Prosthodontic Treatment for Edentulous Patients : Complete Dentures and Implant-Supported Prostheses

Covering the functional and esthetic needs of edentulous patients, Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses, 13th Edition helps you provide complete dentures, with and without dental implant support. It addresses both the behavioral and clinical aspects of diagnosis and treatment and covers treatment modalities including osseointegration, overdentures, implant-supported fixed prosthesis, and the current and future directions of implant prosthodontics. New to this edition are full-color photographs and coverage of immediately loaded complete dental prostheses. From lead editor and respected educator George Zarb, Prosthodontic Treatment for Edentulous Patients provides an atlas of clinical procedures and emphasizes the importance of evidence-based treatment. Short, easy-to-read chapters cover the essentials of care for both short- and long-term patients, stressing the importance of evidence-based treatment. Expanded coverage of implant prosthodontics addresses the clinical protocols for implant-retained and implant-supported prosthodontic management. Specific chapters address the three surfaces of the complete denture : (1) an impression or intaglio surface, (2) a polished surface, and (3) an occlusal surface, the integration of which is crucial to creating a stable, functional, and esthetic result. Chapter on health and nutrition examines a number of systemic conditions (vesciculoerosive conditions, systemic lupus erythematosus, burning mouth syndrome, salivary dysfunction, Sj�gren's syndrome, hyper/hyposalivation, diabetes) that affect the oral cavity and specifically influence the prognosis for wearing complete dentures or for accepting osseointegrated prostheses. Chapter on the time-dependent changes which occur in the oral cavity focuses on both time-related direct (ulcer/cheek biting, irritation hyperplasia, denture stomatitis, flabby ridge and pendulous maxillary tuberosities, hyperkeratosis and oral cancer, residual ridge reduction) and indirect (atrophy of masticatory muscles, nutritional status and masticatory function, control of sequelae) changes in the oral environment, and provides strategies to minimize the risk of such changes. Chapter on the techniques used to prolong the life of complete dentures focuses on the two techniques used to extend the life of dentures: relining and rebasing, also touching on denture duplication. Well-respected editors and contributors are the leaders in their field, lending credibility and experience to each topic. NEW! Over 800 full-color photos and illustrations highlight key clinical and esthetic details. NEW Immediately Loaded Complete Dental Prostheses chapter describes the rationale for the popular approach to immediately loading full arch implant supported/retained prostheses, allowing both enhanced functional outcomes and an accelerated time frame for completion of treatment. NEW The Impact of Socioeconomic, Cultural and Technological Changes and the Notion of Standards of Care and Alternative Protocols chapter addresses the appropriatech concept of providing cost-effective, appropriate care and describes techniques that make complete dentures accessible to those who do not have access to alternative care, including discussions of alternative protocols such as Complete Dentures in Four Clinical Sessions (CD4). Completely revised Materials Used in the Management of Edentulous Patients chapter includes expanded information on the properties, behaviors, and limitations of dental materials used in the rehabilitation of the edentulous patient, including impression materials (such as zinc oxide-eugenol impression paste, hydrocolloids, agar, and silicones), polymeric denture base materials (including rapid-cure type resins, biocompatibility of acrylic-based resins, residual monomer content, and radio-opacity of denture bases), denture cleansers (microwave radiation), and denture adhesives (such as adjunctive retention, indications/contraindications, application, and adverse reactions). Prosthodontic Treatment for Edentulous Patients, Thirteenth Edition (2013) 466pp. 978-0-323-07844-3 Front cover 1 Inside front cover 2 Prosthodontic Treatment for Edentulous Patients 3 Copyright page 6 Dedication 7 Contributors 9 Preface 11 Acknowledgments 12 Table of Contents 13 I The Patient 15 1 The Edentulous State 15 Historical Context and Current Considerations 15 Biomechanical Support for the Natural Dentition 18 Biomechanical Support Mechanisms for Complete Dentures 22 Mucosal Support and Masticatory Loads 22 The Residual Ridges 23 Natural and Prosthetic Dental Occlusion: Functional and Parafunctional Considerations 23 Function: Mastication and Other Mandibular Movements 28 Parafunctional Considerations 28 Changes in Morphological Face Height and the Temporomandibular Joints 29 Temporomandibular Joint Changes 32 Esthetic Changes 32 Behavioral and Adaptive Responses 35 Treatment Options: Complete Dentures 36 Treatment Options: Implant Prosthodontics 37 Bibliography 41 2 Systemic Health Aspects and Nutritional Considerations for Edentulous Patients 42 Mucosal Conditions 42 Vesiculoerosive 42 Systemic Lupus Erythematosus (SLE) 42 Burning Mouth Syndrome 42 Oral Movement Disorders 43 Salivary Dysfunction 44 Sjögren’s Syndrome 44 Hypersalivation/Hyposalivation 45 Diabetes 45 Nutrition and the Impact of