Application of the Neutral Zone in Prosthodontics

Wiley-Blackwell (Verlag)
  • erschienen am 6. Juni 2017
  • |
  • 176 Seiten
E-Book | ePUB mit Adobe DRM | Systemvoraussetzungen
978-1-119-15858-5 (ISBN)
Application of the Neutral Zone in Prosthodontics offers a step-by-step guide to successfully designing and placing complete and implant-retained dentures using neutral zone concepts.
* Illustrates every technique described with more than 300 color photos
* Covers all phases of complete denture therapy
* Presents a step-by-step assessment and examination protocol
* Details the importance of accurate diagnosis and prognosis prior to committing to treatment
* Describes an alternative to traditional impressioning procedures that can be accomplished in a single appointment
* Includes access to a companion website with video clips and student handouts, with teaching PowerPoints available for instructors
1. Auflage
  • Englisch
  • Newark
  • |
  • USA
John Wiley & Sons
  • 19,74 MB
978-1-119-15858-5 (9781119158585)
1119158583 (1119158583)
weitere Ausgaben werden ermittelt
The authors
Joseph J. Massad, DDS, is Associate Professor in the Department of Prosthodontics at the University of Tennessee Health Center, School of Dentistry in Memphis, Tennessee, USA; Adjunct Associate Professor in the Department of Prosthodontics and Operative Dentistry at Tufts University School of Dental Medicine in Boston, Massachusetts, USA; Adjunct Associate Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center, School of Dentistry in San Antonio, Texas, USA; Adjunct Associate Professor in the Department of Restorative Dentistry at Loma Linda University School of Dentistry, in Loma Linda, California, USA; Clinical Assistant Professor at the University of Oklahoma College of Dentistry in Oklahoma City, Oklahoma, USA; and Private Practice in Tulsa, Oklahoma, USA.
David R. Cagna, DMD, MS, is a Professor in the Department of Prosthodontics, Associate Dean of Postgraduate Affairs & Director of Advanced Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry, Memphis, Tennessee, USA; Diplomate & Director of the American Board of Prosthodontics; and Fellow of the American College of Prosthodontists.
Charles J. Goodacre, DDS, MSD, is Distinguished Professor in the Department of Restorative Dentistry at Loma Linda University School of Dentistry in Loma Linda, California, USA; and Diplomate and Past-President of the American Board of Prosthodontics.
Russell A. Wicks, DDS, MS, is Professor and Chairman in the Department of Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry in Memphis, Tennessee, USA.
Swati A. Ahuja, BDS, MDS, is Adjunct Assistant Professor in the Department of Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry in Memphis, Tennessee, USA; and Prosthodontic Consultant at Lutheran Medical Center in New York City, New York, USA.
  • Intro
  • Title Page
  • Copyright Page
  • Contents
  • Foreword
  • Preface
  • About the Companion Website
  • Chapter 1 Assessment of Edentulous Patients
  • Introduction
  • The Patient Interview
  • Patient Interview: Age
  • Patient Interview: Attitude
  • Patient Interview: Expectations
  • Patient Interview: Chief Complaint
  • Patient Interview: General Health
  • Patient Interview: Complete Denture Experience
  • Patient Interview: Denture Remake Frequency
  • Patient Interview: Patient Satisfaction
  • Patient Interview: Photographs, Diagnostic Casts, and Radiographs
  • The Facial Analysis
  • Facial Analysis: Facial Tissue Tone
  • Facial Analysis: Tooth and Denture Base Display
  • Facial Analysis: Midlines
  • Facial Analysis: Lip Mobility
  • Facial Analysis: Lip Dimension
  • Prosthetic Factors
  • Prosthetic Factors: Vertical Dimensions
  • Prosthetic Factors: Existing Dentures
  • Prosthetic Factors: Skeletal Relationship
  • Prosthetic Factors: Saliva
  • Prosthetic Factors: Oral Tolerance
  • Prosthetic Factors: Temporomandibular Joints
  • Prosthetic Factors: Oral Cancer Review
  • Oral Characteristics
  • Oral Characteristics: Palatal Throat Form
  • Oral Characteristics: Arch Size
  • Oral Characteristics: Maxillary Ridge Height
  • Oral Characteristics: The Palate
  • Oral Characteristics: Maxillary Ridge Contour
  • Oral Characteristics: The Maxillary Denture Foundation
  • Oral Characteristics: Mandibular Ridge Height
  • Oral Characteristics: Mandibular Ridge Contour
  • Oral Characteristics: Mandibular Muscle Attachments
  • Oral Characteristics: Mandibular Denture Foundation
  • Oral Characteristics: Maxillary Tuberosity Curve
  • Oral Characteristics: Vestibule
  • Oral Characteristics: Frenula Attachments
