Analysis Of Complete Denture Cases Report For Severely Resorbed Edentulous Alveolar Ridge

Objective: To provide edentulous patients especially with severely resorbed alveolar ridge a better prosthodontic therapy procedure,and further to improve the masticatory efficiency and to restore the function of the stomatognathic system,through the application of secondary impression and window tray technique,lingualized occlusion and secondary occlusal adjustment with semi-adjustable articulator.Methods: The five edentulous patients(male1,female 4,age from 67 to 83,average age 75.6)were obtained from XXX Stomatological Hospital affiliated to XXX,from October 2014 to October 2015.All 5 cases are edentulous patients with severely resorbed alveolar ridge,(According to the classification method of Atwood and Cawood,their alveolar ridges level is the third or fourth grade,whose height and width were seriously absorbed,even below the base bone).Among them,2 cases are flabby alveolar ridge and 3 cases have the symptom of habituation mandibular advancement or chin tremor.All patients demand treatment as their old denture used by them for many years were not suitable.All of them can better cooperate with the treatment,have no systemic disease,and with good mental condition.In some cases,we particularly applied secondary impression and open tray technique,artificial teeth arrangement of lingualized occlusion and secondary occlusal adjustment with semi-adjustable articulator to make complete denture,and observed the outcomes.Firstly,we communicated with patients positively before the treatment,and got their subjective requirements,history of past illness,physiology and psychology conditions.After that,we made a rigorous examination as follows: 1.The routine examination of the oral cavity,especially to check whether there is abnormal alveolar ridge,to assess the degree of absorption of the alveolar ridge,to determine the elasticity of oral mucosa and the situation of intraoral soft tissue,and to understand the relationship between the function of stomatognathic system and occlusion.2.The examination of the face type of maxillofacial region.3.The examination of the temporomandibular joint disorders,such as pain,snapping and difficulty in opening mouth.4.The observation of the wear and breakage of the old denture.At last,we made the treatment plan for the patients according to the clinical examination information.Firstly,the combined impression was applied in the treatment.We made the primary impression with the appropriate size of the edentulous tray,red paste and alginate materials.Then we casted in plaster model and made the custom impression tray by light-cure materials and preliminary cast.After polishing,we put the custom impression tray into patient's mouth and eliminated redundant edges.We made the final impression with polyether rubber and casted in super hard gypsum into it to get the master cast.In order to determine the vertical dimension and horizontal jaw relation,we made the temporary base-plate by the light-cure materials and master cast.Finally,we transferred jaw relationship to semi-adjustable articulator with face-bow,arranged artificial teeth and tried the wax-up denture.After a week of wearing the denture,we asked the patients to subsequent visits and made the occlusal adjustment.Among them,the alveolar ridges of cases 1 and 5 are type IV with flabby alveolar ridge.Also,they had symptom of habituation mandibular advancement and chin tremor.Considering about their conditions,we applied secondary impression and open tray technique,secondary occlusion adjustment with semi-adjustable articulator in treatment to avoid the master cast distortion caused by the pressure of the impression material exerting to flabby alveolar ridge.In order to enhance the retention and stability of complete denture,all cases were selected artificial teeth arrangement of lingualized occlusion.Results: All cases of patients were satisfied with their complete denture.After one week,5 patients felt pains and the case 2 got ulcer.But the effect of the denture has already been significantly improved after 2 times of occlusion adjustment.After 1-3 weeks of denture wearing,the pronunciation,chewing function and facial appearance of all cases were well restored.Moreover,the retention of denture improved significantly.Denture base is closely fitting with oral mucosa and the balanced occlusion is achieved.Conclusion: For complex edentulous patients(such as,severely resorbed alveolar ridge,flabby alveolar ridge,symptom of habituation mandibular advancement,chin tremor,etc),the treatment of complete denture is very difficult.As the flabby alveolar ridge and oral mucosa are shaking and soft,and the stability of muscle function is low,we have difficulty in getting the accurate cast,the favorable retention and precise occlusal adjustment.For this kind of patients,we suggest that the application of secondary impression and open tray technique,artificial teeth arrangement of lingualized occlusion and secondary occlusal adjustment with semi-adjustable articulator could effectively enhance the retention and stability of complete dentures.