what a case!

bigj1972

bigj1972

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Seem like plenty of room for acrylic. I wonder why she was having so much breakage? Awesome work.
Debris, and forced alignment. You pack it full, then fraye the insert.... Soon same effect as a high abutment. Creates fulcrum then squish, just like grape.
 
Sda36

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you guys are welcome to critique! i want to hear all the feedback so we can continue getting better!
Beautiful case Bob, stunning in workflow and creative thinking given what you were up against. My only critique, since you asked, would be leaving the buccal occlusal 1/3rd completely non visible. Non working area, chrome won't flex and cause any problems of much load there. Different design if porcelain were involved though.
Absolutely loved all the thought processes that went into your design, just fabulous!!!!!!!🙂🙂🙂 Yes, what a case, have had several PT's over the years with Gorilla bites and can't believe what they can do, mostly elderly ladies who you can't believe could close with such massive force. Something for all to keep in mind, a force to be reckoned with 😉
 
Sda36

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Beautiful case Bob, stunning in workflow and creative thinking given what you were up against. My only critique, since you asked, would be leaving the buccal occlusal 1/3rd completely non visible. Non working area, chrome won't flex and cause any problems of much load there. Different design if porcelain were involved though.
Absolutely loved all the thought processes that went into your design, just fabulous!!!!!!!🙂🙂🙂 Yes, what a case, have had several PT's over the years with Gorilla bites and can't believe what they can do, mostly elderly ladies who you can't believe could close with such massive force. Something for all to keep in mind, a force to be reckoned with 😉
P.S. With this particular Pt though, I'm sure she rejoices in the metal as a point of confidence, Terminator, I can eat Anything 😜🤣
 
sidesh0wb0b

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Beautiful case Bob, stunning in workflow and creative thinking given what you were up against. My only critique, since you asked, would be leaving the buccal occlusal 1/3rd completely non visible. Non working area, chrome won't flex and cause any problems of much load there. Different design if porcelain were involved though.
Absolutely loved all the thought processes that went into your design, just fabulous!!!!!!!🙂🙂🙂 Yes, what a case, have had several PT's over the years with Gorilla bites and can't believe what they can do, mostly elderly ladies who you can't believe could close with such massive force. Something for all to keep in mind, a force to be reckoned with 😉
we toyed with the idea of leaving less metal, or full metal coverage in the posterior but chose to go the hooded route instead. without knowing exactly why there were so many issues with her previous dentures we wanted to cover our backsides and make sure there would be no chance for fractures, or popping off teeth.
thank you for the feedback! i truly appreciate it
 
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Midline fractures of complete dentures is common given the problems illustrated in your pictures. The most frequent error when setting these cases is to allow the buccal cusps to "hang down". This tooth position puts lateral load on the palatal areas rather than centralizing the load towards the ridges. Your solution was innovative but costly. When setting these cases think "lingualized occlusion" so that the loads are directed towards the ridge rather than to the midline of the denture.
1692124755026.png
 
sidesh0wb0b

sidesh0wb0b

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Midline fractures of complete dentures is common given the problems illustrated in your pictures. The most frequent error when setting these cases is to allow the buccal cusps to "hang down". This tooth position puts lateral load on the palatal areas rather than centralizing the load towards the ridges. Your solution was innovative but costly. When setting these cases think "lingualized occlusion" so that the loads are directed towards the ridge rather than to the midline of the denture.
View attachment 43533
we don't know what the problems were. our dentures dont have fractures like this patient experienced over many years with dentures made from a handful of labs and practices i believe.
you may consider our solution to be costly, but i assure you the Dr and the patient are not sharing the same experience.

bear in mind we don't typically fabricate dentures for this Dr....in fact this was our first and only time making a prosthetic for him over many years of great success on the restorative collaborations.

(@Gru i think you know this client ;) )
 
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My comment was not intended to be a criticism of your setting technique but to answer a question in the thread as to why complete dentures against natural dentition are prone to midline fractures. Just to ensure this is understood I will finish the list of causes:
- the pattern of ridge resorption from the buccal toward the ridge leaves the lateral aspect of the denture unsupported (relines should be more frequent)
- the geometry of the arch form can lead to a tendency for midline fractures
- artificial teeth are 25% narrower than natural teeth for a given mesial-distal length causing buccalization of the teeth as mentioned before (select specially made teeth that match the buccal-lingual width of the natural teeth (Portrait IPN® 40° EuroLine)
- patients biting habits, bruxers tend to have more dentures failures
- prescribe a metal palate for cases that continue to break after dealing with all the other issues.
It was not my intention to be critical, but rather to answer the question "why? " if my comment came across that way I apologize. Once the implants were placed the problem should have been solved because of the support from the implants as long as the loads are being presented axially. Your design is a wonderful hybrid solution drawing from all aspects of our technology.
 
sidesh0wb0b

sidesh0wb0b

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My comment was not intended to be a criticism of your setting technique but to answer a question in the thread as to why complete dentures against natural dentition are prone to midline fractures. Just to ensure this is understood I will finish the list of causes:
- the pattern of ridge resorption from the buccal toward the ridge leaves the lateral aspect of the denture unsupported (relines should be more frequent)
- the geometry of the arch form can lead to a tendency for midline fractures
- artificial teeth are 25% narrower than natural teeth for a given mesial-distal length causing buccalization of the teeth as mentioned before (select specially made teeth that match the buccal-lingual width of the natural teeth (Portrait IPN® 40° EuroLine)
- patients biting habits, bruxers tend to have more dentures failures
- prescribe a metal palate for cases that continue to break after dealing with all the other issues.
It was not my intention to be critical, but rather to answer the question "why? " if my comment came across that way I apologize. Once the implants were placed the problem should have been solved because of the support from the implants as long as the loads are being presented axially. Your design is a wonderful hybrid solution drawing from all aspects of our technology.
all good, really! i love the dialogue so bring it on! and you are correct with the points you have brought up
 
Sda36

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all good, really! i love the dialogue so bring it on! and you are correct with the points you have brought up
I attended a lecture maybe 6 years ago , Tom Bormes and his Dad in Chicago. Biggest take that was news to me was that the resorption anterior to posterior was twice as fast as the vertical component. Changed my thinking then and there. Thanks Tom & Dad
 
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Philophil5

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I taught Removable Prosthetics at a university and then a college (Denturist Program) for 20 years after 25 years in the Canadian Dental Corps as a technician. I have extensive teaching materials (PowerPoints) on all aspects of the technology. There is a graphic I will try to find on bone morphology and patterns of resorption that beautifully illustrate the point you raise. The labial/buccal (horizontal) aspects resorb much more quickly as you describe Take care.

1692320182300.png
 

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