  • Oral Characteristics: Pterygomandibular Raphe
  • Oral Characteristics: Denture Bearing Soft Tissues
  • Oral Characteristics: Retromolar Pads
  • Oral Characteristics: Maxillary Ridge Crest to Resting Lip Length (Esthetic Space)
  • Oral Characteristics: Mandibular Ridge Crest to Resting Lip Length (Esthetic Space)
  • Oral Characteristics: Maximal Oral Opening
  • Oral Characteristics: Retromylohyoid Space
  • Oral Characteristics: Tongue Size
  • Oral Characteristics: Tongue Position
  • Oral Characteristics: The Neutral Zone
  • Summary
  • References
  • Chapter 2 Orthopedic Resolution of Mandibular Posture
  • Introduction
  • Conditioning Abused Tissues and Stabilizing the Existing Prosthesis
  • Materials Properties and Technique
  • Technique
  • Re-establishing Orthopedic Mandibular Position
  • Summary
  • References
  • Chapter 3 Definitive Impressions
  • Preimpression Considerations
  • Background
  • Impression Fundamentals
  • Impression Materials
  • Edentulous Impression Trays
  • Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures
  • Tray Selection and Tray Adaptation
  • Fabrication of Tray Stops
  • Border Molding the Impression Tray
  • Final (Definitive) Impression
  • Techniques for Making Single Appointment Definitive Impressions for Implant-Assisted Complete Dentures and Immediate Dentures
  • Attachment Selection
  • Implant-Retained Overdentures
  • Tray Selection
  • Impression Technique
  • Implant-Retained and Supported Overdentures
  • Immediate Dentures
  • Master Cast Production
  • Summary
  • References
  • Chapter 4 Fabricating Record Bases, Occlusal Rims, and Mounting a Central Bearing Device
  • Introduction
  • Fabrication of Record Base and Occlusal Rims
  • Fabrication of Maxillary Wax Occlusal Rim
  • Fabrication of Neutral Zone Mandibular Occlusal Rim
  • Technique
  • Jaw Recorder Device (Central Bearing Device)
  • Jaw Recorder Device Assembly
  • Mounting the Jaw Recorder Device on Record Bases
  • Mounting of the Jaw Recorder for Implant Overdentures
  • Mounting the Jaw Recorder Device on Partially Edentulous Arches
  • Procedure
  • Summary
  • References
  • Chapter 5 Developing an Esthetic Blueprint
  • Introduction
  • Contouring and Shaping the Maxillary Occlusal Rim
  • Summary
  • References
  • Chapter 6 Registering the Maxillo-Mandibular Jaw Relationship
  • Introduction
  • Facebow Recording
  • Centric Relation Recording for the Edentulous Patient
  • Centric Relation Recording for the Partially Dentate Patient
  • Summary
  • References
  • Chapter 7 Neutral-Zone Registration
  • Introduction
  • Recording the Physiologic Neutral Zone for Edentulous Patients
  • Technique
  • Recording the Physiologic Neutral Zone for a Dentate Patient
  • Technique
  • Summary
  • References
  • Chapter 8 Second Laboratory Procedure:: Selection and Arrangement of Prosthetic Teeth
  • Introduction
  • Indexing the Esthetic Blueprint Record
  • Indexing the Neutral Zone Record
  • Selection of Anterior Teeth
  • Maxillary Anterior Teeth Arrangement
  • Mandibular Anterior Teeth Arrangement
  • Selection of Posterior Teeth
  • Mandibular Posterior Teeth Arrangement
  • Maxillary Posterior Tooth Arrangement
  • Tooth Selection and Arrangement for the Partially Edentulous Patient
  • Summary
  • References
  • Chapter 9 Trial Placement Appointment
  • Trial Placement
  • Evaluation of Esthetics
  • Evaluation of Phonetics
  • Evaluation of Occlusal Vertical Dimension (OVD)
  • Evaluation of Centric Contact Position
  • External Impressions
  • Technique
  • Summary
  • References
  • Chapter 10 Denture Placement
  • Introduction
  • Placement of Immediate Dentures
  • Placement Procedures
  • Evaluation and Adjustment of Intaglio Surface
  • Technique
  • Evaluation and Adjustment of Denture Borders
  • Evaluating the Cameo Surface
  • Occlusal Evaluation and Correction
  • Subtractive Correction Technique
  • Additive Correction Technique
  • Patient Education and Instructions
  • Technique for Adhesive Application
  • Technique for Adhesive Removal
  • Home Care Instructions for Denture Patients
  • Postplacement Problems with New Dentures
  • Retention Problems
  • Soreness
  • Sore Throat
  • Speech Problems
  • Gagging
  • Summary
  • References
  • Chapter 11 Use of CAD/CAM Technology for Recording and Fabricating Neutral-Zone Dentures
  • Introduction
  • Registering the Neutral Zone during Impression Making
  • Technique
  • Registering the Neutral Zone during Maxillo-Mandibular Records
  • Technique
  • Registering the Neutral Zone during the Trial Placement
  • Technique
  • Summary
  • References
  • Index
  • EULA

