Neutral Zone/ Massad Technique

[kcdt]

Thanks, and Congrats to Bumfrey!
BTW - who made those central bearing device set for you?
LCM

If memory serves those are a set of Massad devices. They're from before his team developed the disposable ones.
They're a lot like the swissdent/ptc ones. They have both brass and Delron styli in the set.

 

[kcdt]

This subject is one of the more important subjects in our work. Forget about esthetics it just makes function a priority. Were I able to upload a PowerPoint I would be glad too but most info needed is right here....I do work with a lot of elderly patients who cannot afford implants but are sensitive to irregularities in their dentures... I recently participated in a symposium featuring one of Massad's fellow prosthodontists who gave us a synopses of Massad's technique in full. Best symposium ever. Also bought a set of Massad's CD's....which I found interesting..however more related to clinical rather than lab work..Wondering if affordable dentures could be done that way...I would need to charge about 3500 - 5000 for a set that follows his protocol. But I think some people would pay a little extra for some options such as Massad's or Turbyfill's techniques....Totally agree with kcdt's assertion that we need to do away with esthetic concepts such as stippling and anatomically correct detail...To me the buccal surfaces and intaglio are as equally important as the occlusion....further to all of this I am leaning away from intra oral equilibration in favor of a clinically mounted post insert equilibration of the occlusion...the intra oral environment is not stable enough to perform any sort of equilibration especially given the instability of the lower denture.

I was a one point trying to put together lab related stuff on the technique. Hence the slide lecture.

 

[Car 54]

This is a online course that is worthy of at least CDT credits. It would be nice if you all were able to submit this link to NBC/NADL as a online study. Nice work, kcdt.

 

[denturist-student]

Excellent presentation kcdt...I might add that the trick is to achieve balance between the buccinator and tongue at rest and in functional positions... I run the patient through several exercises first so I can make sure they are capable of actually doing them...The one patient I had when I was in intern actually told me to go to blazes when I asked her to do the skinamarinkydink song...But in the end she takes her upper set out at night and leaves the lowers in and admitted that they feel just like her real teeth shes worn for years. Funny what a few simple techniques can do for a patient who has not worn any dentures for ten years. for now not all of my patients can tolerate the extent that Massad wants us to carry out...but if I ever open up a clinic it will be His or Turbyfills techniques exclusively....You can listen to Turbyfills lecture on VIVA.

 

[kcdt]

This is a online course that is worthy of at least CDT credits. It would be nice if you all were able to submit this link to NBC/NADL as a online study. Nice work, kcdt.

Thanks. When I gave the lecture it was two credits.

 

[Flipperlady]

yeah!! I'm 4-5 weeks to the finish line. A F/F and a P/P left to finish with 2 exams in the final weeks. Fairly confident I am good to go. Looking forward to making people some new teeth!!!!
Let the grey hair come forth!

Congrats Bumfrey, I'm envious. The only advice I could give you is that dentures are 25 % technique and 75% psychological. First you have to have the sales ability of a used car salesman and secondly take the old denture away for awhile or the new ones will never fit right ;-)

 

[Flipperlady]

Great job Ken, thank you for posting this!

 

[dborla01]

I first saw Massad's technique' and photos in a professional denturist' publication last year. I could not get beyond the fact that the posterior teeth were set like a horseshoe, noticeably outside the lower ridge. I am sure that perceived fact may have helped to fill out the buccal corridor and thus the Pt.'s cheeks benefited, however, I would not feel comfortable with that result in our work.
We follow the dictum that lower posteriors' need to be very near the center of the edentulous ridge, to promote stability, etc. We use an inter-oral tracing device, an extra, clear upper baseplate in addition to the striking plate one, and do three or four tryins, to achieve clinical/Pt. satisfaction, before going to finish...then remount and equilibrate after process. Lingualized occlusion is our "friend".

 

[kcdt]

I first saw Massad's technique' and photos in a professional denturist' publication last year. I could not get beyond the fact that the posterior teeth were set like a horseshoe, noticeably outside the lower ridge. I am sure that perceived fact may have helped to fill out the buccal corridor and thus the Pt.'s cheeks benefited, however, I would not feel comfortable with that result in our work.
We follow the dictum that lower posteriors' need to be very near the center of the edentulous ridge, to promote stability, etc. We use an inter-oral tracing device, an extra, clear upper baseplate in addition to the striking plate one, and do three or four tryins, to achieve clinical/Pt. satisfaction, before going to finish...then remount and equilibrate after process. Lingualized occlusion is our "friend".

If the neutral zone is properly executed, you shouldn't see large deviations from anatomical norms, unless there's been a stroke or something affecting muscle tonicity.
In fact, I've found even severe crossbite resulting from a resorbed mandible will still fall in the nz without forcing one the set up off crestal ridge or outside Pound's triangle.
So, without judging another's work unseen, I would caution against using ANY published case as the sole dictum of whether a technique has value. The publishing bar's set too low for that.
Don't even get me started on the relative technical expertise I've witnessed from my personal exposure to denturists....

 

[dborla01]

"Don't even get me started on the relative technical expertise I've witnessed from my personal exposure to denturists...."