Dental Status on Food Intake 45 Dietary Counseling of Patients Undergoing Prosthodontic Treatment 46 Summary 47 References 47 3 The Aging Edentulous Patient 49 The Aging Population 49 Distribution and Impact of Edentulism in Old Age 49 Distribution 49 Impact 49 The Impact of Age on the Edentulous Mouth 50 Mucosa 50 Bone 50 Saliva 51 Jaw Movements in Old Age 51 Taste and Smell 51 Nutrition 51 Aging Skin and Teeth 52 Skin 52 Teeth 52 Concerns for Personal Appearance in Old Age 53 Summary 54 References 54 4 Sequelae Caused by Wearing Complete Dentures 56 Control of Sequelae with the Use of Complete Dentures 56 Dentures in Their Oral Environment 56 Direct Sequelae: Changes in Local Mucosal Morphology 56 Traumatic Ulcers and Cheek Biting 58 Denture Irritation Hyperplasia 58 Denture Stomatitis 58 Candida-Associated Denture Stomatitis (Fig. 4-5) 59 Etiology and Predisposing Factors 59 Management and Preventive Measures 61 Flabby Ridge and Pendulous Maxillary Tuberosities (See Also Chapter 5) 62 Hyperkeratosis and Oral Cancer 62 Residual Ridge Reduction 62 Indirect Sequelae: Changes in Functional Morphology 64 Atrophy of Masticatory Muscles 64 Nutritional Status and Masticatory Function 64 Control of Sequelae with the Use of Complete Dentures 65 Summary 65 References 65 Bibliography 66 II Treatment Options 67 5 History Taking, Treatment Planning, and Improving Denture-Bearing Areas for Edentulous Patients 67 On History Taking and Treatment Planning for Edentulous Patients 67 The First Visit 67 Patient Attitude 67 General Health and Dental History 68 Treatment Planning 68 Social and Behavioral Information 68 Psychological Considerations 69 Systemic Health Status 70 Extraoral Examination 71 Temporomandibular Joint 71 Cheeks and Lips (Fig. 5-1) 72 Intraoral Examination 74 Mucosa (Figs. 5-2 and 5-3) 75 Infection (Fig. 5-5) 77 Tongue (Fig. 5-6) 78 Saliva (See Also Chapter 2) 80 Bone Ridge Morphology 80 Tori (See Figs. 5-2 and 5-3) 81 Bony Undercuts (Fig. 5-8) 81 Arch Relations 82 Enlarged Maxillary Tuberosities (Fig. 5-9) 83 Existing Dentures (Fig. 5-10) 83 Additional Considerations with the Partially Dentate Patient 86 Radiographs, Photographs, Measurements 88 Radiographic Images (Fig. 5-13) 88 Photographic Images 90 Measurements 90 Diagnostic/Study Casts 90 Financial Implications 91 Development of the Treatment Plan 91 Summary 91 Improving Denture-Bearing Foundations for Edentulous Patients 91 Preprosthetic Nonsurgical Methods 91 Managing Traumatized Tissues 92 Occlusal Correction of the Old Prostheses 93 Preprosthetic Surgical Methods 93 Surgical Correction of Conditions that Preclude Optimal Prosthetic Function 94 Hyperplastic Ridge, Epulis Fissuratum, and Papillomatosis (Fig. 5-17) 94 Frenular Attachments and Pendulous Maxillary Tuberosities 94 Bony Prominences, Undercuts, Spiny Ridges, and Tori 94 Pressure on the Mental Foramen 97 Ridge Parallelism 98 Enlargement of Denture- Bearing Areas 100 Vestibuloplasty 100 Ridge Augmentation 104 Discrepancies in Jaw Size 104 Replacement of Tooth Roots with Osseointegrated Dental Implants 104 Summary 104 Bibliography 106 On History Taking and Treatment Planning for Edentulous Patients 106 Improving Denture-Bearing Foundations for Edentulous Patients 106 6 Additional Treatment Planning Options for Both Edentulous and Potentially Edentulous Patients 107 Considerations for Implant Prosthodontic Treatment 107 Maladaptive Denture Behavior 107 The Scientific Era in Implant Prosthodontics 109 Patient Considerations 112 Treatment Outcome Considerations 115 Summary 115 The Potentially Edentulous Patient to be Treated with Overdentures 116 Advantages and Disadvantages of the Overdenture Technique 121 Indications and Treatment Planning 121 Group 1 121 Group 2 122 Selection of Abutment Teeth 123 Methods and Techniques for Enhancing the Overdenture’s Retentive Role 124 Loss of Abutment Teeth 125 Summary: Treatment Outcome Studies 126 The Potentially Edentulous Patient to be Treated with Immediate Dentures 126 Advantages and Disadvantages of Immediate Denture Treatment 127 Contraindications to Immediate Denture Treatment 128 Treatment Planning the Choice of the Immediate Denture Clinical Technique or Protocol 128 Explanation to the Patient 128 Oral Examination 128 Examination of Any Existing Prosthesis If it is to be Included in an Iid 130 Tooth/Teeth Modifications 130 Prognosis 131 Referrals/Adjunctive Care 132 Oral Prophylaxis 132 Other Treatment Needs 132 Bibliography 132 Considerations for Implant Prosthodontic Treatment 132 The Potentially Edentulous Patient to Be Treated with Overdentures 133 Immediate Dentures for Potentially Edentulous Patients 133 III The Materials Used 135 7 Materials Used in the Management of Edentulous Patients 135 Impression Materials 136 Nonelastic Impression Materials 137 Impression Plaster 137 Zinc Oxide Eugenol (ZOE) Impression Paste 137 Dental Impression Compound (Types I and II) 138 Important Considerations for Proper Use of Impression Compound 138 Elastic Impression Materials 139 Hydrocolloids 139 Agar (Reversible Hydrocolloid). 139 Composition and Manipulation of Agar (Box 7-5). 139 Alginate (Irreversible) Hydrocolloid Material (Box 7-6). 