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patmo141
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Hi DLN'ers,
Long time no see. I've been super busy with school and the like, and I'm out in Keene, NH working at a clinic on rotation. I was wondering if I could get anyone to scan some models for me and return the .stl files (and the models). Ill pay for shipping. The short story is that I have some partial impressions which I need to merge, conventional full arch elastomeric impressions of this patient are impossible. At this point they are just for diagnostic purposes but could be used later for surgical guide or prosthesis fabrication...for now...just for getting an idea and for proof of concept. Long story below, open for discussion, ideas, feedback and criticisms as well. PM me if willing to scan some models for me so we can work out $$, shipping etc.
-Patrick
Pt Presents edentulous, Mom is interested in having dentures made for him so he can have some teeth to work with.
Pt Info: Approx 50 years old, and has down syndrome. He's totally comfortable in the chair, compliant and tolerates intra-oral work well. Finances not a huge concern (although fully fixed implant supported prosthesis is out of the question). We've been very clear about expectations, whether or not pt will be able to wear/tolerate any prostheses at all, implant supported options, the whole gamut. We've also discussed exit strategies if pt/guardian decides the time/effort/$$ are not worth the outcome. Right now, the plan is to see if he can tolerate/wear an upper, then, see if we can tackle the mandible (see below). Obviously, we don't want to leave a maxilary denture hanging in space, so we will design the upper with the eventual lower occlusal scheme in mind...the problem is deciding what that's going to be.
Findings: The palate is very small (photos later) and the mandibular arch is medium sized. I'm expecting class III and posterior cross bite. The tongue is VERY LARGE and has a very strong reflex. When I go in with anything...boom, the tongue is pushing on it. Patient will eventually relax it, but it makes a mandibular impression impossible. The tongue sweeps all material out of tray, or prevents tray from seating in any way that doesn't destroy the impression. (Hmm...how are we going to restore this?). Working on the maxilla is a dream, he just over-seated my final impression with (very)firm upward tongue pressure so I've got showthrough to the ruggae in my final (That's what PIP will be fore). He tolerated prelims, border molding, custom tray adjustment, light body wash etc on the upper no problem.
What I did for the lower: I took some disposable trays, and sectioned them into 2/3 trays hoping to get each side, and then make a jig (plaster index) with the overlaping sections so I could make a kind of altered cast type thing. OR, since it's 2012, scan them and register them together digitally. I displaced the tongue with one hand and cheek with the other so we could see the ridge on one side, let him relax, then had the assistant slide in the tray over my fingers so it would go past the tongue and seat. It worked fairly well. Unfortunately, I didn't get a whole lot of overlap in the information in the anterior, but for a first try, it went well enough that I think I could make some custom trays and make a sectioned final impression this way. For now, I need a rough diagnostic model of the lower to just visualize what our plan is for the top. I will need to take an anterior 2/3 impression later to get a better overlap/registration, but I think I have just a few reference points right now where I can hook these two models together roughly in 3d using picked points.
any takers?
Long time no see. I've been super busy with school and the like, and I'm out in Keene, NH working at a clinic on rotation. I was wondering if I could get anyone to scan some models for me and return the .stl files (and the models). Ill pay for shipping. The short story is that I have some partial impressions which I need to merge, conventional full arch elastomeric impressions of this patient are impossible. At this point they are just for diagnostic purposes but could be used later for surgical guide or prosthesis fabrication...for now...just for getting an idea and for proof of concept. Long story below, open for discussion, ideas, feedback and criticisms as well. PM me if willing to scan some models for me so we can work out $$, shipping etc.
-Patrick
Pt Presents edentulous, Mom is interested in having dentures made for him so he can have some teeth to work with.
Pt Info: Approx 50 years old, and has down syndrome. He's totally comfortable in the chair, compliant and tolerates intra-oral work well. Finances not a huge concern (although fully fixed implant supported prosthesis is out of the question). We've been very clear about expectations, whether or not pt will be able to wear/tolerate any prostheses at all, implant supported options, the whole gamut. We've also discussed exit strategies if pt/guardian decides the time/effort/$$ are not worth the outcome. Right now, the plan is to see if he can tolerate/wear an upper, then, see if we can tackle the mandible (see below). Obviously, we don't want to leave a maxilary denture hanging in space, so we will design the upper with the eventual lower occlusal scheme in mind...the problem is deciding what that's going to be.
Findings: The palate is very small (photos later) and the mandibular arch is medium sized. I'm expecting class III and posterior cross bite. The tongue is VERY LARGE and has a very strong reflex. When I go in with anything...boom, the tongue is pushing on it. Patient will eventually relax it, but it makes a mandibular impression impossible. The tongue sweeps all material out of tray, or prevents tray from seating in any way that doesn't destroy the impression. (Hmm...how are we going to restore this?). Working on the maxilla is a dream, he just over-seated my final impression with (very)firm upward tongue pressure so I've got showthrough to the ruggae in my final (That's what PIP will be fore). He tolerated prelims, border molding, custom tray adjustment, light body wash etc on the upper no problem.
What I did for the lower: I took some disposable trays, and sectioned them into 2/3 trays hoping to get each side, and then make a jig (plaster index) with the overlaping sections so I could make a kind of altered cast type thing. OR, since it's 2012, scan them and register them together digitally. I displaced the tongue with one hand and cheek with the other so we could see the ridge on one side, let him relax, then had the assistant slide in the tray over my fingers so it would go past the tongue and seat. It worked fairly well. Unfortunately, I didn't get a whole lot of overlap in the information in the anterior, but for a first try, it went well enough that I think I could make some custom trays and make a sectioned final impression this way. For now, I need a rough diagnostic model of the lower to just visualize what our plan is for the top. I will need to take an anterior 2/3 impression later to get a better overlap/registration, but I think I have just a few reference points right now where I can hook these two models together roughly in 3d using picked points.
any takers?
