics permit the use in numerous areas of dental prosthetics. The material shows good physical and chemical properties such as increased hardness, stiffness considerable tensile strength, capability restoration and a very good dimensional stability. The material is Bio Dentaplast opaque and prevents glare color metal. We find it available in shades A2, A3, B2, B3 (shades similar to VITA)
3 Materials used in obtaining flexible partial denture - III ✓ Flexiplast,is a monomer-free denture base material for the fabrication of unbreakable flexible partial restorations. The color pigments used for this material do not contain anymetal oxides and comply The flowable thermoplastic resin exhibits outstanding flow properties.with the requirements for dental products. Indicated for removable partial restoration with a highly esthetic appearance, which fulfils all requirements on proper function and wearing comfort. Excellent temporary during the healing Flexiplast phase of implant-supported restorations. Almost invisible flexible partial denture - without metal clasps. Can be used in combination with metal frameworks or precision attachments.
4 Clinical stages in obtaining the flexible partial denture 8.The wax try-in 6. The skeleton probe of thermoplastic partial denture 9 8 4. final or 7 functional 6 impression 5 9. Applying the 7.maxilomandibular flexible partial2. Preliminary 4 relation record denture in oralimpression 5. The analysis of cavity 3 the percise topological or 2 3.The analysis of functional model the study model 1 and the design of the partial denture 1. Examination of the made of bio patient, radiographs, dentaplast diagnosis and therapeutic indication
4.1 Examination of the patient, radiographs, diagnosis and therapeutic indication - I Clinical examination of patient,diagnosis and treatment plan Develop a diagnosis can be made not only based on historical data but also on the clinical examination. Clinical examination is done in a certain sequence: • general medical examination; • local exam. Local exam Includes two main stages : A.Facial exam: • Inspection begins with assessing facial symmetry, proportionality floors of the face, observing aspects of facial tics or oral breathing. Mouth opening amplitude is observed, if the opening is straight, deflected or painful. In TMJ exam we can identify auscultatory crepitation, which can betray occlusal dysfunction or degenerative phenomena of joint.
4.1 Examination of the patient, radiographs, diagnosis and therapeutic indication - II Local Exam B. Oral exam: Soft tissue examination Radiographs Remaining teeth Bone density Periodontal diseases
4.2 Preliminary impression ✓ Is the negative copy of the partially edentulous prosthetic field and it is a clinical stage which includes all oral structures . It is made with elastic materials such as irreversible hydrocolloids
4.3 The analysis of the study model/cast ✓ The study model is used in: - Diagnosis - Treatment plan development - But is also a legal evidence.
4.4 The final or functional impression ✓ Is the prosthetic field’s copyobtained by very preciseimpression material placed incustomized final impressiontray,materials that can be AdditionSilicones or Tissue Conditioners
4.5 The analysis of the percise topological or functional model and the design of the partial denture made of bio dentaplast - I ✓ On the model are being performed all the technical stages until the completion of the partial denture. If the partial denture will be made out of Biodentaplast ,a duplicate model it will be necessary to create the skeleton of thermoplastic material for the partial dentures. Manufacture of duplicate model
4.5 The analysis of the percise topological or functional model and the design of the partial denture made of bio dentaplast - II The biodentaplast skeleton of the denture is obtained on the duplicate model by injecting under pressure
4.6 The skeleton probe of thermoplastic partial denture ✓ Its an extra step when using Biodentaplast material ,at this time the doctor is checking the correctness of thermoplastic skeleton.
4.7 Maxilomandibular relation record ✓ The maxilomandibular relation record is made with wax occlusal rims that have as a baseplate the Bio dentaplst skeleton.
4.8 The wax try-in ✓ The purpose of the wax try-in appointment is to verify all aspects of the denture tooth setup – the appearance, phonetics, occlusal relationships and patient comfort and in this stage the doctor with the patient can make changes related to aesthetics.
4.9 Applying the flexible partial denture in oral cavity ✓ This is not the last step in the patient’s edentulous treatment , he is invited to return to practice after 24-48 hours to verify the correctness of performance and realization of the dentures and retouching the denture where necessary.
5 Clinical cases CASE 1: M.V. 70 years oldDiagnosis of edentulous:- Total edentulous upperjaw untreated- Class 1 edentulous lower jawTratament:• Polyan total upper denture• Biodentaplast lower denture with clasps on 33.43
5 Clinical cases Study model Customised impression tray Customised impression tray Functional impression
5 Clinical cases Biodentaplast skeleton Biodentaplast skeleton The wax try-in The wax try-in
5 Clinical cases Flexibility appreciation of theBiodentaplast clasps Flexible Wax try-in probe Applying the flexible partial Biodentaplast clasps denture in oral cavity
5 Clinical cases CASE 2: D.L. 70 years old Diagnosis of edentulous:• latero-lateral upper jaw edentation treated with two metal-acrylic fixed prostheses with the aggregation elements 17,16,13 and 23.27. 12,11,21,22 presents metal-acrylic crowns sided;• edentulous lower jaw, class 1 untreatedTratament:• Biodentaplast dentureon the lower jaw with clasps on 33.43
5 Clinical cases Biodentaplast Preliminary impression skeleton The clasps position Skeleton’s probe
5 Clinical cases Maxilomandibular relation record Wax try-in
5 Clinical cases Applying the flexible partial denture in oral cavity The clasps position
5 Clinical cases CASE 3: F.N. 71 years oldDiagnosis of edentulous:• superior edentulous partial treated with metal- acrylic bridge,aggregation elements 21,12,13 with 15 extension, and aggregation elements of another bridge on 22,23,24. 26 and 27 have metal crowns sided• 2nd class edentation with 1 modification on the lower jaw untreated.
5 Clinical cases Tratament: • 21,12,13 bridge removal and its restoration without distal extension • Biodentaplast partial denture on upper jaw with clasp on the 13, 27 • Biodentaplast denture on lower jaw with clasps on33.43 ,33.43 that were in advance covered with acrylic crowns and 47 was previously covered with a metal crown Superior denture The denture applied in the oral cavity - I Clasps position
5 Clinical cases The denture applied in the oral cavity - II Clasps position
6 Conclusions Advantages : - biocompatibility - the materials used do not give allergy - patient adapt much easier to the dental prosthesis - resistance to fracture, flexible, unbreakable, comfortable, highly accurate, no metalic taste, tooth-colored clasps or gum colored. - very good price quality ratio. The price is on average 40-50% higher than a conventional denture.
6 Conclusions Disadvantages: - are that it is difficult to repair and implies a broader technological process - the price is higher than conventional partial dentures