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    Dry Mouth impressions

    Discussion in 'Denturist' started by denturist-student, Jan 21, 2017.

    1. denturist-student

      denturist-student Active Member Full Member

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      I am having a difficult time with an elderly lady with very dry mouth. I get great repeatable suction when I reline the denture but then when I insert there is no suction at all....Perhaps impression material viscosity, poor flow, or processing errors...
       
    2. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Out there a bit, but...
      Postsurgically many patients are not allowed to eat or even drink anything whatsoever in case they have complication requireing going back inside surgically. They want no chance of aspiration, etc. under anesthesia.
      Insead of drinking, there are spongelike lollipop things that they are allowed to use to keep their mouth, lips, and tounges moist.
      Perhaps using one of these prior to impressing would provide the impression material the envionment and situation more akin to that for which they are formulated, designed and expected to encounter. The impression materials, like anything else, have an operating envelope of expected variables providing increasing and decreasing efficacy within that design range. and this patients oral environment may be just on the outside edge and providing a close, but ultimately ineffiecient, improper or incomplete result.

      I have sent a message to a hospital friend and will have the object's name for you Monday if you would like. As it is not a medicant, soley a moisture applicator, it should be available for use by non-MD directed personnel.
       
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    3. JMN
      Curious

      JMN Christian Member Donator Full Member

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      They are called Glycerine Swabs, and do not require a MD's order to use or possess in Virginia.
       
    4. JMN
      Curious

      JMN Christian Member Donator Full Member

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      One other possiblity. I was involved with a case once with a fairly straightforward F/ that at delivery would not pull suction. As soon as the patient opened, the denture fell. Solution? Remove the postdam. Happy as a clam.

      Still wonder why that worked, but my guess is the tissue wasn't resilient enough to accept the deformation. And with an exteame dry mouth your patient's tissue may have the same issue.
       
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    5. PDLtd

      PDLtd Member Full Member

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      Sexual lubricant. Make sure it isn't the self warming type etc, and is water based and obviously it is safe for oral application. Well you know why haha. Banana flavour works best! Nah just joking, use non flavoured - unless the patient wants it. Who knows they might have a preferred brand lol


      Sent from my iPhone using Tapatalk
       
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    6. denturist-student

      denturist-student Active Member Full Member

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      I was thinking of just that. Something called play diluted down a bit.
       
    7. denturist-student

      denturist-student Active Member Full Member

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      When I make the impression whether it is a reline , silicone or even tissue conditioner, I am finding that it has suction when we make the impression however when we take it out and reinsert all suction is absent. Pretty certain it is due to the dry environment and viscosity of the impression materials. Not getting very good flow. When I do carve out the palate to achieve adequate flow, I can do the impression and have suction naturally while the impression is placed but when it is taken out and then even when I do a functional impression nothing seems to stay in place...Old dentures will have some suction and stay in place and have a higher post dam. I wanted to try a luckman dam but have not acheived adequate suction even on any impression to continue to processing...Once I placed a tempo tc and wanted to get some functonal impressions. Patient could eat apples and cookies at first but then when I went back two days later, they were loose...this is turning out quite frustrating both for me and the patient. Patient cannot tolerate long involved procedures. After two attempts to reline family is getting impatient. I have even proposed to try and replicate old denturebases but I am not certain that will work either....attaching photo of old denture base which patient says stays in place. Problem I have is that old denture seems to stay in place but new denture has no suction at all...has suction when impression material is not dislodged ie leave in place but then taking it out and reinsert has no suction all and falls out. Not really certain what is keeping old denture in place....tissues are very loose and lack any tone at all...My thinking is to just keep trying various viscosities until something works. May even try a dual viscosity impression using regular on borders and extra light intaglio. but I am certain that the dry mouth is a factor because most materials are slightly hydrophilic and are water resorptive...might try a non hydrophylic material but not sure which one would work. Currently using Elite light body wash with heavy border molding. That works well and stays in place post impression however post processing produces no suction at all.

      Tried Biotene rinse but that made things worse too slippery...and it stings patients mucosa....

      Wondering if a dilluted hyrdrocast might work. I have yet to try hydrocast but want to suspend until I find something that will work. Patient is not enjoying this at all because it hurts to handle her oral tissues. I have tried Tempo tc and Elite silicon pvs light body both as reline impressions....COEcomfort tc tried a third time but cannot maintain any suction post impression. Elite pvs works and stays in place but not post processing. palatal curtain is downward sloping. ridges slightly tapering.

      I recall Turbyfill uses a reline jig to place the hydrocast and I have also done this....but standard protocol is not like this...obviously this patient cannot be treated using standard protocols...Unlikely the patient will pay for Turbyfill protocol. Nor will she endure what it takes to complete the Turbyfill protocol.
      Thing is we sometimes are limited by insurance companies to standard protocols. Patient doesn't see difference in results. To them a denture is a denture is a denture...Luckilly now up here at least insurance companies will pay part of a higher level of protocol.
       