140 Technical Considerations in the Manipulation of Alginates 140 Elastomeric Impression Materials 141 Recommended Technique for Final Elastomeric Impressions 142 Points of Importance When Handling Elastomers 142 Polysulfide Rubber 142 Condensation Silicone (Box 7-8) 142 Addition Silicones (Box 7-9) 143 Polyether Impression Materials 144 Disinfection of Elastomeric Impression Materials 145 Summary of Impression Material 147 Polymeric Denture Base Materials 147 Technical Considerations and Properties of Denture Base Resins 148 Heat-Activated PMMA 148 The Polymerization Cycle. 148 Denture Base Porosity. 148 Rapid-Cure Type Resins 148 The Bond Between Heat-Cured Denture Bases and Resin Denture Teeth 149 Biocompatibility of Methacrylate-Based Resins 149 Residual Monomer Content 149 Radiopacity of Denture Bases 150 Injection Molding Technique 150 Chemically Activated Resins (Box 7-13) 150 Pour or Fluid Resin Technique 150 Microwave-Activated Resins (Box 7-14) 152 Light-Activated (VLC) Resins (Box 7-15) 152 Modified Resin Base Materials (Box 7-16) 153 Materials Used in the Fabrication of Prosthetic Denture Teeth 153 Methacrylate-Based (PMMA) Resin Teeth 153 Technical Considerations 156 Esthetics of Methacrylate Resin Teeth 156 Additional Advantages and Disadvantages of Methacrylate Resin Teeth 156 Composite Resin Denture Teeth 157 Porcelain Teeth 157 Additional Advantages and Disadvantages of Porcelain Teeth 157 Summary of Prosthetic Teeth 158 Denture Lining Materials 158 Short-Term Soft Liners (Tissue Conditioners) 159 Rheological and Viscoelastic Properties of Tissue Conditioners 160 Self-Administered Home Relines* 160 Long-Term Soft Liners 161 Methacrylate Resin and Heat-Activated Resilient Liners 161 Chemically Activated Methacrylate Resins 161 Silicone-Based Soft Liners 162 Heat-Activated Silicone Liners. 162 Chemically Activated Silicone Liners (Room Temperature Vulcanized [RTV] Silicones). 162 Summary of Denture Lining Material 163 Cast Metal Alloys as Denture Bases 163 Technical Considerations 163 Cobalt-Chromium Alloys 165 Cobalt-Chromium Nickel Alloys 165 Nickel-Chromium Alloys 165 Properties of Base Metal Alloys Used in Removable Prostheses 165 Physical Properties 165 Mechanical Properties 165 Chemical Properties 165 Biocompatibility 166 Commercially Pure Titanium and Its Alloys 166 Titanium Alloys 166 Denture Cleansers 166 Cleansing and Disinfecting 167 Mechanical Techniques 168 Chemical Denture Cleansers 168 Oxygenating Cleansers 168 Hypochlorite Solutions 168 Other Techniques and Materials 168 Ultrasonic Units 168 Dilute Acids 169 Enzyme-Containing Denture Cleansers 169 Silicone Polymers 169 Microwave Radiation 169 Adverse Reactions to Denture Cleansers 169 Summary of Cleansers 169 Denture Adhesives 169 Adjunctive Retention by Using Denture Adhesives 170 Indications and Contraindications for Denture Adhesive 170 Application of Denture Adhesives 172 Adverse Reactions to Denture Adhesive 172 Summary 172 Bibliography 173 IV Clinical Protocols for Diverse Treatment Scenarios 175 8 Maxillary and Mandibular Substitutes for the Denture-Bearing Area 175 Anatomy Of Supporting Structures 175 Mucous Membrane 176 Residual Ridge 176 Maxilla 177 Peripheral Border Tissues And Contours 178 Mandible 179 Peripheral Border Tissues And Contours 181 Principles And Objectives Of Impression Making 184 Impression Procedures 185 Preliminary Impressions: Trays, Materials, Technique 186 Final Impressions: Trays, Materials, Technique 187 Posterior Palatal Seal 190 Boxing Impressions And Making The Casts 192 Summary 193 Bibliography 193 9 The Dentures’ Polished Surfaces, Recording Jaw Relations, and Their Transfer to an Articulator 194 Neutral Zone or Arch Form Design 196 Mandibular Arch 198 Maxillary Arch 200 Level or Height of the Occlusal Plane 202 Establishing the Desired Vertical Dimension of Occlusion 204 Esthetics 204 Phonetics (See Chapter 15) 205 Mechanics 206 The Preliminary Centric Relation Record (Box 9-1) 206 Relating the Patient to the Articulator 209 Facebow 209 Laboratory Steps 210 Articulators 211 Types of Patient Records 212 Interocclusal Records 212 Graphic Records 213 Hinge-Axis Records 213 On Selecting an Articulator for Making Complete Dentures 214 Programming the Articulator 214 Condylar Elements (Fig. 9-14, A) 214 Incisal Elements (Fig. 9-14, B and C) 215 Arbitrary Settings 216 Bibliography 216 10 The Occlusal Surfaces: 218 On Meeting Patient Expectations When Selecting Teeth 218 On Guiding Patient Decisions 219 Additional Clinical and Technical Considerations in Anterior Tooth Selection 222 Patient Preferences 222 Overdentures and Implant Dentures 222 Opposing Natural Teeth 222 Materials for Denture Teeth 222 Posterior Tooth Molds and Cuspal Anatomy 222 Ten Landmarks for Complete Denture Teeth Setup 223 The “Standard Anterior” Arrangement 223 Arranging the Mandibular Anterior Teeth (Fig. 10-9) 224 Mandibular Central Incisor Positions 225 Mandibular Lateral Incisors 226 Mandibular Canines 226 Setting The Maxillary Anterior Teeth (Fig. 10-10) 226 Maxillary Central Incisors 226 Maxillary Lateral Incisors 228 Maxillary Canines 228 “Anteriors Only” Try-In 229 Arranging Posterior Teeth 229 Number of Posterior Teeth Set 229 Occlusal Concepts for Complete Denture Occlusion 229 Lingualized Articulation 229 Arranging Maxillary Posterior Teeth to Lingualized Articulation (Fig. 10-15) 233 Arranging Anatomical Teeth to a Balanced Articulation (Fig. 10-16) 235 Setting the Mandibular Teeth First 235 Evaluating Bilateral Balanced Articulation 235 Arranging Nonanatomical Teeth To Monoplane Articulation (Fig. 10-17) 236 Arranging Nonanatomical Teeth With A Balancing Ramp (Fig. 10-18) 237 Arranging Nonanatomical Teeth To Balanced Articulation (Fig. 10-19) 237 Setups For Retrognathic and Prognathic Facial Skeletons 239 The Lingual Look Test (Fig. 10-23) 240 Completing The Wax-Up For The Try-In Appointment (Fig. 10-24) 241 Summary of Tooth Selection and Arrangement 243 Bibliography 243 11 The Try-in Appointment 244 Before The Try-In Appointment 244 At The Try-In Appointment 246 Explanation 246 Chairside Comparison 246 Denture Comparison 247 The Real Try-In 248 Speaking And Phonetic Assessment 249 Vertical Dimension Of Occlusion 250 Check the Dental Occlusion 253 Relaxing and Rehearsal of a Relaxed Jaw Closure 253 Single-Base Stabilization for Try-In Assessment (Fig. 11-13) 255 Double-Base Stabilization for Try-In Assessment (Fig. 11-14) 255 When Is A Remount Needed? 