Application of the Neutral Zone in Prosthodontics

Foreword ix
Preface xiii
1 Assessment of Edentulous Patients 1
Introduction 1
The Patient Interview 1
Patient Interview: Age 2
Patient Interview: Attitude 2
Patient Interview: Expectations 2
Patient Interview: Chief Complaint 3
Patient Interview: General Health 3
Patient Interview: Complete Denture Experience 3
Patient Interview: Denture Remake Frequency 4
Patient Interview: Patient Satisfaction 4
Patient Interview: Photographs, Diagnostic Casts, and Radiographs 4
The Facial Analysis 4
Facial Analysis: Facial Tissue Tone 5
Facial Analysis: Tooth and Gingival Display 6
Facial Analysis: Midlines 6
Facial Analysis: Lip Mobility 7
Facial Analysis: Lip Dimension 7
Prosthetic Factors 8
Prosthetic Factors: Vertical Dimensions 8
Prosthetic Factors: Existing Dentures 8
Prosthetic Factor: Skeletal Relationship 9
Prosthetic Factor: Saliva 9
Prosthetic Factor: Oral Tolerance 10
Prosthetic Factor: Temporomandibular Joints 10
Prosthetic Factor: Oral Cancer Review 10
Oral Characteristics 11
Oral Characteristics: Palatal Throat Form 11
Oral Characteristics: Arch Size 11
Oral Characteristics: Maxillary Ridge Height 11
Oral Characteristics: The Palate 12
Oral Characteristics: Maxillary Ridge Contour 13
Oral Characteristics: The Maxillary Denture Foundation 13
Oral Characteristics: Mandibular Ridge Height 14
Oral Characteristics: Mandibular Ridge Contour 14
Oral Characteristics: Mandibular Muscle Attachments 14
Oral Characteristics: Mandibular Denture Foundation 15
Oral Characteristics: Maxillary Tuberosity Curve 15
Oral Characteristics: Vestibule 16
Oral Characteristics: Frenula Attachments 16
Oral Characteristics: Pterygomandibular Raphe 16
Oral Characteristics: Denture Bearing Soft Tissues 16
Oral Characteristics: Retromolar Pads 17
Oral Characteristics: Maxillary Ridge Crest to Resting Lip Length (Esthetic Space) 17
Oral Characteristics: Mandibular Ridge Crest to Resting Lip Length (Esthetic Space) 17
Oral Characteristics: Maximal Oral Opening 17
Oral Characteristics: Retromylohyoid Space 18
Oral Characteristics: Tongue Size 19
Oral Characteristics: Tongue Position 19
Oral Characteristics: The Neutral Zone 20
Summary 21
References 21
2 Orthopedic Resolution of Mandibular Posture 25
Introduction 25
Conditioning Abused Tissues and Stabilizing the Existing Prosthesis 26
Materials Properties and Technique 26
Technique 26
Re?]establishing Orthopedic Mandibular Position 28
Summary 33
References 33
3 Definitive Impressions 35
Preimpression Considerations 35
Background 35
Impression Fundamentals 35
Impression Materials 36
Edentulous Impression Trays 37
Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures 37
Tray Selection and Tray Adaptation 37
Fabrication of Tray Stops 38
Border Molding the Impression Tray 39
Final (Definitive) Impression 41
Techniques for Making Single Appointment Definitive Impressions for Implant?]Assisted Complete Dentures and Immediate Dentures 43
Attachment Selection 43
Implant?]Retained Overdentures 43
Tray Selection 43
Impression Technique 44
Implant?]Retained and Supported Overdentures 45
Immediate Dentures 46
Master Cast Production 47
Summary 48
References 48
4 Fabricating Trial Denture Bases, Occlusal Rims, and Mounting a Central Bearing Device 51
Introduction 51
Fabrication of Trial Denture Base and Occlusal Rims 51
Fabrication of Maxillary Wax Occlusal Rim 52
Fabrication of Neutral Zone Mandibular Occlusal Rim 56
Technique 56
Jaw Recorder Device (Central Bearing Device) 59
Jaw Recorder Device Assembly 59
Mounting the Jaw Recorder Device on Trial Denture Bases 59
Mounting of the Jaw Recorder for Implant Overdentures 61
Mounting the Jaw Recorder Device on Partially Edentulous Arches 61
Procedure 62
Summary 62
References 64
5 Developing an Esthetic Blueprint 65
Introduction 65
Contouring and Shaping the Maxillary Occlusal Rim 65
Summary 72
References 72
6 Registering the Maxillo?]Mandibular Jaw Relationship 75
Introduction 75
Face?-Bow Recording 75
Centric Relation Recording for the Edentulous Patient 76
Centric Relation Recording for the Partially Dentate Patient 83
Summary 86
References 86
7 Neutral?-Zone Registration 89
Introduction 89
Recording the Physiologic Neutral Zone for Edentulous Patients 89
Technique 90
Recording the Physiologic Neutral Zone for a Dentate Patient 93
Technique 93
Summary 95
References 95
8 Second Laboratory Procedure: Selection and Arrangement of Prosthetic Teeth 97
Introduction 97
Indexing the Esthetic Blueprint Record 97
Indexing the Neutral?]Zone Record 98
Selection of Anterior Teeth 99
Maxillary Anterior Teeth Arrangement 100
Mandibular Anterior Teeth Arrangement 101
Selection of Posterior Teeth 103
Mandibular Posterior Teeth Arrangement 104
Maxillary Posterior Teeth Arrangement 106
Teeth Selection and Arrangement for the Partially Dentate Patient 107
Summary 109
References 109
9 Wax Try?]In Appointment 111
Wax Try?-In 111
Evaluation of Esthetics 111
Evaluation of Phonetics 112
Evaluation of Occlusal Vertical Dimension (OVD) 114
Evaluation of Centric Contact Position 115
External Impressions 116
Technique 117
Summary 121
References 123
10 Denture Placement 125
Introduction 125
Evaluation and Adjustment of Intaglio Surface 127
Technique 127
Evaluation and Adjustment of Denture Borders 129
Evaluating the Cameo Surface 131
Occlusal Evaluation and Correction 131
Subtractive Correction Technique 133
Additive Correction Technique 134
Patient Education and Instructions 135
Technique for Adhesive Application 136
Technique for Adhesive Removal 136
Home Care Instructions for Denture Patients 138
Postplacement Problems with New Dentures 138
Retention Problems 138
Soreness 139
Sore Throat 139
Speech Problems 139
Gagging 139
Summary 140
References 140
11 Use of CAD/CAM Technology for Recording and Fabricating Neutral?-Zone Dentures 143
Introduction 143
Registering the Neutral Zone during Impression Making 143
Technique 143
Registering the Neutral Zone during Maxillo?-Mandibular Records 145
Technique 145
Registering the Neutral Zone during the Wax Try?-In 145
Technique 145
Summary 148
References 149
Index 000