Assessment of Edentulous Patients


A critical and somewhat perplexing aspect of the management of the edentulous condition is the prediction of therapeutic outcomes and patient satisfaction. The most fundamental factor determining a precise prognosis is a thorough and accurate pretreatment examination [1-3]. Even though patients may receive the best therapy, the treatment will fail if underlying conditions remain undiagnosed.

This chapter reviews a method for the pretreatment evaluation of edentulous patients and existing prostheses to arrive at a sound understanding of factors that will affect therapy and the probability that the treatment's objective can be achieved. Using appropriate assessment tools, the practitioner can better determine if the patient's expectations can be met.

Much has been published in the dental literature regarding anatomic [4, 5] and psychological variations [6, 7] in edentulous patients. Before considering management of these challenging patients, objectives include thorough examination, diagnosis of existing conditions, consideration of available therapy, and assessment of the prognosis of each available treatment option [1, 2]. Both subjective and objective patient factors must be taken into consideration [1]. A rational stepwise pretreatment protocol will help to prevent critical diagnostic information from being overlooked. Detailed documentation of findings is essential from a dento-legal standpoint.

The pretreatment protocol provided is relatively easy to follow, quick to perform, and easy to reproduce. It yields summary findings that correspond with specific prognostic conclusions. The protocol is divided into: (i) patient interview; (ii) examination of existing facial characteristics; and (iii) examination of edentulous conditions, i.e., anatomic, morphologic, and muscular status.

The Patient Interview

Successful therapy is facilitated by the provider coming to know the patient, from both personal and logistical perspectives; this includes how the patient arrived in the practice. If the patient was referred, the referral source should be known and contacted, and the reason for the referral noted. If the patient arrived due to marketing of the practice, care must be taken to investigate if the patient's needs are consistent with therapy provided by the practitioner.

The initial patient interview permits the patient and the practitioner to know one another [8]. Quality time spent at the beginning sets the stage for an optimized patient-provider relationship. Both the physical and psychological status of the patient should be triaged during the first appointment [8]. Anticipation of communication problems and interception of commonly encountered interpersonal problems are frequently as important as clinical findings. Discerning the primary etiology of existing patient dissatisfaction is essential for breaking the cycle of unsuccessful treatment attempts. Complaints and expectations expressed by the patient, and treatment obstacles encountered by previous dentists, can provide a critical influence on the acceptance of the patient into the practice and the treatment offered.

Be aware that the pretreatment protocol provided might initially appear to consume an inordinate amount of time and effort. Some might say that this is financially unjustifiable. However, once understood and skillfully conducted, the protocol reduces overall management time, permits appreciation of the treatment rendered, and significantly contributes to overall therapeutic success.

