tissue displacement

sidesh0wb0b

sidesh0wb0b

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I have had this come up now 3 times in the past year....

patient 1: unknown to us to start, the patients maxillary tissue muscles moved a LOT during impressions. we did multiple tryins for a full denture and finally got what we believed was a proper fit and setup. went to finish and sure enough, no suction at all. didnt fit properly. 4 relines later, we got a "better" result but never got proper vac. further exploration throughout determined the massive shifting of tissue on the palate.

patient 2: similar to above, but we caught it earlier and its less severe. still took 3 tryins and 3 relines after processing. VERY frustrating.

patient 3: in the works now. Dr just called and he can literally see the tissue over the patients (max.) ridge moving while hes taking the impression. alginate, medium body, doesnt matter. the tissue is extremely "flappy and loose" (doctors words) and seems the patient is one of the never-satisfied types.

what options do we have to present to the Dr and patient? is there a chemical that can be applied to stabalize the tissue for impressioning? does it make sense to send the patient (pt #3) for surgery, cut out some extra tissue, suture it back up, and wait for it to heal and see if that helps? both the Dr and I dont want to waste our time or the patients time in moving forward if theres not an appropriate result. i just dont know enough about the removable side to offer great options
 
JKraver

JKraver

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I don't know of a chemical but there is something like 4 little metal anchors called implants.
 
sidesh0wb0b

sidesh0wb0b

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I don't know of a chemical but there is something like 4 little metal anchors called implants.
ive heard of those. thought i was just dreaming.
 
JKraver

JKraver

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Only option IMO, everything else is pretty iffy. You could remove tissue, suture up, put pt through a ton of pain just to tell them they need implants.
 
JKraver

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Possibly relieve the palate and put a huge post dam in.
 
sidesh0wb0b

sidesh0wb0b

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Only option IMO, everything else is pretty iffy. You could remove tissue, suture up, put pt through a ton of pain just to tell them they need implants.
patient has been wearing a (albeit poor) denture for the better part of 2 decades. there is not enough bone to work with implants (shes already seen the surgeon as it was our first attempt at treatment planning). denture wasnt made by my client, or in this state.
 
dmonwaxa

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Maybe an intraoral soft reline/conditioner aka coe- soft, try for a few weeks. If it works move forward with a longer lasting soft reline material.
 
kcdt

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I have had this come up now 3 times in the past year....

patient 1: unknown to us to start, the patients maxillary tissue muscles moved a LOT during impressions. we did multiple tryins for a full denture and finally got what we believed was a proper fit and setup. went to finish and sure enough, no suction at all. didnt fit properly. 4 relines later, we got a "better" result but never got proper vac. further exploration throughout determined the massive shifting of tissue on the palate.

patient 2: similar to above, but we caught it earlier and its less severe. still took 3 tryins and 3 relines after processing. VERY frustrating.

patient 3: in the works now. Dr just called and he can literally see the tissue over the patients (max.) ridge moving while hes taking the impression. alginate, medium body, doesnt matter. the tissue is extremely "flappy and loose" (doctors words) and seems the patient is one of the never-satisfied types.

what options do we have to present to the Dr and patient? is there a chemical that can be applied to stabalize the tissue for impressioning? does it make sense to send the patient (pt #3) for surgery, cut out some extra tissue, suture it back up, and wait for it to heal and see if that helps? both the Dr and I dont want to waste our time or the patients time in moving forward if theres not an appropriate result. i just dont know enough about the removable side to offer great options
Degree of tissue mobility is something that should be diagnosed at the start.
Options for treatment include selective pressure impression using ultra light viscosity material on the most mobile areas,
Or in severe cases, surgical removal of excess tissue.
At the very least, no denture or reline should be performed on a current denture wearer without a tissue conditioning first.
If dr is unaware how to treat someone so severely debilitated, perhaps referral to a specialist is in order.
 
KentPWalton

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I say just use some Silly Putty to make it comfortable for them AND they can read the Funnies from the paper!! :D

Silly-Putty.jpg
 
lcmlabforum

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Really, this is a clinical issue and I would stay far away from giving 'advice' before getting liable from it.
Sometimes, surgery only remove the last bit of undercut for any retention, albeit mobile retention,
and now you have a pt end up worse than before subjectively.
Like KCDT said - this should have been diagnosed at the initial visit by DDS, and not blamed on
the lab at the end . . . unless labwork had accident and destroyed to cast before final processing.
Tread carefully is what I am thinking.
LCM
 
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kytoothdude

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Have pt leave out denture for one week. Have pt massage gums with cheap (rough) washcloth twice a day. Like that will ever happen!
 
