Neutral Zone/ Massad Technique

[kcdt]

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?

I agree.
NZ is not a technique for anyone who cuts corners or doesn't fully grasp removable prosthodontics.

 

[kcdt]

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?

I'm also curious what they look like after time in the hole, as you so aptly put it.
Accumulation should be a wake up call.

 

[dborla01]

Those beautifully characterized dentures look awesome on an articulator or in-hand.....however that beauty is highly muted where it is supposed to function....in the mouth. We find that it is of far greater importance to get correct centric relationship and vertical opening. Achieving a harmonious shade, rather than screaming white or overly dark' is also of importance.... and of course correct placement of 'said teeth. We also make sure to achieve a correct curing cycle that converts as much monomer as is possible.
As we have been addressing lately, an anatomically correct wax-up that enables cleanliness, is also of greater importance. The cost-cutting "denture mills" sell that which the Pt. clientele settles for, and many of them fail, resulting in customers going to an operator who takes the time to achieve more harmonious results.

 

[JKraver]

Those commercial ones do stay clean as can be though, they are slicker than snot.

 

[denturist-student]

Those beautifully characterized dentures look awesome on an articulator or in-hand.....however that beauty is highly muted where it is supposed to function....in the mouth. We find that it is of far greater importance to get correct centric relationship and vertical opening. Achieving a harmonious shade, rather than screaming white or overly dark' is also of importance.... and of course correct placement of 'said teeth. We also make sure to achieve a correct curing cycle that converts as much monomer as is possible.
As we have been addressing lately, an anatomically correct wax-up that enables cleanliness, is also of greater importance. The cost-cutting "denture mills" sell that which the Pt. clientele settles for, and many of them fail, resulting in customers going to an operator who takes the time to achieve more harmonious results.

As a denturist I can understand your remarks and tend to agree with you...but for pure lab people who never really see their work in vivo, the artistry appears to be in the presentation of the dentures on the models....and I understand that too....because I was trained as a tech first and migrated to denturist clinical later on.

 

[denturist-student]

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.

I follow your theory quite rigidly now...I have used both cutter bars against dr. french zero degree uppers, or candulour or ivoclar lingualized uppers against a bioblend zero degree lower set on a curve...I have done quite a few neutral zone impressions and they are really cumbersome for geriatric folks but I was using a tissue conditioner before. Since seeing Massad's videos, I now use his technique of doing external impressions on the lower....getting really good feedback from that....

 

[kcdt]

I follow your theory quite rigidly now...I have used both cutter bars against dr. french zero degree uppers, or candulour or ivoclar lingualized uppers against a bioblend zero degree lower set on a curve...I have done quite a few neutral zone impressions and they are really cumbersome for geriatric folks but I was using a tissue conditioner before. Since seeing Massad's videos, I now use his technique of doing external impressions on the lower....getting really good feedback from that....

Migrating to PVS over tissue conditioner was a major improvement.

 

[denturist-student]

Migrating to PVS over tissue conditioner was a major improvement.

The two methods yield slightly different results. The TC captures lingual lower very accurately which is a little different impression. Seems the TC flows much better over several minutes...I keep it in for about 20 minutes but applying three or four layers of that is time consuming. I think overall the TC yields a higher acceptance to patients when the insertion happens. They are really pleased when they are outfit with a lower denture that seems stable... The disadvantage of course is the lack of lip support...but then for geriatric patients in general that is not really a problem.....Who knows maybe I will try a hybrid version of both some day...

 

[kcdt]

The two methods yield slightly different results. The TC captures lingual lower very accurately which is a little different impression. Seems the TC flows much better over several minutes...I keep it in for about 20 minutes but applying three or four layers of that is time consuming. I think overall the TC yields a higher acceptance to patients when the insertion happens. They are really pleased when they are outfit with a lower denture that seems stable... The disadvantage of course is the lack of lip support...but then for geriatric patients in general that is not really a problem.....Who knows maybe I will try a hybrid version of both some day...

Thanks. That's really enlightening

 

[denturist-student]

Thanks. That's really enlightening

We use TC to make a functional impression...We leave it in for two or three days and then process it like that....Works out very well....I take it one step further like Turbyfill and mount the case for reline on a reline jig and then take it back to the patient with the TC applied...the results are way better than doing a straight TC....

 

[JKraver]

Keep it coming guys.