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Removable prosthodontics at a glance PDF

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Removable Prosthodontics at a Glance James Field Claire Storey Removable Prosthodontics at a Glance Dr James Field BSc(Hons) BDS PhD MFGDP RCSEng MFDS MPros FDTFEd RCSEd CertClinEd MA(Ed) FAcadMEd PFHEA Senior Specialist Clinical Teacher in Restorative Dentistry & Consultant in Prosthodontics National Teaching Fellow and Principal Fellow, HEA Miss Claire Storey BDS MSc MRes CertEd MFDS FDS RCSEng Consultant and Specialist in Restorative Dentistry This edition first published 2020 © 2020 John Wiley and Sons Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopy- ing, recording or otherwise, except as permitted by law. Advice on how to obtain permis- sion to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of James Field and Claire Storey to be identified as the author(s) of this work has been asserted in accordance with law. Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats. Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understand- ing, and discussion only and are not intended and should not be relied upon as recom- mending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in gov- ernmental regulations, and the constant flow of information relating to the use of medi- cines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all war- ranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organiza- tion, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the informa- tion or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Fur- ther, readers should be aware that websites listed in this work may have changed or disap- peared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Library of Congress Cataloging-in-Publication Data Names: Field, James, 1979- author. | Storey, Claire, author. Title: Removable prosthodontics at a glance / James Field, Claire Storey. Description: Hoboken, NJ : Wiley-Blackwell, 2020. | Includes bibliographical references and index. Identifiers: LCCN 2019056770 (print) | LCCN 2019056771 (ebook) | ISBN 9781119510741 (paperback) | ISBN 9781119510710 (adobe pdf) | ISBN 9781119510697 (epub) Subjects: LCSH: Dentures. | Prosthodontics. Classification: LCC RK656 .F495 2020 (print) | LCC RK656 (ebook) | DDC 617.6/92—dc23 LC record available at https://lccn.loc.gov/2019056770 LC ebook record available at https://lccn.loc.gov/2019056771 Cover Design: Wiley Cover Image: Courtesy of James Field Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY Set in Minion Pro 9.5/11.5 by Aptara Inc., New Delhi, India 10 9 8 7 6 5 4 3 2 1 Contents About the companion website viii 1 Introduction 2 James Field 2 The function of removable prostheses 4 James Field 3 Stability and retention 6 James Field 4 Patient assessment for complete dentures 8 James Field 5 Edentulous ridge presentations 10 James Field 6 Patient assessment for partial dentures 12 James Field 7 Factors complicating success 14 James Field 8 Accessibility and operator position 16 James Field 9 Pre-prosthetic treatment 18 Claire Storey and James Field 10 Revisiting the anatomy 20 James Field 11 Making a primary impression – complete dentures 22 James Field 12 Making a primary impression – partial dentures 24 James Field 13 Special trays 26 James Field 14 Compound and putty materials – handling and manipulation 28 James Field 15 Recording an upper functional impression 30 James Field 16 Recording a lower functional impression 32 James Field 17 Managing fibrous ridges 34 James Field 18 Denture bases 36 James Field 19 Recording the maxillo-mandibular relationship 38 James Field v 20 Prescribing the upper wax contour 40 James Field 21 Prescribing the lower wax contour 42 James Field 22 Tooth selection and arrangement 44 James Field 23 Occlusal dimensions and occlusal schemes 46 James Field 24 Respecting the neutral zone 48 James Field 25 Assessing trial prostheses 50 James Field 26 Fitting and reviewing finished prostheses 52 James Field 27 Copying features from existing prostheses 54 James Field 28 Classifying partial prostheses and material choices 56 James Field 29 Designing partial prostheses 58 James Field 30 Saddles, rests and clasps 60 James Field 31 Connectors and bracing 62 James Field 32 Surveying and preparing guide planes 64 James Field 33 Designing frameworks – case examples 66 James Field 34 Precision attachments – the fixed–removable interface 68 James Field 35 Dealing with frameworks and substructures 70 James Field 36 The altered cast technique and the RPI system 72 James Field 37 Swing-lock prostheses 74 James Field 38 Gingival veneers 76 James Field 39 Immediate and training prostheses 78 Claire Storey and James Field 40 Occlusal splints 80 James Field 41 Implant-supported mandibular overdentures 82 Claire Storey and James Field 42 Principles of restoring maxillary defects 84 James Field 43 Tissue conditioners, liners and re-basing 86 Claire Storey and James Field 44 Maintaining adequate oral hygiene 88 Claire Storey and James Field 45 Troubleshooting loose or painful dentures 90 James Field vi 46 Gagging, other difficulties and making a referral 92 James Field 47 Summary of procedural stages 94 James Field Appendices 97 Recommended and supplementary reading 106 Index 110 vii 2 1 Introduction C h a p te r 1 In tr o d u c tion Figure 1.1 Assessment processes • Social reasons • Mechanical and for failure technical reasons for failure • Noticeable pain • Visible pathology Often objective Often subjective Integration Shared understanding and decision-making Exchange of information Shared both ways decision-making All discussions should be recorded in the notes Removable Prosthodontics at a Glance, First Edition. James Field and Claire Storey. © 2020 James Field and Claire Storey. Published 2020 by John Wiley & Sons Ltd. Companion Website: www.wiley.com/go/fi eld/removable Removable prosthodontics is often described as a ‘black This incredibly important part of the process is investigative. 