A 55-year-old male patient reported to the Department of Prosthodontics, Kamineni Institute of Dental Sciences, Narketpally, India with chief complaint of excessive tooth wear, with difficulty in chewing and discoloured teeth. The patient gave a history of gradual wearing of teeth over almost a decade. On examination, there was generalized attrition, poor aesthetics, sensitivity of teeth, chewing difficulties and loss of tooth substance due to chipping and wearing .Both the arches were fully dentate, with spacing between maxillary and mandibular anterior teeth. The patient had a bilateral class I molar relation and a canine-guided occlusion. Approximately 3 mm of loss was established in VDO. The case was diagnosed as ''Mutilated dentition with reduced vertical dimensions due to severe attrition" [Table/ Fig-1].Diagnostic impressions were made by using alginate. Face bow records, along with cast, were mounted on a Hanau Wide Vue semi adjustable articulator. A modeling compound, an anterior deprogramming jig was made and centric relation was recorded by using polyether bite registration material. A diagnostic wax up was done to analyze the need of altering the vertical dimension of occlusion, occlusal plane, tooth contour position and aesthetics.Minimal occlusal reduction is indicated for patients who are scheduled for rehabilitation at an altered VDO. Teeth preparations for full coverage metal ceramic crowns were completed for the entire dentition. Full-arch impressions were made by using addition silicone in a single step putty wash technique. A Hobo's twin stage technique for full mouth reconstruction, with the occlusal scheme as group function, was selected as the treatment of choice. A cast with a removable anterior and posterior segment is required.In this technique, occlusal morphology of the posterior teeth is established without the anterior segment. For this, articulator was programmed to condition I of twin stage procedure, where the values of sagittal condylar path and Bennett angle, were set to 25 degrees and 15 degrees respectively. The values of anterior guide table, that is, the sagittal inclination and lateral wing angle were adjusted to 25 and 10 degrees respectively. At this position, the diagnostic waxup was balanced in protrusive and lateral excursions. The anterior segment of the cast was reassembled, the condylar guidance and incisal guidance were set again (condition 2) and the wax-up was completed, so as to generate posterior disocclusion. [Table /Fig-2,3]. At condition II, the Hanau semi-adjustable articulator was adjusted, with sagittal condylar path and Bennett angle being set at 40 degrees and 15 degrees respectively. The value of anterior guide table was set, with the sagittal inclination and lateral wing angle being set at 45 degrees and 0 degrees respectively. Provisional restorations were made with heat polymerizing acrylic resin which was derived from the wax-up template from above mentioned procedure. Provisional crowns were then cemented with zinc oxide non-eugenol. The interim ...
A 65-year-old male patient reported to the Department of Prosthodontics, with the chief complaint of fractured mandibular implant supported over denture due to which he was unable to wear his denture since one week. Patient was systemically healthy with no medical compromise. History revealed placement of two endosseous dental implants with ball attachments [Table/ Fig-2] three years back and history of previous denture fracture one year back and new denture made, subsequently fracture of second set of denture occurred within the gap of six months. Intra oral examination revealed natural teeth in relation to 15,17,23,24,25. The radiographic investigation revealed well osseointegrated implants in relation to the lower arch. The main treatment objective was to overcome this repeated fracture of the lower denture. So it was planned to reinforce mandibular implant supported over denture with metal. As the patient is socially active, the fracture denture was temporarily repaired and given to the patient in order to provide minimum function. PROCEDUREAlginate impression of edentulous ridge along with the ball abutments were made with perforated edentulous tray and special tray fabricated with auto polymerizing acrylic resin. Border molding was done with the help of green stick compound and final impression was made with additional silicone. Metal housings were not removed from the existing denture as patient did not want to be edentulous. Definitive casts poured with type II dental stone. Relief wax was placed along the crest of the residual alveolar ridge and tissue stops were positioned. Since the metal housings were placed in the repaired denture, shaped block out was made over Dentistry SectionRemedy for Repeated Implant Retained Denture Fracture-A Challenging Case Report ABSTRACTThe most common site of fracture in a maxillary or a mandibular complete denture is along an anteroposterior line that coincides with the labial notch in in the denture which used to provide the frenum relief. Osseointegrated implants have been a boon to the patients who are completelly edentulous and are not satisfied with the conventional removable complete denture approach.Implant supported dentures have proven to provide superior retention and support for removable complete dentures. Nevertheless, fracture of the denture bases is a common complication of implant-supported mandibular overlay dentures,ecspecially when the artificial denture is opposing natural dentition. This article describes and illustrates a method of reinforcing implant-supported mandibular overdentures to overcome this problem. the ball abutments of the definitive cast with the similar dimensions [Table/ Fig-3]. Further, definitive cast was duplicated with agar. Refractory cast was achieved, on which wax pattern was adapted corresponding to the planned metallic frame work design [Table / Fig-4]. The pattern along with the refractory cast was invested, burned out, casted, divested, finished and polished.The framework was tried in patients mouth and was evaluated f...
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