How Would You Handle This Immediate?

[Brian]

I will be meeting with the doctor this Thursday to discuss this immediate maxillary.. I have had some pretty rough stuff come across my bench lately, but this one looks a little challenging to say the least.

My question is how would you manage this area? I have one idea in mind is let the oral surgeon handle this when he does the extractions.. I have no idea what kind of tissue this is, ( soft or a hard growth )

 

[Kreyer]

Brian,

What is interesting everyone I talk with is currently seeing more and more immediate conventional dentures. Sign of the times..

Regarding your case hard or soft it has to go......

You will have to trim the buccal on both sides to create a stable base.
This patient will have substantial resorption and tissue conditioning for a month after extractions.....Is that bridge supported by only the first premolars with six pontics?

 

[Brian]

Brian,

What is interesting everyone I talk with is currently seeing more and more immediate conventional dentures. Sign of the times..

Regarding your case hard or soft it has to go......

You will have to trim the buccal on both sides to create a stable base.
This patient will have substantial resorption and tissue conditioning for a month after extractions.....Is that bridge supported by only the first premolars with six pontics?

I guess I can offer the surgeon for him to trim the cast process and make stent from the denture.. And yes only the premolars and not much longer...

 

[kcdt]

That tissue is soft. Used to see that kind of hyperplasia in patients taking medications (especially the old anti-epileptic) combined with poor hygiene.
Patient could also be diabetic....

 

[JohnWilson]

This is a nasty case.

Of course the Surgeon has his work cut out for him/her.

Your job is considerably easier.

Big white knock down wheel
Course carbide
320 sandpaper
Putty duplicate
1.50 clear surgical stent vac formed suck down

Bet you can make a ridge that looks pretty decent

We started using sandpaper to refine smooth the cast and its amazing how much nicer the separator works. Even on that weird stone that always seems to stick no matter how perfect your technique is.

 

[CShof]

Could you post some pictures of this model after you get done trimming? I'm interested to see how it turns out and it'll give me some reference photos just in case I ever run into something looking like that. Thanks.

 

[CYNOSURER]

Nice tip, John, on the sandpaper.

I have a doc who likes his surgical stents out of 0.20 clear vacuum formed.

My personal preference is to make a clear AED. Funtions as a surgical stent now and a custom tray/bite later. Of course it cost a bit more but can save a lot of steps (appointments and chairtime) down the road. So it should be a money saver...still hard to sell for some reason.

 

[Brian]

That tissue is soft. Used to see that kind of hyperplasia in patients taking medications (especially the old anti-epileptic) combined with poor hygiene.
Patient could also be diabetic....

I did not know that...

I use the 200 wet dry sand paper on everything... Great stuff leaves the sides off the cast nice and smooth, use it when you mount as well.. Easy on the hands and leaves a nice finish.. I, like Timmy use .020 My default on every immediate is to make a stent from the processed denture..

CShof, I will post some after photos, hell I'll even document the case from start to finish.. The teeth I have selected are the Preference from Candulor..

 

[kcdt]

Nice tip, John, on the sandpaper.

I have a doc who likes his surgical stents out of 0.20 clear vacuum formed.

My personal preference is to make a clear AED. Funtions as a surgical stent now and a custom tray/bite later. Of course it cost a bit more but can save a lot of steps (appointments and chairtime) down the road. So it should be a money saver...still hard to sell for some reason.

That's a great solution Tim. Probably a hard sell because trying to get some folks to see you're doing them a good service is like, well, pulling teeth.

 

[Brian]

Met with the OS...




Trim / shape cast

 

[Brian]

Set up..

 

[Brian]

Wax up...





I'll finish up Monday and process...

 

[hydent]

Thanks for sharing Brian it would be cool to be chairside to see how it all turns out, how much adjusting etc.

 

[hydent]

It would also be interesting to see what the ridge and tissue looks like after healing.

 

[Brian]

The healing part I can schedule and photograph... I will have zero time for the other.. Pt. will have surgery Tues. morn @ 8am and will be a lengthy one at that...

 

[Brian]

Post Op,,

 

[hydent]

nice job!

 

[TheLabGuy]

Wow.........
Great Job and thanks a bunch for sharing it with us all.

 

[kcdt]

Brian, I gotta say- you do a real nice job with the way your smile line follows the lip contour! Looks like a million bucks.

 

[JohnWilson]

Brian you hit a home run nice job!

Thank goodness you had the natural teeth to use as a guide to get the smile line as bang up perfect as it came out.

Neat to see the post op pics of the ridge as well.

Hi 5 buddy!!!