ppt

1. CAMEO SURFACE RECORDING IN COMPLETE
DENTURE FABRICATION USING
TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION : A CLINICAL REPORT
PRESENTED BY-
Dr Harminder Singh
By- Dheeraj Koli et al
J Prosthet Dent 2017

2. • Excessive resorption of the maxillary edentulous arch
opposing a completely dentate arch presents a challenging
clinical situation.
• Patients may not elect implant therapy because of cost, an
underlying medical condition, or an aversion to surgical
procedures.
• However, a complete denture prosthesis may lack adequate
stability and compromise esthetics and phonetics.
• In addition, the midline fracture of the denture is a
frequent complication in such patients.
• These problems may lead to unsatisfactory complete
denture therapy.
• Several methods have been described for plumping or
lifting the buccal flange of dentures to improve the
outcome of the removable prosthesis in such situations.
INTRODUCTION

3. • This report describes an alternative procedure
to overcome the limitations imposed by
resorbed maxilla by using transcutaneous
electrical nerve stimulation (TENS) to record
the cameo surface of the dentures.
• The procedure was implemented at the
clinical evaluation stage during complete
denture fabrication.

4. • A 55-year-old woman presented
with a completely edentulous
maxillary arch and a completely
dentate mandibular arch.
• The patient had lost the
maxillary teeth 5 years
previously subsequent to trauma
and periodontitis.
• The maxillary edentulous arch
was classified as class V stage of
resorption.
Clinical Report

5. • The maxilla was retrognathic to the mandibular
arch (which was confirmed at the jaw relation
stage). Her history revealed that she had used 2
dentures in the previous 4 years.
• Both of the dentures had unsatisfactory stability;
one denture also fractured along the midline.
• The patient declined maxillary implant-
supported dentures or a fixed implant supported
prosthesis because of cost.
• The treatment plan was to rehabilitate the
maxillary arch with a removable complete
denture prosthesis

6. • Conventional steps for complete denture
fabrication were performed up to the clinical
evaluation appointment.
• During this session, the maxillary teeth were
correctly set in a reverse articulation
relationship to the mandibular natural teeth
to avoid facial placement of the maxillary
artificial teeth, which can increase both
denture instability and the risk of fracture of
the maxillary denture base

7. • After confirming the tooth arrangement, the
cameo surface of the maxillary denture was
recorded. To do this, TENS of the perioral and
buccal muscle regions was performed to
record the cameo surface in its most
physiologic state.

8. • The electrodes were attached in
the posterior triangle of the neck
and in the pre-auricular region .
• The TENS unit was set to operate
in continuous mode. The current
was graduated from 0 to 20 mA
(the maximum amount the
patient was able to tolerate),
ensuring control of the left and
right sides for the corresponding
muscles.
• Thirty minutes of muscle
stimulation was required.

9. • Once the muscles were
stimulated, a thin layer of
adhesive (Caulk Universal Tray
Adhesive, Dentsply Intl) was
applied to the trial denture base,
followed by a layer of polyvinyl
siloxane (Aquasil Monophase;
Dentsply Intl).
• The denture base was then
inserted in the patient’s mouth as
the muscles continued to be
stimulated.
• No functional or manual molding
was performed.
• The trial base with recorded
cameo surface was thus obtained.

10. • The completed denture
provided improved stability
during function and at rest.
• The denture base was
invested and processed in
heatpolymerized poly
(methyl methacrylate)
(Lucitone 199; Dentsply Intl).

11. • During the first 2 weeks after complete
denture fabrication, the patient reported
minor complaints unrelated to denture
displacement.
• Thereafter, the patient was followed at 3-
month intervals for 2 years.
• The patient noted a satisfactory improvement
in comfort, and the maxillary denture
exhibited improved retention and stability,
with a Kapur score of 5 with no midline
denture fracture

12. • Routine complete denture therapy with an emphasis
on using the available muscle activity and preserving
the remaining parts of the oral cavity can help to
improve the outcome for completely edentulous
patients with severe bone loss.
• In the patient discussed here, the extensive loss of
maxillary labial bone resulted in a retrognathic maxilla.
• The loss of lip support gave a “dished-in” appearance
in the middle third region of the face.
• In the patient’s previously fabricated dentures,
arbitrary addition of material on the labial cameo
surface resulted in maxillary denture instability.
DISCUSSION

13. • The electrodes in the posterior triangle of neck
stimulated the accessory nerve (innervating the
palatoglossus, palatopharyngeus, and levator veli
palatini muscles) and increased the
parasympathetic activity by stimulating the vagus
nerve, leading to a generalized calming effect on
the patient.
• Electrodes in the preauricular area stimulated
the seventh cranial nerve (innervating the
buccinators, orbicularis oris, and levator labii
superioris muscles) and the mandibular division
of the trigeminal nerve (innervating the tensor
veli palatini muscle).

14. • The bulk and support to the lips and cheeks by
the physiologic molding of the artificial
substitute provided improvement in stability
because of the stabilization action of the soft
tissue drape contacting the cameo surface
during rest and during movement.
• The outcomes were acceptable esthetics and
speech and increased patient satisfaction

15. • The advantage of the described technique
using TENS instead of the conventional
method of recording the neutral zone is a
reduction in inconsistencies associated with
manual and functional molding (operator-
determined and patient-determined,
respectively) that may occur if the operator is
less experienced or if the patient cannot
comply to correctly perform functional
movements

16. • Thus, the suggested method using TENS is
useful for such patients and those who cannot
follow instructions.
• No additional patient visits are required, as
the technique can be implemented during the
clinical evaluation visit.
• At the time of writing, the cost of the TENS
machine was approximately USD $2700.

17. • The operator will require the machine that generates
transcutaneous electrical stimulation of nerves in order
to perform this procedure, in the absence of which this
technique cannot be implemented.
• This is one of the main drawbacks of the suggested
method.
• Also, the time required to set up is approximately 10
minutes and to perform the procedure is
approximately 30 minutes.
• This is slightly more than the time for conventional
techniques of recording the neutral zone.
• In addition, this method should not be used in areas of
infection, over malignant lesions, over tissues with
limited patient sensation, and for women who are
pregnant.

18. SUMMARY
• A satisfactory outcome can be attained in
patients with resorbed ridges by recording a
physiological zone of muscle activity that aids
in improving denture stability.
• A method of recording this zone using TENS
has been described in this report.
• Denture performance and patient satisfaction
were markedly improved.

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20. Thank you