256 Remount at Increased Vertical Dimension (Fig. 11-17) 257 Remount at Correct Vertical Dimension (Fig. 11-18) 257 The Interappointment Laboratory Procedure for the Wax Try-in Remount (Fig. 11-19) 260 Resetting the Dentition for Try-in 262 Try-In For Esthetics 262 The Next Level: Characterization of Individual Tooth Colors and Position 262 Establishment of the Posterior Palatal Seal (PPS) 263 Final Decision Making and Closure 266 The Laboratory Prescription 267 Summary 268 Bibliography 268 12 Prosthesis Insertion and Follow-up Appointments 269 Waxing and Processing the Dentures 269 Development of the Proper Forms of the Polished Surfaces 269 Completion of Wax-Up and Festooning 271 Formation and Preparation of the Mold 271 Packing the Mold 277 Fabrication of Facebow Transfer Jig 277 Laboratory Remount and Equilibration (As # 2 Remount in Table 11-2) 277 Removing Processed Dentures from the Master Casts 278 Finishing and Polishing Dentures 279 Fabrication of Clinical Remount Casts 279 Hydrate the Dentures 279 Delivery of the Completed Dentures 281 Elimination of Basal Surface Errors 281 Adjustment of Denture Base 281 Adjustment of Denture Borders 282 Errors in Occlusion 282 Clinical Remount and Occlusal Equilibration (As #3 Remount in Table 11-2) 282 Centric Relation Record 283 Remount the Mandibular Denture 283 Verifying Centric Relation 283 Protrusive Record (Optional) 283 Eliminating Occlusal Errors in Anatomical Teeth 285 Eliminating Occlusal Errors in Nonanatomical Teeth 286 Advantages of Balanced Occlusion in Complete Dentures 286 Special Instructions to the Patient 287 Individuality of Patients 287 Appearance with New Dentures 287 Mastication with New Dentures 287 Speaking with New Dentures 288 Oral Hygiene with Dentures 288 Preserving the Residual Ridges 289 Educational Material for Patients 289 Follow-Up Appointments 289 Twenty-Four-Hour Oral Examination and Treatment 289 Examination Procedures 290 Adjustments Related to the Occlusion 290 Adjustments Related to the Denture Bases 290 Subsequent Oral Examinations and Treatments 292 Periodic Recall for Oral Examination 294 Bibliography 294 13 Modified Protocols for Immediate Dentures, Overdentures, and Single Dentures 295 Immediate Dentures 295 Preliminary Impressions 296 Final Impression 296 Posterior Palatal Seal 296 Maxillomandibular Relationship Records 298 Denture Teeth Arrangement 301 Laboratory Procedures 301 Teeth Removal and Denture Insertion 303 Postoperative Care 303 Overdentures 304 Treatment Planning for Overdentures 307 Retention 308 Insertion 309 Clinical and Laboratory Procedures 309 Tooth-Supported Complete Denture 309 Tooth-Supported Immediate Complete Denture 309 Maintenance 312 Single Denture 312 Diagnosis and Treatment Planning 312 Teeth Arrangement 313 Summary 315 Bibliography 316 14 Prolonging the Useful Life of Complete Dentures: 317 Rebasing/Relining 317 Treatment Rationale 317 Diagnosis 318 Preliminary Treatment 320 Clinical Impression Procedures 323 Static Impression Technique 323 Functional Impression Technique 324 Chairside Technique 325 Relining/Rebasing Materials 325 Repairs 326 Denture Duplication (see Chapter 23) 327 Bibliography 328 15 Speech Considerations with Complete Dentures 329 Speech Production 329 Speech Production: The Role of Teeth and Other Oral Structures 330 Bilabial Sounds 331 Labiodental Sounds 331 Linguodental Sounds 331 Linguoalveolar Sounds 332 Articulatory Characteristics 332 Acoustic Characteristics 332 Auditory Characteristics 332 Linguopalatal and Linguovelar Sounds 333 Methods for Speech Analysis 334 Prosthetic Considerations 334 Special Consideration in Implant Prosthodontics 335 Summary 335 Bibliography 335 V Clinical Protocols Specific to Implant-Retained and Implant-Supported Prosthodontic Management 337 16 The Science of Osseointegration 337 Osseointegrated Interface 337 Factors That Determine Success and Failure of Osseointegration 338 Implant Biocompatibility 338 Implant Design 338 Implant Surface 340 Host Bed 341 Surgical Technique 342 Loading Conditions 343 Summary 343 Bibliography 343 17 Implant Overdentures 344 General Overdenture Treatment Considerations 344 Inclusion and Exclusion Criteria 345 Presurgical Evaluation and Treatment Planning 345 Surgical Protocol and the Osseointegration Phase 348 Prosthodontic Protocol 349 Guidelines for Selecting Attachment Systems 349 Indications for Ball or Magnetic Attachments 350 Indications for Bar Attachments 350 Implant Overdenture Design 350 Clinical and Laboratory Procedures 350 Maintenance 352 Bibliography 353 18 Fixed Full Arch Implant-Supported Prostheses for the Edentulous Patient 354 Patient Selection 354 Considerations