Clinical Case Presentation OneRoss Chapman

Student Number: 20579504

Background89 yr old MalePresenting Complaint

Poorly fitting F/F denturesPoor retention on upper dentureStruggling to eat comfortably

History of presenting complaintCurrent dentures 10+ yrs oldHas had various new dentures made but not

toleratedDental History

Denture wearer 50+ yrsRegular attendee at this practice

BackgroundMedical history

Previous heart attack 20+ yrs agoPace maker fittedPatient quite unsteady on feetHigh blood pressure

Medication: BendroflumethiazideAsprin

BackgroundSocial history

Tea total and non smoker (quit smoking 25+ years)

Widower and lives alone with daily family contact

Active patient considering age and health

BackgroundFamily history

No history of dental diseaseFamily history of heart problems

Current OH regimeCleans mouth and dentures twice daily with

soft brushSoaks denture in cleaning solution weeklyDentures in good condition for age yet worn

Extra-Oral ExaminationNo facial asymmetry Nil pain in trismus No palpable lymph nodesLips and soft tissue all competentTMJ – NAD

Nil clicking, pain, normal opening, deviationSkeletal class I

Chart

Key: = Acrylic Denture

Intra-oral ExaminationSoft tissues

Lips – Nothing abnormal detected (NAD), Competent lips, medium lip line

Tongue – NADFloor of Mouth – NADBuccal Mucosa – NADParotid Secretion - NADPalate - NAD

Intra-oral ExaminationUpper and lower arches

Gross resorption on upper ridge with flabby anterior residual alveolar process

Gross resorption on lower residual alveolar process leaving very flat ridge

Existing dentureF/F very looseF/- dropping on patient opening-F rotates in mouth with no lateral retentionReduced OVD through wearX bite on LHS

Initial Photographs

Diagnosis/Treatment PlanDiagnosis

No retention on upper dentureVery ill fitting lower denturePatient quite old and unable to tolerate major

changeReduced OVD

Treatment planMake new Full/Full dentures using copy techniqueImprove fit in all areasIncrease OVD to restore wear (no more than 2mm)Add soft lining on lower to aid comfort

Possible referralPatient has had many set made in previous

years, informed if this set is still not able to meet expectations we may refer to dental hospital for specialist treatment. Patient happy to have one last go before referral

Patient referred into myself internally as routine for prosthetics cases

Appointment 1Consent for examination taken

Consultation – C/O, History of complaint

MH, DH, SH checked as taken by referring GDP

Exam E/O & I/O

Consent to dental photographs given

Appointment 2Current F/F dentures copied using stock trays and

“Sheradup” 50/50 duplication putty

Appointment 2Current F/F dentures copied using stock trays and

“Sheradup” 50/50 duplication putty

Appointment 3Wash impressions and moose bite registration taken

Appointment 3Wash impressions and moose bite registration taken

Appointment 4 Try-in ready

Appointment 4 Try-in StageDelphic V teeth used for set up at laboratory

OVD opened on articulator by 2mm to restore worn teeth

Bite checked and adjusted chair side for high spots

Upper try in not as retentive as expected. Light bodied silicone wash taken to improve.

Patient happy with feel and aesthetics of denture

Appointment 5Denture fit StageUpper denture retention good at rest yet still

dropping when patient opens wide

No adjustment required to lower denture

No adjustment needed to bite

Patient happy to wear for 1/52 to see if upper retention improves when bedded in

Appointment 6Review Stage

1 weeks post insertion review

Patient feels upper retention not adequate, still dropping on opening and unable to eat.

Denture dropping causing sore lower ridge as interfering with bite

Reline imp taken on upper to improve retention

Appointment 7Review Stage

Assessed fit of relined upper still not happy so have decided to remake upper denture

S/T and bite made from existing upper

Secondary imp and bite against existing lower at N/V

Appointment 8Review Stage

Secondary impression taken in window tray to allow for flabby anterior ridge

Bite registration rim recorded

Existing lower denture fine

Appointment 9Review Stage

New F/- retention greatly improved. Patient can fully open and close with no dropping

Slight inter-cuspal interference so blue moose taken between upper and lower for adjustment prior to finish

Appointment 10Review Stage

F/F fitted good retention on upper

Slight adjustment to bite and pain on lower RHS

R/V in 2 weeks

Appointment 11Review Stage

2 week review

Patient only wore denture for 2 days as painful on lower

Upper retention good and now not a problem

Decided to double the thickness of soft lining as patient unable to tolerate new bite and increased OVD

Appointment 12Review Stage

-F rebase try in with 5 mm thick spacer for extra soft lining

Bite and fit good. Patient able to open and close returning to bite every time.

Patient happy to proceed to fit

Appointment 13Review Stage

F/F with extra thick soft lining fitted

Minor adjustment to buccal extension on RHS

Patient happy with fit of dentures

R/V in 1 week

Appointment 14Review Stage

R/V 1 week post insertion

Patient able to eat pain free

F/- retentive on function

Patient very happy

TCA if problems arise ! Phew

Post treatment photographs

Maintenance/RecallPatient given instruction on cleaning the

denture and maintaining the soft lining without damaging the soft material

Patient to continue annual check up at practice

Told TCA if any problems occurTreatment complete

ReflectionCase started off as a simple copy and

morphed into really complex case In hindsight should have insisted that we

made new dentures from scratch at the beginning of treatment course and not used copy technique to appease the patient

Patient was a pleasure to work with and understood problems we were having however a less amiable patient may have been frustrated by amount of appointments

ReflectionNot a problem when working as a student

but this case would have financially cost the practice when taking into account repeated clinic visits and laboratory expenditure.

On reflection some basic mistakes were made during this treatment plan, however my mentor insists these are the cases you learn and take the most from.