Reline issues

[JMN]

got a practitioner who for reasons that escape reason, can't reliably take a complete max reline impression that will not boomerang with 'no suction, redo' less than every 10th denture.

I would like to give a list and "Do it this way and I'll cover the ones that still have issues. If you don't want to, then it's on you."

This is the only doc who I ever have issues with (well, of this type ) so I know it is not something I'm doing. Here's a picture of the reline model still on the jig from the first go (left) and the second go (right).

Sadly I cannot leave them both on the jigs as I'll need them before doc comes back on shift.

My suggestion list:
Make sure the patient is sitting up comfortably.
Don't overfill. It'll open them too much.
Just put it in gently and let them close to comfort after the teeth interdigitate as the pt is accustomed. Don't hold it in like an impression tray or the occlusion will likely be off and knock it out of sealing.

Any other ideas I can take to this person? Aside from request a refund from your school?

 

[basler]

What impression material is used?Looks overextended......Alginate?
If taking the impression is a issue (probably ....100% is) instead of taking a impression sugest the Dr. do a soft reline and have the pt wear it for a day or two when both the Dr and patient are happy just do your lab part.....

 

[JMN]

What impression material is used?Looks overextended......Alginate?
If taking the impression is a issue (probably ....100% is) instead of taking a impression sugest the Dr. do a soft reline and have the pt wear it for a day or two when both the Dr and patient are happy just do your lab part.....

1st was VPE. 2nd was PVS.

I'll suggest that. Thank you.

 

[kcdt]

got a practitioner who for reasons that escape reason, can't reliably take a complete max reline impression that will not boomerang with 'no suction, redo' less than every 10th denture.

I would like to give a list and "Do it this way and I'll cover the ones that still have issues. If you don't want to, then it's on you."

This is the only doc who I ever have issues with (well, of this type ) so I know it is not something I'm doing. Here's a picture of the reline model still on the jig from the first go (left) and the second go (right).

Sadly I cannot leave them both on the jigs as I'll need them before doc comes back on shift.

My suggestion list:
Make sure the patient is sitting up comfortably.
Don't overfill. It'll open them too much.
Just put it in gently and let them close to comfort after the teeth interdigitate as the pt is accustomed. Don't hold it in like an impression tray or the occlusion will likely be off and knock it out of sealing.

Any other ideas I can take to this person? Aside from request a refund from your school?

View attachment 31734

Is any tissue conditioning being performed before reline?
That's usually where rebound comes from in my experience (the lack TC, I mean)

 

[JMN]

Is any tissue conditioning being performed before reline?
That's usually where rebound comes from in my experience (the lack TC, I mean)

Unknown, but highly doubtful.
These always seem to be (from memory here) relines of immediate C/. The interesting thing is it is not always the first hard reline of the immed c/. Sometimes it's the second that boomerangs.

Sadly, I think it's low clinical give-a-hoot, but I'm willing to push to try and make it better and see if it is lack of training or lack of concern.

 

[Doris A]

Who is taking the impression, Dr or Assistant?
Do the patients have high blood pressure? If they do and the impression is taken in the morning the tissue can be puffy and when he delivers it in the afternoon the tissues have receded and they have no retention.

 

[JMN]

Who is taking the impression, Dr or Assistant?

I hate to say it, but it can only be one person to be this consistently rotten. Which person is under investigation.

 

[nickate]

This is an easy one.
PLAN A. After imp is set up-- remove from mouth. Reinsert in mouth and confirm midline, fit,occlusion, border and post palatal seal extention. Explain to Dr. the importance of checking the work to avoid a possible remake. I'm sure this will not happen as the office figures they are batting 90% so the lab is the f'up. You may need to be present when imp is taken to check yourself.
PLAN B. Have Dr. use tissue conditioner and let patient wear for 24-72 hours. I always suggest Hydrocast as it has the drops you can add to extend setup time by HOURS. This crap is magic for functional impressions.

 

[TomZ]

Express holes.
Prevents incomplete seating and undue tissue compression.

 

[Affinity]

You cant expect a busy Dr to take the time to drill holes.. haha

 

[TomZ]

If you noticed, I also get them to border mold them.

 

[kcdt]

If you noticed, I also get them to border mold them.

Bottom line is it only fits as well as the effort put in

 

[JMN]

Okay. Had a chat with the assistant.

He's been putting cotton wads in the post and getting them to bite hard as they can, been taking them laying down half the time, been hand holding them like a impression tray...Explained how all those went wrong when it came back and why it was causing them (and me) grief.

Took both reline models and showed the difference. And explained how a reline was done. They had no idea. None. Sometimes "underaware" looks just like "don't care".

We're trying new things. Starting today. Well, tomorrow.

Cautiously optimistic.

Thank you @basler , @kcdt, @Doris A , @nickate , @TomZ for the humor of hoping all our drs are like yours, & @Affinity for the assist on that joke.
What a day. THIS is why I'm a dental tech.

 

[kcdt]

Okay. Had a chat with the assistant.

He's been putting cotton wads in the post and getting them to bite hard as they can, been taking them laying down half the time, been hand holding them like a impression tray...Explained how all those went wrong when it came back and why it was causing them (and me) grief.

Took both reline models and showed the difference. And explained how a reline was done. They had no idea. None. Sometimes "underaware" looks just like "don't care".

We're trying new things. Starting today. Well, tomorrow.

Cautiously optimistic.

Thank you @basler , @kcdt, @Doris A , @nickate , @TomZ for the humor of hoping all our drs are like yours, & @Affinity for the assist on that joke.
What a day. THIS is why I'm a dental tech.

Sounds like they wanted to make every single error, just to be sure.

 

[CoolHandLuke]

i cannot explain the hilarity of putting speed holes in a denture.

 

[JMN]

i cannot explain the hilarity of putting speed holes in a denture.

With a butterfly postdam they really go!

 

[nickate]

Express holes.
Prevents incomplete seating and undue tissue compression.
View attachment 31735

We learned at Triton College that those are "vent" holes..... remember?

 

[TomZ]

yep, Spear Education advocates it also.

 

[bigj1972]

We learned at Triton College that those are "vent" holes..... remember?

Had a Dr once who switched from rubber base to VPS, drilled about 5 holes in palate, used light body for reline, and it went running down the patients throat.

 

[JMN]

I certainly see the utility of the vents, but the running out from material selection issues would be a fear point for the dds's.