The prosthesis transitional denture

transitional denture denture

In complete denture, the problem of the prosthesis provisionally re ¬ arises in two different ways depending on the clinical situation it s works: a prosthesis in the transition to total edentulism, more or less abrupt transition stage toothed stage of toothless, the keyword is then "emergency", or a complete denture old modified and improved in the goal of functional rehabilitation before the establishment of a new prosthesis use. The keyword here is "treatment". But it can be both at once. Interim response to the urgency and the transition to bring the best clinical outcomes for the prosthesis to use in the future.

It is in both cases to respond to the request of the patient who requires comfort (keeping, efficiency, aesthetics). The practitioner, in turn, must not interfere or organs (bones, mucous membranes, muscles ...) or the functions of the masticatory system.

This clinical situation may affect one or both jaws. In the first case, taking into account the maxillary antagonist is essential.

Temporary prosthesis and total edentulism

The multiple indications extraction often leads the patient to the gradual or abrupt and difficult stage of the toothed part (sometimes complete) at the stage of total edentulous (Fig. 1 and 2).

The prosthesis must register and use part of a biological system (masticatory) as stable as possible. However, patients condemned to total edentulism often carry diseases acquired, caused by the use of dentures or a partial edentulism that is inadequately compensated or not.

Several techniques have been proposed. They all try to favorable riser passage taking into account, more or less, the biological, psychological and social. The practitioner is faced with two options:

- there is full control all the parameters and functional anatomical stabilized. It can then immediately consider the prosthesis usage (Fig. 3 and 4) or apply for example the technique of immediate dentures;

- or he must change, restore or prepare to stabilize or fix these parameters, then it must go through an artificial transition (adaptation, rehabilitation ...).

Fig. 1 and 2 - Treatment of maxillary calls for patient preparation before the introduction of the prosthesis to use.

Fig. 3, and 4 - functional rehabilitation can sometimes be done immediately without passing through a transitional prosthesis.

This is the "processing prosthesis" oriented therapy, which nevertheless hazard and adverse effects should be to save the patient. Unfortunately, the therapeutic approach which is to "tinker" the existing prosthesis to meet the urgent need for an extraction is different. Precipitated, it has none of the characteristics required to carry properly the transition to the completely edentulous. It is incorporated in a given situation and lay down the characteristics. It should be exceptional. Yet it is the most common. This is usually a PAP (partial dentures) to which is added or the last teeth that have just extracted with an indication, if not the pretext or excuse, to serve the patient suffering from or on leave.

Now add the teeth, one by one, leads to:

- freeze, record and fix the condition, if any, related to the pre presence of this prosthesis or create a new one; - increase the discomfort of the pa is. The prosthesis and made ex-temporanea is modified in its mechanical concepts: RSS (retention, levitation, stabilization) are processed and certainly insufficient. Retention provided more or less a hook on a mobile tooth disappears with it. The relative comfort is suddenly broken and not replaced by a prosthesis adapted to the new clinical situation.

Fig. 5 A rough beauty and illusion.

In addition, the patient who underwent extractions one to one ends up dreading the time of the loss of the last tooth "... and when I 'will have more teeth, it will be even worse. " This has the effect of putting it in a negative psychological situation;

- Always get a rough aesthetic. The teeth may not have the same color ... the soft tissue either. The addition of teeth is always frustrating, and it provides only aesthetic illusion to the patient (Fig. 5 to 7);

- create situations that are not functional, because these additions can not be consistent with the original design of the existing prosthesis. The extraction of last molar, for example, completely transforms the nature of the occlusal relationship with the opposing arch, and thus the nature of the M RI (jaw relationship) when the total tooth loss affects only one arch;

- lead to alveolar resorption by the extreme conservation of persistent and unjustified mobile teeth (which can be equated to overtreatment) and lead to genuine cases of difficulty criticism at the time of total edentulism. These prostheses are indeed always those of the last time, those used to extend the deadline;

- cause changes in the RIM. Many of these existing prostheses are no longer guarantors of RIM and occlusal pathologies cause irreversible joint may complicate the treatment of total edentulism in its future phases of development and adaptation. The opposing arch is often not adapted to the sustenance of the complete denture, do not meet the mechanical requirements of support and stabilization (Fig. 8 and 9); - making prosthetic sub-tracts, rather than the lift n is not assured of rapid absorption peaks settle jeopardizing the prognosis of the case. However, they can serve and be pathetic building footprints from succinct and clinical approaches more or less attention to the urgency of the disease.

Extemporaneous addition of four front teeth and extension of the base in the vestibular area with a self-curing resin in the chair

Fig. 6 and 7 - Addition extemporaneous four front teeth and extension of the base in the vestibular area with a self-curing resin in the chair.

Fig. 8 and 9 - maxillary full bridge must be filed with its different pillars. The opposing arch that has five remaining teeth and denture occlusion Assistant will provide existing non-conducive to the sustenance of the base jaw. From a single footprint in alginate, a model is mounted on an articulator in the jaw relationship exists. The teeth are extracted on the model and replaced with artificial teeth supported by a wax base whose boundaries are conjectural.

First clinical case (Fig. 10 to 24):

Fig. 10 - Periodontal disease poses an indication
of the extraction of all maxillary teeth.

Fig. 11 - The toothed arch antagonist completely
be restored by surgical treatment (48),
periodontal and implementation of elements of
joint prosthesis. The jaw relationship is
not stabilized and the occlusal scheme is not final.
However, the clinical urgency requires a prosthesis
provisional maxilla.

Fig. 12 - The maxillary model is from a print to alginates ...

Fig. 13 - Once the models mounted on an articulator
in their report of occlusion,
the natural teeth are replaced with artificial teeth.

Fig. 14 - On the models, the mining areas had been appointed a mi no me.
The bone healing in these places can not be anticipated.
The lift is not controlled except at the periphery
of the base edges whose profile is not functional,
because it arises as a primary imprint.

Fig. 15 - The temporary restoration is complete
and a duplicate is made transparent resin.

Fig. 16 - The extractions are performed and the prosthesis
is put in place immediately before use.
At this level, the practitioner does not control the lift
or the relationship of occlusion. Only the aesthetic is satisfactory.

Fig. 17 - The healing is achieved in a few weeks and guided by the gradual establishment
of the base through the development and unbalanced occlusal edges.

Fig. 18 - Once the periodontal and prosthetic treatment
of the mandibular arch over ...

Fig. 19 -... the duplicate of the prosthesis, adjusted and fitted simultaneously to the model in place,
is used as a custom tray.
An impression is made: marginage edges (orange and blue Permadyne Espe) ...