'satisfactory smile' with a restorative approach - Indian Dental ...

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IMAGE 2010-11 ISSN: 2229-5658 Vol No: 11 ISSUE No: 4 11 SINGLE VISIT DENTURE A PSYCHOLOGICAL AID FOR EDENTULOUS PATIENT - CLINICAL REPORT Kumar Lakshya(Lecturer),Singh Kamleshwar (Astt Prof.), Mishra Neeraj(Astt Prof.)- Department of Prosthodontics Faculty of Dental Sciences C .S.M Medical University Lucknow. Yadav Akanksha(PG Student), Department of Oral Medicine & Radiology, B.B.D College Of Dental Sciences, Lucknow. INTRODUCTION An immediate denture is a dental prosthesis constructed to replace the lost dentition and associated structures of the maxillae and mandible and inserted immediately following removal of the remaining teeth. 1 This can be partial or complete interim, conventional and immediate overdenture prosthesis. The main advantage of immediate denture is that help in maintaining psychological status of the patient. There are some contraindications to immediate dentures, such as cardiac, endocrine, and blood disturbances, slow healing potential, acute periapical or periodontal diseases, extensive bone loss, or mental incapacity, indifferent and uncooperative patients. CASE REPORT The female patient 56 years of age has reported to the department. Patient chief complaint was that she wants replacement of missing teeth. On clinical examination it was diagnosed that patient is partially edentulous having 11,13,14,21,22, 23,24,25,28,32,42,43 No tooth. The condition of all the teeth was compromised (Fig.1) presenting with advanced PROSTHODONTICS ABSTRACT: Psychological impact of the edntulousness is well known, the impact of losing teeth can be traumatic for the young, the old, and everyone in between it affect the social and personal life of the patient. There are many advantages to immediate as opposed to conventional complete denture. From the patientís point of view, the preservation of the natural appearance of a person is of major importance. The aim of this clinical report is to present clinical procedure helps in maintaining psychological status of the patient. KEYWORDS: immediate denture, dental prosthesis, Single visit denture. periodontal disease. Medical history was not significant. Depending of the oral condition patient was advised to go for total extraction and later on replacement by complete denture prosthesis. The patient was teacher by occupation & she was quite adamant for not being edentulous for any length of time because it might be quite embarrassing for her. Patient was very cooperative and of philosophical type. The patient was referred to the dept of periodontics for oral prophylaxis. After complete scaling the primary impression of the maxillary and mandibular arch was made in irreversible hydrocolloid (Zelgan 2002, Dentsply, India) impression material. The mandibular teeth were grade III mobile. So impression was made after blocking the teeth with the wax 2 .The sectional maxillary secondary impression was made by the nonaqueous electrometric impression material (Reprosil TM , Dentsply-Caulk, Milford, DE, USA). (Fig 2,3) mandibular impression was made in irreversible hydrocolloid (Zelgan 2002, Dentsply, India). Maxillomandibular jaw relation records were made to articulate the casts. The proper shade and size of teeth were selected. The posterior artificial teeth arrangement was Visit: http://image.idakunnamkulam.com/ The International Journal of Indian Dental Association, Kunnamkulam Branch. Indexed in Journals Master List of IC TM
IMAGE 2010-11 ISSN: 2229-5658 Vol No: 11 ISSUE No: 4 12 completed and evaluated in the patientís mouth to confirm maxillo-mandibular relation records. (Fig.4, 5). While arranging the anterior teeth the every other tooth was trimmed from the cast and artificial teeth were placed respectively. Artificial anterior teeth were arranged in such a fashion that it reflect the position of the patientís natural teeth. While arranging anterior teeth we estimate the amount of ridge to be removed from the stone model 3 . The maxillary and mandibular wax up was completed, at the stage of dewaxing the casts was duplicated and on the duplicated casts surgical template were fabricated (Fig 6). These templates were also invested and cured in clear heat cure acrylic (DPI, New Delhi, India). The remaining three teeth were extracted on the very next appointment and with the help of surgical template necessary modification of alveolar ridges were performed. After satisfactory fit of the templates on the alveolar tissue (Fig. 7). Tissue Flaps were sutured and patient was referred back to the Dept of Prosthodontics for complete denture insertion. The maxillary and mandibular dentures were inserted and checked for areas of excessive pressure and adjusted (Fig.8). If the fit of dentures is not satisfactory then it can be relined lined with a tissue conditioning material. The patient was given postoperative home care instructions, which include: not removing the denture for 24h, the use of analgesics and ice packs, if necessary, and appointed the next day for postoperative examination and any needed adjustments. After one week, at the recall, we proceeded to reline the immediate complete denture with a permanent soft resilient silicone (Permasoft, Dentsply, India). The patient was satisfied with both the retention and the esthetics of the complete denture (Fig. 9). DISCUSSION Patients vary greatly in what they want, expect and demand. To attain the maximum degree of success, the following requirements should be satisfied: 1) Compatibility with the surrounding oral environment; 2) Restoration of masticator efficiency; 3) Harmony with the functions of speech, respiration and deglutition; 4) Esthetic acceptability 5) Preservation of the remaining tissues. 4 For the dentist it is a challenge to accomplish the requirements in immediate denture service. To accomplish these requirements, it is mandatory that each patient be analyzed and evaluated on an individual basis. The best patient for immediate dentures is the philosophical type. Their motivation for denture is the maintenance of health and appearance, and they accept replacement of natural teeth that cannot be saved as a normal procedure. These patients overcome conflicts and organize their time and habits in an orderly manner. They eliminate frustrations and learn to adjust rapidly. The philosophic patient will listen to and carry out instructions in an intelligent manner. Their mental attitude contributes to a favorable prognosis for the immediate denture. 5 Advantages : 1. Patient does not have to suffer through edentulous period 2. Reduced pain and swelling 3. Current esthetics retained in dentures 4. Patient adapts rapidly 5. Good speech and appearance are retained 6. Patient does not develop undesirable habits and is more cooperative emotionally 7. Acts as a bandage to control hemorrhage, Promotes rapid healing 8. Provides for minimum social interruptions and maximum psychological advantages. Visit: http://image.idakunnamkulam.com/ The International Journal of Indian Dental Association, Kunnamkulam Branch. Indexed in Journals Master List of IC TM
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