Some patients may be fearful, nervous, or shy, and inadvertently fail to respond directly to questions. Recognition of these individuals early in the interview process is critical. In many cases, a dental auxiliary can better elicit patient responses than the practitioner. Obtaining honest and accurate patient responses will affect outcomes. The pretreatment protocol and associated electronic documentation presented incorporate data-gathering processes designed to elicit thorough, concentrated, and accurate answers from patients.

Patient Interview: Age

The patient's chronological age should be critically compared with general physical health and existing oral conditions. Older patients may be afflicted with poor neuromuscular coordination [9, 10], suboptimal nutritional status [11, 12], diminished adaptability [9, 10], and salivary secretion (both quantity and quality) [11], and highly vulnerable denture-bearing tissues [10, 11]. These factors adversely influence aging edentulous patients' ability successfully to tolerate and function with conventional complete dentures, which should be discussed prior to initiating treatment [8]. Analogies such as "when dentures move and there's limited saliva, the pink plastic acts like sand paper against your gums creating irritation" help patients to understand better the problems that they face.

Patient Interview: Attitude

Coming to appreciate patient attitude may be as simple as presenting nonleading questions and permitting the patient time to respond. Questions that may be used to gauge patient attitude include:

  • How are you feeling today?
  • How was your experience with the previous dentist that treated you?
  • What do you think about your current and previous dentures?

Based on patient responses and ensuing discussions, qualifications of patient attitude as good, average, or poor may be made. Of course, additional questioning may be necessary to arrive at a reasonable determination.

Patient Interview: Expectations

If not thoroughly investigated prior to initiating treatment, patient expectations may not be apparent until problems unexpectedly emerge in the course of therapy, and the patient's demeanor begins to decline [9, 13]. Direct and specific questioning of the patient regarding expectations will permit documentation of responses and qualification of expectations as high, medium, low, or still unsure. Patients can also be asked the following questions to understand further the nature of their expectations:

  • What kind of improvement in appearance do you expect from your new dentures? In response to this question, a 50-year-old patient may provide a picture of an 18-year-old celebrity stating, "I want my teeth to look like hers." This would indicate that the patient possesses unrealistic expectations. A subsequent patient may suggest, "I want perfect teeth," necessitating a better understanding of what is meant by "perfect."
  • What kind of improvement in chewing ability do you expect from new dentures?
  • What kind of improvement in fit do you expect from the new dentures?
  • How long do you expect new dentures to last?
  • How often do you expect to return to the dentist for examinations and adjustments?

The nature of the patient's desires and demands relative to proposed treatment must be considered by the practitioner within the context of his?/?her level of experience and expertise. If the patient expects more than the practitioner can comfortably provide, definitive treatment should not commence and referral to a more experienced colleague should be in order. Additionally, if the patient is unable to appreciate the limitations of the therapy offered, it is inappropriate to initiate treatment.

It is the responsibility of the practitioner to address unattainable expectations fairly and honestly, through frank discussion with the patient, communicating what can and cannot be accomplished with treatment; this is particularly true with complete denture therapy. Failure to address unrealistic expectations often leads to treatment failure and rapid deterioration of the patient-provider relationship. Patients that refuse to accept known limitations of therapy and express inflexibility in this regard are generally challenging to manage successfully. Not initiating definitive treatment for these individuals is ethically, professionally, and financially appropriate.

Patient Interview: Chief Complaint

Providing state-of-the-art treatment that does not manage the patient's main concerns may provide a level of personal satisfaction for the provider but is rarely successful in the long run. It is therefore important to: (i) request that patients specifically voice their greatest dental concern?/?concerns; (ii) document these chief concerns using the patients' exact words, and (iii) review the chief concern?/?concerns, as documented, with the patients to confirm accuracy [13].

Most dental patients are not familiar with professional and dental terminology. It is therefore important to ensure that the practitioner understand clearly the patient's chief concerns as expressed. Asking the following questions may permit a greater appreciation for the nature of the chief concerns:

  • Are your dentures loose?
  • Can you eat most foods?
  • Do your gums get sore?
  • Do you have pain now?
  • Are you happy with the appearance of your smile?
  • Is there anything else that bothers you?

Patient Interview: General Health

General health is a significant factor that can affect the overall success of...

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