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Follow Bob: Impressions, record keeping crucial in treatment

July 14, 2014

By Kimber Solana

 Follow Bob logo
Editors note: This is the second in a unique series of ADA News articles following a patient's full-mouth reconstruction from A to Z. Installments will appear as treatment milestones are reached.

Robert "Bob" Hartman knew his teeth were worn down and broken — but it was something else when he saw a detailed model of his mouth and teeth.

"When I saw the final impression I was rather embarrassed to see what I had lived with for a long portion of my life," Bob said. "You just don't realize how bad they looked. No wonder I was afraid to smile."

Due to decay and bone loss from lack of proper care over the years, combined with a deteriorating tooth structure, the 62-year-old is in need of a full-mouth restoration. His jaw has also moved forward affecting his bite and the way he eats.

Led by Dr. Joseph Massad, of Tulsa, Oklahoma, and co-treated by Dr. David Little, of San Antonio, Bob will have immediate maxillary and mandibular dentures placed, with extractions of all of his teeth, appropriate bone reduction and placement of prosthesis.

It will not only ultimately correct his dental problems but also educate ADA members on the assessment and treatment of patients who need such an extensive treatment plan. Bob's case will be part of a continuing education online series where ADA members are able follow his treatment — from diagnosis to surgery — through courses to be posted on ADA CE Online.

image of Bob's impression
Colorful impressions: Bob's impressions were made of polyvinyl siloxane impression material and by utilizing a special technique for accuracy. The impressions were done to make a determination of the pressures that affect the outer surface of any prosthesis.
The process is expected to take about 18 months, culminating in a three-hour Education in the Round course at the ADA 2015 — America's Dental Meeting in Washington, D.C., by Dr. Massad.

As part of the process, Bob returned to Dr. Massad's office three weeks after his January examinations to begin impressions and record making—a crucial part in Bob's overall treatment.

 "It was extremely important that accurate impressions of both the teeth and the tissues, including the functional areas of all borders, be extremely accurate," Dr. Massad said. The creation of the prosthesis would be utilized in the implant placements. The impressions were made of polyvinyl siloxane impression material, utilizing a special technique for accuracy.
 
"The purpose for this procedure was to be assured that the new prosthesis would fit functionally within the confines of the facial oral cavity and reflect the muscles of facial expression and mastication, which would be in intimate contact with the prosthetic," Dr. Massad said. "This prosthetic will become the guideline for implant placement."

In addition, Dr. Massad said he "made vertical and horizontal records defining the patient's appropriate spacing and philological repeatable relationship."

Cameo impressions were also made of the surfaces between the cheeks and the labial/buccal surfaces of the teeth and tissues to determine whether or not the pressures in that area would allow repositioning in any of the teeth and tissue areas.

"This procedure is done in all cases to make a determination of the pressures that affect the outer surface of any prosthesis," Dr. Massad said. "Several different replicas of teeth were tried over the patient's existing teeth in order for the patient to visualize and have the choice of whether the teeth should be longer or shorter and determine the best midline position."

Once the prosthesis was completely fabricated, it was sent to Dr. Little to have the surgical guides made so that the teeth could be extracted, and any necessary bone trimming would be performed prior to implant placement.

"Dr. Massad showed me my palate, my tongue, etc., and how everything fit together," Bob said of his record-making appointment. "It was really quite amazing."

These initial visits are featured in the first CE online session at ADACEonline.org. To view the first online course, search for the session titled "Treatment of a Failing Dentition with Prosthetic Driven Implant Considerations. A 4 Part Series Part 1: Diagnosis and Prognosis of a Failing Dentition."