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    8. denturist-student

      denturist-student Active Member Full Member

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      would appreciate that...Thanks
       
    9. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Glycerine swabs, perhaps Oral glycerine swabs depending on coloquial nomenclature variants.
       
    10. highscore
      Hungover

      highscore Member Full Member

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      [​IMG]

      Stop messing about, take 20 minutes and reline it with Tokyama rebase. Nothing beats a direct fit with a really good material. Read directions and follow them to the letter. This stuff works. If it still falls out, then put some adhesive powder on the denture, wet it and insert. Sometimes the denture just needs to seat itself into the tissues. There is a ton of other things that may be effecting your final fit, but this is your answer.
       
    11. denturist-student

      denturist-student Active Member Full Member

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      Thanks but already tried that first time i wanted to insert...bunched up in the palate and in the residual ridge crest areas....but thanks...Actually this stuff works wonders on upper dentures. I have used this for chairside relines a lot...this seems to be a very specific case that comes around every ten or so years. so far have tried rebase II, tempo tc, light body silicon pvs (worked with the pvs but after processing did not have suction), and finally COEcomfort but they all seem to leave the denture with a thick palate because flow is not very good......I think I am going to copy original denture base and ensure that the teeth and all are in exactly same position....keeps falling down at the front....Maybe overextension but everything seems to jive with original denture base. If worse comes to worse I am going to just build a lower against existing upper and carve in some sort of compensating curve with a new lower....Thanks again for all of the advise.
       
    12. highscore
      Hungover

      highscore Member Full Member

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      You are making way too much work for yourself. Seriously. You shouldn't have to go through all of this misery dude. PVS is the worst impression material for final impressions on gingival tissue. It's great for dentition but for tissue duplication you're better off with a polyether material like Impregum F. In my 25 years of making dentures, PVS has always resulted in poor retention. It folds over, traps air. Many others will disaggree, but for completely edentulous mucosal duplication PVS is pure garbage. My suggestion is to chuck the current denture and start over. Use the previous denture to take the final in Impregum, pour up, trim and mount without seperating the denture from the casting. Make an occlusal matrix of the old denture using Zeta putty, and set up on that. Try in... yadda yadda... flask it.... pack it.... IMPORTANT: Let case stand for at least a half hour in the clamp before processing. Bench cool... then you know what to do after that. It's okay to chuck a case and start over once in a while if it's not working out. If you still have a fit issue. Don't be afraid to let it settle in for at least 20 minutes. It it still drops, then use your Tokyamo. THIN apllicaton. Read the directions. AGAIN... THIN APPLICATION. If you get folding of the material then you most likely have relieved the denture or bored it out too much and you're short on resin. THIN the application. Works every time.
       
    13. kcdt

      kcdt Well-Known Member Full Member

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      Or it could be an aggressive bead crossing over the hamular notch.
       
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    14. JMN
      Curious

      JMN Christian Member Donator Full Member

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      Not me. But I get your idea, and will remember that.
       
    15. budgenator

      budgenator Active Member Full Member

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      Hydrocast functional impression, until the tissues get healthy and firm you're just spinning your wheels. Sometimes with older people their tissues are just so fragile, that nothing seems to work.
       
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    16. denturist-student

      denturist-student Active Member Full Member

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      I will try hydrocast next. Thanks for all the advise. I will also have to try the impregum. My thinking was it may have something to do with impression technique or processing. I will have to review all my lab procedures to ensure nothing on that side is responsible. Last time I had a good fitting pvs impression that when reinserted it was good. But after processing it fell out even with the Luckman dam. I guess what is frustrating is that the current upper denture seems to stay in place.....wondering if the trays are warping in the mouth? I am currently using a light cured base and taking the finals with that. But yes next step would be hydrocast....COEsoft appearts to be quite slippery when first applied so it falls out too. Tempo usually does the trick but few people can tolerate the bad aftertaste. I will give hydrocast another try. thanks again...
       
    17. denturist-student

      denturist-student Active Member Full Member

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      Are you familiar with a material called MIcroseal? Bought some but have yet to try it.
       
    18. denturist-student

      denturist-student Active Member Full Member

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      I have been using Elite brand of pvs.....I think I will go back to Ivoclars virtual and see if I get better results. I think vitrual light body is a bit lighter viscosity than many others I have used....
       
    19. denturist-student

      denturist-student Active Member Full Member

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      No but this patient has a very steep palatal curtain almost straight downward. But its falling out at the front which leads me to think that palatal curtain may be pushing it forward enough to break the seal. the lady is very old and tissue tension is a real issue...I am going through all the motions for border molding okay and the impression seems good when I take it out. But yes the curtain may be thrusting it forward. I have heard that patients with a steep palatal curtain ie almost 90 degrees are difficult cases. but I am missing something here. It may be technique related....May be overextension at the back of the denture....that would push it forward a bit and break the seal. Even when doing the final impressions the lady said it was loose....arghhhhh.....I don't have any hair to pull out...lol
       
    20. Doris A
      Angelic

      Doris A Well-Known Member Donator Full Member

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      I have a Dr who uses hydrocast, and before he sends it to me he does a microseal wash inside the hydrocast.
       
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