Specific to the Edentulous Mandible 356 Immediate Load Rehabilitation of the Edentulous Mandible 356 Step-by-Step Procedures 356 The Edentulous Maxilla 359 Summary 362 References 363 19 Maxillofacial Prosthodontics for the Edentulous Patient 365 Form and Function 365 Anatomic and Physiologic Considerations: Normal Function 365 Functional Deficits of Speech and Swallowing 366 Prosthetic Considerations for Edentulous Maxillofacial Prosthesis 367 Facial Form 367 Loss of Vertical Opening and Altered Mandibular Movements 367 Processed Bases 367 Border Molding Soft Palate and Maxillary Defects 367 Border Molding The Velopharyngeal Area: Patient Movements 367 Border Molding Peripheries of Maxillary Resections and Hard Palate Defects: Patient Movements 368 Testing The Prosthetic “Seal” Between The Oral Cavity and The Nasal Cavity 369 Maxillary Obturator Prosthesis 369 Immediate Surgical Obturator Prosthesis 369 Interim Obturator Prosthesis 370 Definitive Obturator Prosthesis 372 Troubleshooting An Obturator Prosthesis 374 Lack of Retention 374 Nasal Reflux 375 Hypernasality 376 Soft Palate Obturator Prosthesis 376 Troubleshooting The Soft Palate Obturator Prosthesis 379 Prosthesis Feels Too Long 379 Hypernasality 379 Palatal Augmentation Prosthesis 379 Clinical Examination 379 Informing The Patient 379 Mandibular Resection Prostheses 380 Marginal Mandibulectomy Prostheses 380 Discontinuity Mandibulectomy Prostheses 381 Troubleshooting Prostheses For The Patient With An Edentulous Mandibulectomy 383 Unstable Mandibular Denture 383 Inability to Chew or Inability to Chew Beyond a Soft Diet 383 Prostheses For Reconstructed Mandibles 383 Maxillofacial Implant-Assisted Prostheses For The Edentulous Patient 383 Risks and Benefits Assessment of Implants In Irradiated Tissues 384 Risk of Osteoradionecrosis 386 Hyperbaric Oxygen Therapy 386 Irradiation of Existing Implants 387 Prosthodontic Treatment Considerations For The Irradiated Edentulous Patient 387 Timing of Denture Placement 387 Salivary Consideration for the Irradiated Edentulous Patient 388 Occlusal Forms 388 Delivery and Postinsertion Care 388 Bibliography 388 20 Managing Problems and Complications 390 Problems 390 Complications 391 Surgically Related Complications 391 At Stage I Surgery 391 Interval Between Stage I and Stage II 393 At Stage II Surgery 394 Prosthodontic-Related Complications (Table 20-2) 394 Abutment Related 394 Impression Related 395 Try-in of Tooth Arrangement 396 Framework Try-in 396 Insertion Of Prosthesis 396 Implant-Supported Fixed Prosthesis 396 Implant-Supported Overdenture 397 Postinsertion 397 Biological Complications 397 Mechanical/Prosthodontic Complications 397 Summary 399 Bibliography 399 21 Immediately Loaded Complete Dental Prostheses 401 Immediate Load Complete Denture Technique 403 References 407 22 Current and Possible Future Directions in Implant Prosthodontics 409 Systemic Health and Host Bone Response 409 Smoking 412 Osteoporosis 413 Bisphosphonate Therapy 414 Irradiation Therapy 415 Other Systemic Conditions 415 Imaging Protocol 415 Surgical Protocols 416 Bone Quality 416 Bone Quantity And Site Improvement 417 Prosthodontic Loading 417 Oral Ecological Concerns 420 Summary 421 Bibliography 422 VI Additional Considerations in the Management of Edentulous Patients 423 23 The Impact of Socioeconomic, Cultural, and Technological Changes and the Notion of Standards of Care and Alternative Protocols 423 Standards Of Care 424 Minimum Acceptable Protocols 424 An “Appropriatech” Method For Complete Dentures In Four Clinical Sessions 424 First Clinical Session 425 Impressions 425 Position of Maxillary Anterior Teeth 426 First Laboratory Session 426 Second Clinical Session 426 Establishing the Vertical Dimension of Occlusion 426 Recording the Horizontal Jaw Relationship 426 Second Laboratory Session 430 Third Clinical Session 430 Remount and Occlusal Adjustment 430 Counseling the Patient 430 Fourth Clinical Session 430 Summary 430 Reproducing Complete Dentures 430 First Clinical Session 431 First Laboratory Session 432 Second Clinical Session 433 Second Laboratory Session 433 Third Clinical Session 433 Adaptation And Advancing Technology 433 Summary 433 References 433 Bibliography 434 Index 435 A 435 B 437 C 438 D 440 E 443 F 444 G 445 H 446 I 447 J 449 K 449 L 449 M 450 N 454 O 454 P 456 Q 459 R 459 S 461 T 463 U 465 V 465 W 466 X 466 Z 466 Front cover......Page 1 Inside front cover......Page 2 Prosthodontic Treatment for Edentulous Patients......Page 3 Copyright page......Page 6 Dedication......Page 7 Contributors......Page 9 Preface......Page 11 Acknowledgments......Page 12 Table of Contents......Page 13 Historical Context and Current Considerations......Page 15 Biomechanical Support for the Natural Dentition......Page 18 Mucosal Support and Masticatory Loads......Page 22 Natural and Prosthetic Dental Occlusion: Functional and Parafunctional Considerations......Page 23 Parafunctional Considerations......Page 28 Changes in Morphological Face Height and the Temporomandibular Joints......Page 29 Esthetic Changes......Page 32 Behavioral and Adaptive Responses......Page 35 Treatment Options: Complete Dentures......Page 36 Treatment Options: Implant Prosthodontics......Page 37 Bibliography......Page 41 Burning Mouth Syndrome......Page 42 Oral Movement Disorders......Page 43 Sjögren’s Syndrome......Page 44 Nutrition and the Impact of Dental Status on Food Intake......Page 