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Application of the Neutral Zone in Prosthodontics

Massad, Joseph J. / Cagna, David R. / Goodacre, Charles J. / Wicks, Russell A. / Ahuja, Swati A.

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1. Auflage August 2017
176 Seiten, Hardcover
Wiley & Sons Ltd

ISBN: 978-1-119-15814-1
John Wiley & Sons

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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

Foreword ix

Preface xiii

1 Assessment of Edentulous Patients 1

Introduction 1

The Patient Interview 1

Patient Interview: Age 2

Patient Interview: Attitude 2

Patient Interview: Expectations 2

Patient Interview: Chief Complaint 3

Patient Interview: General Health 3

Patient Interview: Complete Denture Experience 3

Patient Interview: Denture Remake Frequency 4

Patient Interview: Patient Satisfaction 4

Patient Interview: Photographs, Diagnostic Casts, and Radiographs 4

The Facial Analysis 4

Facial Analysis: Facial Tissue Tone 5

Facial Analysis: Tooth and Gingival Display 6

Facial Analysis: Midlines 6

Facial Analysis: Lip Mobility 7

Facial Analysis: Lip Dimension 7

Prosthetic Factors 8

Prosthetic Factors: Vertical Dimensions 8

Prosthetic Factors: Existing Dentures 8

Prosthetic Factor: Skeletal Relationship 9

Prosthetic Factor: Saliva 9

Prosthetic Factor: Oral Tolerance 10

Prosthetic Factor: Temporomandibular Joints 10

Prosthetic Factor: Oral Cancer Review 10

Oral Characteristics 11

Oral Characteristics: Palatal Throat Form 11

Oral Characteristics: Arch Size 11

Oral Characteristics: Maxillary Ridge Height 11

Oral Characteristics: The Palate 12

Oral Characteristics: Maxillary Ridge Contour 13

Oral Characteristics: The Maxillary Denture Foundation 13

Oral Characteristics: Mandibular Ridge Height 14

Oral Characteristics: Mandibular Ridge Contour 14

Oral Characteristics: Mandibular Muscle Attachments 14

Oral Characteristics: Mandibular Denture Foundation 15

Oral Characteristics: Maxillary Tuberosity Curve 15

Oral Characteristics: Vestibule 16

Oral Characteristics: Frenula Attachments 16

Oral Characteristics: Pterygomandibular Raphe 16

Oral Characteristics: Denture Bearing Soft Tissues 16

Oral Characteristics: Retromolar Pads 17

Oral Characteristics: Maxillary Ridge Crest to Resting Lip Length (Esthetic Space) 17

Oral Characteristics: Mandibular Ridge Crest to Resting Lip Length (Esthetic Space) 17

Oral Characteristics: Maximal Oral Opening 17

Oral Characteristics: Retromylohyoid Space 18

Oral Characteristics: Tongue Size 19

Oral Characteristics: Tongue Position 19

Oral Characteristics: The Neutral Zone 20

Summary 21

References­ 21

2 Orthopedic Resolution of Mandibular Posture 25

Introduction 25

Conditioning Abused Tissues and Stabilizing the Existing Prosthesis 26

Materials Properties and Technique 26

Technique 26

Re?]establishing Orthopedic Mandibular Position 28

Summary 33

References 33

3 Definitive Impressions 35

Preimpression Considerations 35

Background 35

Impression Fundamentals 35

Impression Materials 36

Edentulous Impression Trays 37

Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures 37

Tray Selection and Tray Adaptation 37

Fabrication of Tray Stops 38

Border Molding the Impression Tray 39

Final (Definitive) Impression 41

Techniques for Making Single Appointment Definitive Impressions for Implant?]Assisted Complete Dentures and Immediate Dentures 43

Attachment Selection 43

Implant?]Retained Overdentures 43

Tray Selection 43

Impression Technique 44

Implant?]Retained and Supported Overdentures 45

Immediate Dentures 46

Master Cast Production 47

Summary 48

References 48

4 Fabricating Trial Denture Bases, Occlusal Rims, and Mounting a Central Bearing Device 51

Introduction 51

Fabrication of Trial Denture Base and Occlusal Rims 51

Fabrication of Maxillary Wax Occlusal Rim 52

Fabrication of Neutral Zone Mandibular Occlusal Rim 56

Technique 56

Jaw Recorder Device (Central Bearing Device) 59

Jaw Recorder Device Assembly 59

Mounting the Jaw Recorder Device on Trial Denture Bases 59

Mounting of the Jaw Recorder for Implant Overdentures 61

Mounting the Jaw Recorder Device on Partially Edentulous Arches 61

Procedure 62

Summary 62

References 64

5 Developing an Esthetic Blueprint 65

Introduction 65

Contouring and Shaping the Maxillary Occlusal Rim 65

Summary 72

References 72

6 Registering the Maxillo?]Mandibular Jaw Relationship 75

Introduction 75

Face?-Bow Recording 75

Centric Relation Recording for the Edentulous Patient 76

Centric Relation Recording for the Partially Dentate Patient 83

Summary 86

References 86

7 Neutral?-Zone Registration 89

Introduction 89

Recording the Physiologic Neutral Zone for Edentulous Patients 89

Technique 90

Recording the Physiologic Neutral Zone for a Dentate Patient 93

Technique 93

Summary 95

References 95

8 Second Laboratory Procedure: Selection and Arrangement of Prosthetic Teeth 97

Introduction 97

Indexing the Esthetic Blueprint Record 97

Indexing the Neutral?]Zone Record 98

Selection of Anterior Teeth 99

Maxillary Anterior Teeth Arrangement 100

Mandibular Anterior Teeth Arrangement 101

Selection of Posterior Teeth 103

Mandibular Posterior Teeth Arrangement 104

Maxillary Posterior Teeth Arrangement 106

Teeth Selection and Arrangement for the Partially Dentate Patient 107

Summary 109

References 109

9 Wax Try?]In Appointment 111

Wax Try?-In 111

Evaluation of Esthetics 111

Evaluation of Phonetics 112

Evaluation of Occlusal Vertical Dimension (OVD) 114

Evaluation of Centric Contact Position 115

External Impressions 116

Technique 117

Summary 121

References 123

10 Denture Placement 125

Introduction 125

Evaluation and Adjustment of Intaglio Surface 127

Technique 127

Evaluation and Adjustment of Denture Borders 129

Evaluating the Cameo Surface 131

Occlusal Evaluation and Correction 131

Subtractive Correction Technique 133

Additive Correction Technique 134

Patient Education and Instructions 135

Technique for Adhesive Application 136

Technique for Adhesive Removal 136

Home Care Instructions for Denture Patients 138

Postplacement Problems with New Dentures 138

Retention Problems 138

Soreness 139

Sore Throat 139

Speech Problems 139

Gagging 139

Summary 140

References 140

11 Use of CAD/CAM Technology for Recording and Fabricating Neutral?-Zone Dentures 143

Introduction 143

Registering the Neutral Zone during Impression Making 143

Technique 143

Registering the Neutral Zone during Maxillo?-Mandibular Records 145

Technique 145

Registering the Neutral Zone during the Wax Try?-In 145

Technique 145

Summary 148

References 149

Index 000
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

J. J. Massad, University of Tennessee Health Center School of Dentistry, Memphis, Tennessee, USA; Tufts University School of Dental Me