Sorry KC....what do you MEAN by that statement? If you are going to post opinions here concerning fellow dental professionals, please be willing to back up your experience with evidence. I am sorry that you MAY HAVE had negative results, having worked with a small number of Denturists' in your past. However, we are not here to attack fellow-professionals. Concerning the removable domain, there are only a few hard and fast rules and having worked with dentistry and other professionals the past 30 plus years, the only truth I will agree with is that there are many techniques, and the individual operator eventually becomes comfortable with what works for his/her Pt. I do not attack Dentistry in a wholesale manner, understanding that they, us, and Denturists', deal in a highly subjective environment, not to mention the fact that Pt's can be over demanding at times.

 

[Flipperlady]

I think there is no right or wrong here so no need to step on each others tails. When dealing with highly resorbed ridges, especially in a frail elderly patient, you do what you have to do to make the denture comfortable and hopefully stay in place. Personally I'm in the camp that thinks that you have to go with the mechanics of the ridges and if there is a need for a cross bite because of resorption, then so be it. I'm not totally convinced that placing the teeth off into the neutral zone is a wise thing to do if it means going way off the ridge to do so, I think Kenneth addressed this however. I do like the photos Ken made that show adding the acrylic to help keep the denture in place and I myself have used this technique. I'm also a big fan of the 20 deg over monoplane setups. As for denturists, I would imagine just like dentists, there are wonderful and horrific, that's a given.

 

[dborla01]

Flipper..thank you for your reply.

 

[denturist-student]

I first saw Massad's technique' and photos in a professional denturist' publication last year. I could not get beyond the fact that the posterior teeth were set like a horseshoe, noticeably outside the lower ridge. I am sure that perceived fact may have helped to fill out the buccal corridor and thus the Pt.'s cheeks benefited, however, I would not feel comfortable with that result in our work.
We follow the dictum that lower posteriors' need to be very near the center of the edentulous ridge, to promote stability, etc. We use an inter-oral tracing device, an extra, clear upper baseplate in addition to the striking plate one, and do three or four tryins, to achieve clinical/Pt. satisfaction, before going to finish...then remount and equilibrate after process. Lingualized occlusion is our "friend".

As long as the lowers are within pounds triangle, which they usually are, there should be no problem...For an enlarged tongue the lingual cusps can be narrowed somewhat to accommodate it. but placing the fossa of the lowers on the crest of the ridge is optimum and it usually works out that way anyway. I particularly like the way the buccal impressions are formed. I used to use a tissue conditioner for this but have switched to the faster medium silicon pvs for this. Whatever technique is used for me comfort is the most optimum thing. This method will achieve just that. So why not kick it up a notch and do buccal impressions for the time it takes it makes our professionalism stand out.

 

[JMN]

Kcdt, I just wanted to thank you for sharing this. It is this actual, useful, explained knowledge that is missing from most 'trade publications' today.

If you have any more on this or any other techiques, please share when you can. I've started discussing this with my best, most knowledge hungry dentist and he's looking for a patient who'd be willing to try.

Thank you.

 

[kcdt]

"Don't even get me started on the relative technical expertise I've witnessed from my personal exposure to denturists...."

Sorry KC....what do you MEAN by that statement? If you are going to post opinions here concerning fellow dental professionals, please be willing to back up your experience with evidence. I am sorry that you MAY HAVE had negative results, having worked with a small number of Denturists' in your past. However, we are not here to attack fellow-professionals. Concerning the removable domain, there are only a few hard and fast rules and having worked with dentistry and other professionals the past 30 plus years, the only truth I will agree with is that there are many techniques, and the individual operator eventually becomes comfortable with what works for his/her Pt. I do not attack Dentistry in a wholesale manner, understanding that they, us, and Denturists', deal in a highly subjective environment, not to mention the fact that Pt's can be over demanding at times.

I didn't reply to this earlier because I stumbled past it.
Let me clarify:
I meant only that one shouldn't extrapolate from the single example to the general.
What I meant in reference to denturists is what I'd say about anyone. A diploma means squat. The proof is in the pudding.
I've known firsthand denturists whose production has issues. Some couldn't keep a job in a commercial lab.
That was not a indictment of denturism or denturists as a whole.
But rather to point out that just because a guy with a diploma posts a case online doesn't mean that case is a good example of how it's done.

I don't want that to be misinterpreted. I wasn't dissing the group as a whole.

 

[dborla01]

Thanks KC for your reply.

 

[Makes Dentures]

Lotsa good information here... but who's the Dr.?

 

[kcdt]

Lotsa good information here... but who's the Dr.?

Dr practices in HI.

 

[Makes Dentures]

HI? Very sorry.. I did not convey my sarcasm well at all... I was trying to state that the BEST techniques ever are only as good as the dentists, their consistent implementation... and their assistants. They must be on board and have an understanding of this very complicated technique to make it work for their client. I have seen Jack's show twice over my career-- HE is running the show in the operatory- not the dentist.
My limited experience tells me to place the lowers over the ridge (or where it used to be) using the retro-molar pads as a guide. Just hope Dr. does not build up high false expectations for the patient..
As for all the denture base characterization and all the awards given for the best-- how's come we never get to see them in the hole? They are NEVER in a patients' mouth for a true assessment. Why not?

 

[JKraver]

As for all the denture base characterization and all the awards given for the best-- how's come we never get to see them in the hole? They are NEVER in a patients' mouth for a true assessment. Why not?

I have been wondering the same thing!

edit: Although I wish I could do it, even if it wasn't for a patient.