45 Dietary Counseling of Patients Undergoing Prosthodontic Treatment......Page 46 References......Page 47 Impact......Page 49 Bone......Page 50 Nutrition......Page 51 Teeth......Page 52 Concerns for Personal Appearance in Old Age......Page 53 References......Page 54 Direct Sequelae: Changes in Local Mucosal Morphology......Page 56 Denture Stomatitis......Page 58 Etiology and Predisposing Factors......Page 59 Management and Preventive Measures......Page 61 Residual Ridge Reduction......Page 62 Nutritional Status and Masticatory Function......Page 64 References......Page 65 Bibliography......Page 66 Patient Attitude......Page 67 Social and Behavioral Information......Page 68 Psychological Considerations......Page 69 Systemic Health Status......Page 70 Temporomandibular Joint......Page 71 Cheeks and Lips (Fig. 5-1)......Page 72 Intraoral Examination......Page 74 Mucosa (Figs. 5-2 and 5-3)......Page 75 Infection (Fig. 5-5)......Page 77 Tongue (Fig. 5-6)......Page 78 Bone Ridge Morphology......Page 80 Bony Undercuts (Fig. 5-8)......Page 81 Arch Relations......Page 82 Existing Dentures (Fig. 5-10)......Page 83 Additional Considerations with the Partially Dentate Patient......Page 86 Radiographic Images (Fig. 5-13)......Page 88 Diagnostic/Study Casts......Page 90 Preprosthetic Nonsurgical Methods......Page 91 Managing Traumatized Tissues......Page 92 Preprosthetic Surgical Methods......Page 93 Bony Prominences, Undercuts, Spiny Ridges, and Tori......Page 94 Pressure on the Mental Foramen......Page 97 Ridge Parallelism......Page 98 Vestibuloplasty......Page 100 Summary......Page 104 Improving Denture-Bearing Foundations for Edentulous Patients......Page 106 Maladaptive Denture Behavior......Page 107 The Scientific Era in Implant Prosthodontics......Page 109 Patient Considerations......Page 112 Summary......Page 115 The Potentially Edentulous Patient to be Treated with Overdentures......Page 116 Group 1......Page 121 Group 2......Page 122 Selection of Abutment Teeth......Page 123 Methods and Techniques for Enhancing the Overdenture’s Retentive Role......Page 124 Loss of Abutment Teeth......Page 125 The Potentially Edentulous Patient to be Treated with Immediate Dentures......Page 126 Advantages and Disadvantages of Immediate Denture Treatment......Page 127 Oral Examination......Page 128 Tooth/Teeth Modifications......Page 130 Prognosis......Page 131 Considerations for Implant Prosthodontic Treatment......Page 132 Immediate Dentures for Potentially Edentulous Patients......Page 133 7 Materials Used in the Management of Edentulous Patients......Page 135 Impression Materials......Page 136 Zinc Oxide Eugenol (ZOE) Impression Paste......Page 137 Important Considerations for Proper Use of Impression Compound......Page 138 Composition and Manipulation of Agar (Box 7-5).......Page 139 Technical Considerations in the Manipulation of Alginates......Page 140 Elastomeric Impression Materials......Page 141 Condensation Silicone (Box 7-8)......Page 142 Addition Silicones (Box 7-9)......Page 143 Polyether Impression Materials......Page 144 Disinfection of Elastomeric Impression Materials......Page 145 Polymeric Denture Base Materials......Page 147 Rapid-Cure Type Resins......Page 148 Residual Monomer Content......Page 149 Pour or Fluid Resin Technique......Page 150 Light-Activated (VLC) Resins (Box 7-15)......Page 152 Methacrylate-Based (PMMA) Resin Teeth......Page 153 Additional Advantages and Disadvantages of Methacrylate Resin Teeth......Page 156 Additional Advantages and Disadvantages of Porcelain Teeth......Page 157 Denture Lining Materials......Page 158 Short-Term Soft Liners (Tissue Conditioners)......Page 159 Self-Administered Home Relines*......Page 160 Chemically Activated Methacrylate Resins......Page 161 Chemically Activated Silicone Liners (Room Temperature Vulcanized [RTV] Silicones).......Page 162 Technical Considerations......Page 163 Chemical Properties......Page 165 Denture Cleansers......Page 166 Cleansing and Disinfecting......Page 167 Ultrasonic Units......Page 168 Denture Adhesives......Page 169 Indications and Contraindications for Denture Adhesive......Page 170 Summary......Page 172 Bibliography......Page 173 Anatomy Of Supporting Structures......Page 175 Residual Ridge......Page 176 Maxilla......Page 177 Peripheral Border Tissues And Contours......Page 178 Mandible......Page 179 Peripheral Border Tissues And Contours......Page 181 Principles And Objectives Of Impression Making......Page 184 Impression Procedures......Page 185 Preliminary Impressions: Trays, Materials, Technique......Page 186 Final Impressions: Trays, Materials, Technique......Page 187 Posterior Palatal Seal......Page 190 Boxing Impressions And Making The Casts......Page 192 Bibliography......Page 193 9 The Dentures’ Polished Surfaces, Recording Jaw Relations, and Their Transfer to an Articulator......Page 194 Neutral Zone or Arch Form Design......Page 196 Mandibular Arch......Page 198 Maxillary Arch......Page 200 Level or Height of the Occlusal Plane......Page 202 Esthetics......Page 204 Phonetics (See Chapter 15)......Page 205 The Preliminary Centric Relation Record (Box 9-1)......Page 206 Facebow......Page 209 Laboratory Steps......Page 210 Articulators......Page 211 Interocclusal Records......Page 212 Hinge-Axis Records......Page 213 Condylar Elements (Fig. 9-14, A)......Page 214 Incisal Elements (Fig. 9-14, B and C)......Page 215 Bibliography......Page 216 On Meeting