Transcript Review Stage - Chapman Dental Solutions

Clinical Case Presentation One
Ross Chapman
Student Number: 20579504
Background
 89 yr old Male
 Presenting Complaint
 Poorly fitting F/F dentures
 Poor retention on upper denture
 Struggling to eat comfortably
 History of presenting complaint
 Current dentures 10+ yrs old
 Has had various new dentures made but not tolerated
 Dental History
 Denture wearer 50+ yrs
 Regular attendee at this practice
Background
 Medical history
 Previous heart attack 20+ yrs ago
 Pace maker fitted
 Patient quite unsteady on feet
 High blood pressure
 Medication:
 Bendroflumethiazide
 Asprin
Background
 Social history
 Tea total and non smoker (quit smoking 25+ years)
 Widower and lives alone with daily family contact
 Active patient considering age and health
Background
 Family history
 No history of dental disease
 Family history of heart problems
 Current OH regime
 Cleans mouth and dentures twice daily with soft brush
 Soaks denture in cleaning solution weekly
 Dentures in good condition for age yet worn
Extra-Oral Examination
 No facial asymmetry
 Nil pain in trismus
 No palpable lymph nodes
 Lips and soft tissue all competent
 TMJ – NAD
 Nil clicking, pain, normal opening, deviation
 Skeletal class I
Chart
Key:
= Acrylic Denture
Intra-oral Examination
 Soft tissues
 Lips – Nothing abnormal detected (NAD), Competent
lips, medium lip line
 Tongue – NAD
 Floor of Mouth – NAD
 Buccal Mucosa – NAD
 Parotid Secretion - NAD
 Palate - NAD
Intra-oral Examination
 Upper and lower arches
 Gross resorption on upper ridge with flabby anterior
residual alveolar process
 Gross resorption on lower residual alveolar process
leaving very flat ridge
 Existing denture
 F/F very loose
 F/- dropping on patient opening
 -F rotates in mouth with no lateral retention
 Reduced OVD through wear
 X bite on LHS
Initial Photographs
Diagnosis/Treatment Plan
 Diagnosis
 No retention on upper denture
 Very ill fitting lower denture
 Patient quite old and unable to tolerate major change
 Reduced OVD
 Treatment plan
 Make new Full/Full dentures using copy technique
 Improve fit in all areas
 Increase OVD to restore wear (no more than 2mm)
 Add soft lining on lower to aid comfort
Possible referral
 Patient has had many set made in previous years,
informed if this set is still not able to meet
expectations we may refer to dental hospital for
specialist treatment. Patient happy to have one last go
before referral
 Patient referred into myself internally as routine for
prosthetics cases
Appointment 1
 Consent for examination taken
 Consultation – C/O, History of complaint
 MH, DH, SH checked as taken by referring GDP
 Exam E/O & I/O
 Consent to dental photographs given
Appointment 2
 Current F/F dentures copied using stock trays and “Sheradup”
50/50 duplication putty
Appointment 2
 Current F/F dentures copied using stock trays and “Sheradup”
50/50 duplication putty
Appointment 3
 Wash impressions and moose bite registration taken
Appointment 3
 Wash impressions and moose bite registration taken
Appointment 4
Try-in ready
Appointment 4
Try-in Stage
 Delphic V teeth used for set up at laboratory
 OVD opened on articulator by 2mm to restore worn
teeth
 Bite checked and adjusted chair side for high spots
 Upper try in not as retentive as expected. Light bodied
silicone wash taken to improve.
 Patient happy with feel and aesthetics of denture
Appointment 5
Denture fit Stage
 Upper denture retention good at rest yet still dropping when
patient opens wide
 No adjustment required to lower denture
 No adjustment needed to bite
 Patient happy to wear for 1/52 to see if upper retention
improves when bedded in
Appointment 6
Review Stage
 1 weeks post insertion review
 Patient feels upper retention not adequate,
still dropping on opening and unable to eat.
 Denture dropping causing sore lower ridge
as interfering with bite
 Reline imp taken on upper to improve
retention
Appointment 7
Review Stage
 Assessed fit of relined upper still not happy
so have decided to remake upper denture
 S/T and bite made from existing upper
 Secondary imp and bite against existing
lower at N/V
Appointment 8
Review Stage
 Secondary impression taken in window tray
to allow for flabby anterior ridge
 Bite registration rim recorded
 Existing lower denture fine
Appointment 9
Review Stage
 New F/- retention greatly improved. Patient
can fully open and close with no dropping
 Slight inter-cuspal interference so blue
moose taken between upper and lower for
adjustment prior to finish
Appointment 10
Review Stage
 F/F fitted good retention on upper
 Slight adjustment to bite and pain on lower
RHS
 R/V in 2 weeks
Appointment 11
Review Stage
 2 week review
 Patient only wore denture for 2 days as
painful on lower
 Upper retention good and now not a problem
 Decided to double the thickness of soft lining
as patient unable to tolerate new bite and
increased OVD
Appointment 12
Review Stage
 -F rebase try in with 5 mm thick spacer for
extra soft lining
 Bite and fit good. Patient able to open and
close returning to bite every time.
 Patient happy to proceed to fit
Appointment 13
Review Stage
 F/F with extra thick soft lining fitted
 Minor adjustment to buccal extension on
RHS
 Patient happy with fit of dentures
 R/V in 1 week
Appointment 14
Review Stage
 R/V 1 week post insertion
 Patient able to eat pain free
 F/- retentive on function
 Patient very happy
 TCA if problems arise ! Phew
Post treatment photographs
Maintenance/Recall
 Patient given instruction on cleaning the denture and
maintaining the soft lining without damaging the soft
material
 Patient to continue annual check up at practice
 Told TCA if any problems occur
 Treatment complete
Reflection
 Case started off as a simple copy and morphed into
really complex case
 In hindsight should have insisted that we made new
dentures from scratch at the beginning of treatment
course and not used copy technique to appease the
patient
 Patient was a pleasure to work with and understood
problems we were having however a less amiable
patient may have been frustrated by amount of
appointments
Reflection
 Not a problem when working as a student but this
case would have financially cost the practice when
taking into account repeated clinic visits and
laboratory expenditure.
 On reflection some basic mistakes were made during
this treatment plan, however my mentor insists these
are the cases you learn and take the most from.