sidesh0wb0b

sidesh0wb0b

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Degree of tissue mobility is something that should be diagnosed at the start.
Options for treatment include selective pressure impression using ultra light viscosity material on the most mobile areas,
Or in severe cases, surgical removal of excess tissue.
At the very least, no denture or reline should be performed on a current denture wearer without a tissue conditioning first.
If dr is unaware how to treat someone so severely debilitated, perhaps referral to a specialist is in order.

this IS the start, and we are treatment planning. sadly i am too much of a denture noob to know how to treatment plan, and the dr is new to prosthetics as well. we are seeking specialist council (and have already)....figured i would throw it out here to see if there was something additional maybe we had not thought of.
 
sidesh0wb0b

sidesh0wb0b

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Really, this is a clinical issue and I would stay far away from giving 'advice' before getting liable from it.
Sometimes, surgery only remove the last bit of undercut for any retention, albeit mobile retention,
and now you have a pt end up worse than before subjectively.
Like KCDT said - this should have been diagnosed at the initial visit by DDS, and not blamed on
the lab at the end . . . unless labwork had accident and destroyed to cast before final processing.
Tread carefully is what I am thinking.
LCM
ive already thrown that caveat out there. i hold zero responsibility for this case at this stage.
as mentioned above, this IS the treatment planning stage. no one is moving forward without a clear path of expectations. this IS the initial visit(s) from the patient to the dr and we are determining what options are available for presentation of treatment. implants are out, as she was referred for that already. she is not a candidate. her original denture is god only knows how old (approx 20yr) and not mine, nor the treating dr at this time.
we are exploring options, and since i know less than an adequate amount for this type of situation, i brought it here for feedback. dr is also consulting some options on the surgery side of things.
 
kcdt

kcdt

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ive already thrown that caveat out there. i hold zero responsibility for this case at this stage.
as mentioned above, this IS the treatment planning stage. no one is moving forward without a clear path of expectations. this IS the initial visit(s) from the patient to the dr and we are determining what options are available for presentation of treatment. implants are out, as she was referred for that already. she is not a candidate. her original denture is god only knows how old (approx 20yr) and not mine, nor the treating dr at this time.
we are exploring options, and since i know less than an adequate amount for this type of situation, i brought it here for feedback. dr is also consulting some options on the surgery side of things.
Words to live by:

Set low expectations with the patient. Underselling and ( if lucky) over delivering is preferable to over selling or keeping silent and getting blamed for a clusterf**k.
This is crucial in cases of advanced debilitation.
Be brutally realistic.
 
JKraver

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Words to live by:

Set low expectations with the patient. Underselling and ( if lucky) over delivering is preferable to over selling or keeping silent and getting blamed for a clusterf**k.
This is crucial in cases of advanced debilitation.
Be brutally realistic.
You can say that to the dr and they can still pin it on you lol
 
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paul sarratt cdt

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What about a tissue conditioner/funtional impression material like lynol or an equivalent then do a heat cure reline. Really though it is a clinical issue but as usual the lab is the one with your feet held to the fire to get results. As for the implant solution not everyone has implant denture money.
 
sidesh0wb0b

sidesh0wb0b

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What about a tissue conditioner/funtional impression material like lynol or an equivalent then do a heat cure reline. Really though it is a clinical issue but as usual the lab is the one with your feet held to the fire to get results. As for the implant solution not everyone has implant denture money.
as of yet, nothing has moved forward with this specific case.will keep everyone updated if it moves along
 
denturist-student

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What happens when you do a normal impression on soft tissue is that the tissue folds over on itself and distorts...When it comes to fit the final denture, it may fall out due to the pressure the compressed tissue exerts on it. Selective loading works somewhat but only if you drill some relief holes in the impression tray. Far better to do an open tray....But this is a totally foreseeable thing...During a proper prosthetic examination one of the things to check for is flabby tissue on the ridge crest...Exactly the scenario crops up like that when a patient doesn't get a reline for years and then expects a miracle.....For the very reason that you folks mention, relining that type of tissue is problematic in that the front teeth are in the way of the opening needed to do an open tray impression....Alternatively if there is enough room in the denture it would need to be grossly hollowed out and do a selective load reline impression...but yes you folks are right. It is a clinical problem....not necessarily a lab problem...I have had one of those cases recently and placed a Luckman dam across the back of the denture and as well advised the patient from the getgo that I would only try a reline....because they told me they needed a reline which I usually tell patients that I can only do after a full assessment...In my case I already told the patient that relining is only an attempt to correct the problem and may not actually correct the problem....So when I told her it would be $2800 to do a remake she was willing to forgo a bit of discomfort...ON that case selective load was impossible because there was not enough acrylic left to make an open tray or do a selective load impression because they usually require 2-3 mm of relief or an open tray.....a bit more than acrylic that was there...Massad covers these in his videos quite well.
 
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