Patient Expectations When Selecting Teeth......Page 218 On Guiding Patient Decisions......Page 219 Posterior Tooth Molds and Cuspal Anatomy......Page 222 The “Standard Anterior” Arrangement......Page 223 Arranging the Mandibular Anterior Teeth (Fig. 10-9)......Page 224 Mandibular Central Incisor Positions......Page 225 Maxillary Central Incisors......Page 226 Maxillary Canines......Page 228 Lingualized Articulation......Page 229 Arranging Maxillary Posterior Teeth to Lingualized Articulation (Fig. 10-15)......Page 233 Evaluating Bilateral Balanced Articulation......Page 235 Arranging Nonanatomical Teeth To Monoplane Articulation (Fig. 10-17)......Page 236 Arranging Nonanatomical Teeth To Balanced Articulation (Fig. 10-19)......Page 237 Setups For Retrognathic and Prognathic Facial Skeletons......Page 239 The Lingual Look Test (Fig. 10-23)......Page 240 Completing The Wax-Up For The Try-In Appointment (Fig. 10-24)......Page 241 Bibliography......Page 243 Before The Try-In Appointment......Page 244 Chairside Comparison......Page 246 Denture Comparison......Page 247 The Real Try-In......Page 248 Speaking And Phonetic Assessment......Page 249 Vertical Dimension Of Occlusion......Page 250 Relaxing and Rehearsal of a Relaxed Jaw Closure......Page 253 Double-Base Stabilization for Try-In Assessment (Fig. 11-14)......Page 255 When Is A Remount Needed?......Page 256 Remount at Correct Vertical Dimension (Fig. 11-18)......Page 257 The Interappointment Laboratory Procedure for the Wax Try-in Remount (Fig. 11-19)......Page 260 The Next Level: Characterization of Individual Tooth Colors and Position......Page 262 Establishment of the Posterior Palatal Seal (PPS)......Page 263 Final Decision Making and Closure......Page 266 The Laboratory Prescription......Page 267 Bibliography......Page 268 Development of the Proper Forms of the Polished Surfaces......Page 269 Formation and Preparation of the Mold......Page 271 Laboratory Remount and Equilibration (As # 2 Remount in Table 11-2)......Page 277 Removing Processed Dentures from the Master Casts......Page 278 Hydrate the Dentures......Page 279 Adjustment of Denture Base......Page 281 Clinical Remount and Occlusal Equilibration (As #3 Remount in Table 11-2)......Page 282 Protrusive Record (Optional)......Page 283 Eliminating Occlusal Errors in Anatomical Teeth......Page 285 Advantages of Balanced Occlusion in Complete Dentures......Page 286 Mastication with New Dentures......Page 287 Oral Hygiene with Dentures......Page 288 Twenty-Four-Hour Oral Examination and Treatment......Page 289 Adjustments Related to the Denture Bases......Page 290 Subsequent Oral Examinations and Treatments......Page 292 Bibliography......Page 294 Immediate Dentures......Page 295 Posterior Palatal Seal......Page 296 Maxillomandibular Relationship Records......Page 298 Laboratory Procedures......Page 301 Postoperative Care......Page 303 Overdentures......Page 304 Treatment Planning for Overdentures......Page 307 Retention......Page 308 Tooth-Supported Immediate Complete Denture......Page 309 Diagnosis and Treatment Planning......Page 312 Teeth Arrangement......Page 313 Summary......Page 315 Bibliography......Page 316 Treatment Rationale......Page 317 Diagnosis......Page 318 Preliminary Treatment......Page 320 Static Impression Technique......Page 323 Functional Impression Technique......Page 324 Relining/Rebasing Materials......Page 325 Repairs......Page 326 Denture Duplication (see Chapter 23)......Page 327 Bibliography......Page 328 Speech Production......Page 329 Speech Production: The Role of Teeth and Other Oral Structures......Page 330 Linguodental Sounds......Page 331 Auditory Characteristics......Page 332 Linguopalatal and Linguovelar Sounds......Page 333 Prosthetic Considerations......Page 334 Bibliography......Page 335 Osseointegrated Interface......Page 337 Implant Design......Page 338 Implant Surface......Page 340 Host Bed......Page 341 Surgical Technique......Page 342 Bibliography......Page 343 General Overdenture Treatment Considerations......Page 344 Presurgical Evaluation and Treatment Planning......Page 345 Surgical Protocol and the Osseointegration Phase......Page 348 Guidelines for Selecting Attachment Systems......Page 349 Clinical and Laboratory Procedures......Page 350 Maintenance......Page 352 Bibliography......Page 353 Patient Selection......Page 354 Step-by-Step Procedures......Page 356 The Edentulous Maxilla......Page 359 Summary......Page 362 References......Page 363 Anatomic and Physiologic Considerations: Normal Function......Page 365 Functional Deficits of Speech and Swallowing......Page 366 Border Molding The Velopharyngeal Area: Patient Movements......Page 367 Border Molding Peripheries of Maxillary Resections and Hard Palate Defects: Patient Movements......Page 368 Immediate Surgical Obturator Prosthesis......Page 369 Interim Obturator Prosthesis......Page 370 Definitive Obturator Prosthesis......Page 372 Lack of Retention......Page 374 Nasal Reflux......Page 375 Soft Palate Obturator Prosthesis......Page 376 Informing The Patient......Page 379 Marginal Mandibulectomy Prostheses......Page 380 Discontinuity Mandibulectomy Prostheses......Page 381 Maxillofacial Implant-Assisted Prostheses For The Edentulous Patient......Page 383 Risks and Benefits Assessment of Implants In Irradiated Tissues......Page 384 Hyperbaric Oxygen Therapy......Page 386 Timing of Denture Placement......Page 387 Bibliography......Page 