3 art’ – the Marmite of dentistry; practitioners tend to either It should determine the choice of treatment that will follow. If love it or hate it. Fortunately, we love it – and with some simple the patient has an existing prosthesis, ensure that you ask what C h a guidance, hopefully you will too. Like most operative interventions, they think might change with a new one? What would they like p te success depends on: to change? r 1 • The skill of the dentist It is at this early stage that you can begin to modify your In • The technical difficulty of the case patient’s expectations if you feel that they are unrealistic. It is tro d • The patient’s perceptions, ideas and expectations always better to begin this way, than back-tracking later and uc Providing prostheses that are satisfactory to the patient trying to reduce high expectations at the try-in or the fitting tio n is a challenge – and there are many reasons why patients can stages. be dissatisfied with the finished result. Many relate to social It is also a good opportunity to provide your honest thoughts aspects of patients’ lives – how they are able to interact with on the likely outcome. We would caution against promising others, particularly when eating and speaking. Common reasons patients that their new prosthesis will be any better than the include: one that is being replaced, even if you can identify significant • Unacceptable aesthetics technical flaws. Instead, it is beneficial to ensure that you: • Inability to chew food properly • Reiterate why you think the patient would like a new prosthesis • Inability to enjoy the same foods as before • Describe any technical features that you believe you can • Problems with speech improve upon • Discomfort or persistent pain • Estimate how many visits, including retries and review • Disagreements over time and cost appointments, you expect may be needed Despite the diversity of complaints, there is often a common • Explain the fact that when the new prosthesis is fitted, even if thread running through them all – lack of information exchange it is technically better, it will still take a period of acclimatisation and an inappropriate level of patient expectation. We would (up to 6 months, and longer in some cases) before the patient is therefore argue that the most important skill when making able to function optimally satisfactory removable prostheses is that of communication. • Generate an understanding that during this time, the patient will need to adapt slowly to their new prosthesis, even if it appears to function comfortably – and this is particularly important in Communication and expectations relation to complete denture patients Effective communication takes time. As clinicians we often start looking for mechanical reasons to explain why patients might The clinical process be having difficulties with their existing prostheses – excessive movement, trauma or ulceration, poor retention, or design of Communication aside, the process of making removable pros- coverage. On that basis, we often agree to make a new prosthesis. theses is more manageable than it may seem at first. There are In reality, patient tolerance relates to very much more than just often simple approaches that can yield excellent results, without mechanics and physical function. It is crucial that the treatment expensive materials or equipment. In the main, technical success you provide is driven by patient-perceived need. This means that is about attention to detail and knowing which materials work patients need to understand and buy into the clinical rationale, best in your hands. including risks and benefits, of the proposed treatment. Simi- The aim of this at-a-glance guide is to provide advice on larly, we need to understand the patient’s rationale for wanting how to achieve optimal outcomes at each clinical stage of a prosthesis. Given enough time, it is highly likely that these the process. Our opinions are based on decades of combined requirements can be met. experience teaching at undergraduate and postgraduate level, Often, the process of making removable prostheses begins and routinely treating a wide range of cases. We have provided with a primary impression. Try and break that habit, and recommended reading for each chapter in case you wish to implement these simple steps first: read more about the technical stages, or to understand better 1 Set aside at least 5 minutes to talk to your patient the theory and evidence base that underpins the fabrication of 2 Sit in front of your patient – do not stand in front of your removable prostheses. patient with a stock tray in your hand! Educationally, we use the term ‘bricolage’ (tinkering) when 3 Invite your patient to explain why they would like you to make we are teaching our students about new materials in the clinics. a denture – what are they hoping it will provide? If it has been a while since you have used some of the materials in Crucially, your patient needs to feel that they can talk freely this book, then get hold of some of them, and have a play! and comfortably about their tooth loss. This will not happen if they feel rushed, or feel that you are not actively listening to them. 4 2 The function of removable prostheses C h a p te r 2 T h e fu n c tio n o f re Figure 2.1 The function of removable prostheses m o v a b le p r o s th es Improved quality es of life Replace multiple short endentulous saddles Avoid preparing natural teeth for extra coronal restoration Soft tissue support Provide and aesthetics posterior support Mastication Speech Preventing unwanted tooth movement Replace long edentulous saddles Avoid cantilevering fixed bridgework from root-treated teeth Improved transition to edentulism • Partial prostheses can help to acclimatise the patient in anticipation of wearing more extensive or complete prostheses Removable Prosthodontics at a Glance, First Edition. James Field and Claire Storey. © 2020 James Field and Claire Storey. Published 2020 by John Wiley & Sons Ltd. Companion Website: www.wiley.com/go/fi eld/removable

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