388 Problems......Page 390 At Stage I Surgery......Page 391 Interval Between Stage I and Stage II......Page 393 Abutment Related......Page 394 Impression Related......Page 395 Implant-Supported Fixed Prosthesis......Page 396 Mechanical/Prosthodontic Complications......Page 397 Bibliography......Page 399 21 Immediately Loaded Complete Dental Prostheses......Page 401 Immediate Load Complete Denture Technique......Page 403 References......Page 407 Systemic Health and Host Bone Response......Page 409 Smoking......Page 412 Osteoporosis......Page 413 Bisphosphonate Therapy......Page 414 Imaging Protocol......Page 415 Bone Quality......Page 416 Prosthodontic Loading......Page 417 Oral Ecological Concerns......Page 420 Summary......Page 421 Bibliography......Page 422 23 The Impact of Socioeconomic, Cultural, and Technological Changes and the Notion of Standards of Care and Alternative Protocols......Page 423 An “Appropriatech” Method For Complete Dentures In Four Clinical Sessions......Page 424 Impressions......Page 425 Recording the Horizontal Jaw Relationship......Page 426 Reproducing Complete Dentures......Page 430 First Clinical Session......Page 431 First Laboratory Session......Page 432 References......Page 433 Bibliography......Page 434 A......Page 435 B......Page 437 C......Page 438 D......Page 440 E......Page 443 F......Page 444 G......Page 445 H......Page 446 I......Page 447 L......Page 449 M......Page 450 O......Page 454 P......Page 456 R......Page 459 S......Page 461 T......Page 463 V......Page 465 Z......Page 466 Covering the functional and esthetic needs of edentulous patients, Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses, 13th Edition helps you provide complete dentures, with and without dental implant support. It addresses both the behavioral and clinical aspects of diagnosis and treatment and covers treatment modalities including osseointegration, overdentures, implant-supported fixed prosthesis, and the current and future directions of implant prosthodontics. New to this edition are full-color photographs and coverage of immediately loaded complete dental prostheses. From lead editor and respected educator George Zarb, Prosthodontic Treatment for Edentulous Patients provides an atlas of clinical procedures and emphasizes the importance of evidence-based treatment. Short, easy-to-read chapters cover the essentials of care for both short- and long-term patients, stressing the importance of evidence-based treatment. Expanded coverage of implant prosthodontics addresses the clinical protocols for implant-retained and implant-supported prosthodontic management. Specific chapters address the three surfaces of the complete denture: (1) an impression or intaglio surface, (2) a polished surface, and (3) an occlusal surface, the integration of which is crucial to creating a stable, functional, and esthetic result. Chapter on health and nutrition examines a number of systemic conditions (vesciculoerosive conditions, systemic lupus erythematosus, burning mouth syndrome, salivary dysfunction, Sjögren's syndrome, hyper/hyposalivation, diabetes) that affect the oral cavity and specifically influence the prognosis for wearing complete dentures or for accepting osseointegrated prostheses. Chapter on the time-dependent changes which occur in the oral cavity focuses on both time-related direct (ulcer/cheek biting, irritation hyperplasia, denture stomatitis, flabby ridge and pendulous maxillary tuberosities, hyperkeratosis and oral cancer, residual ridge reduction) and indirect (atrophy of masticatory muscles, nutritional status and masticatory function, control of sequelae) changes in the oral environment, and provides strategies to minimize the risk of such changes. Chapter on the techniques used to prolong the life of complete dentures focuses on the two techniques used to extend the life of dentures: relining and rebasing, also touching on denture duplication. Well-respected editors and contributors are the leaders in their field, lending credibility and experience to each topic. Covering the functional and esthetic needs of edentulous patients,helps you provide complete dentures, with and without dental implant support. It addresses both the behavioral and clinical aspects of diagnosis and treatment and covers treatment modalities including osseointegration, overdentures, implant-supported fixed prosthesis, and the current and future directions of implant prosthodontics. New to this edition are full-color photographs and coverage of immediately loaded complete dental prostheses. From lead editor and respected educator George Zarb,provides an atlas of clinical procedures and emphasizes the importance of evidence-based treatment.**Short, easy-to-read chapters****Expanded coverage of implant prosthodontics****Specific chapters address the three surfaces of the complete denture****Chapter on health and nutrition****Chapter on the time-dependent changes which occur in the oral cavity****Chapter on the techniques used to prolong the life of complete dentures****Well-respected editors and contributors****NEW! Over 800 full-color photos and illustrations****NEW__Immediately Loaded Complete Dental Prostheses__chapter****NEW__The Impact of Socioeconomic, Cultural and Technological Changes and the Notion of Standards of Care and Alternative Protocols__chapter****Completely revised__Materials Used in the Management of Edentulous Patients__chapter**