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Volume 2 (2011 - 2012) - Issue 2 (Feb 2012-Apr 2012)

Case Report

  • Final Impression and Centric Jaw Relation in Complete Dentures Using Single Appointment Technique –A Clinical Feasibility

    S K Jagdish*, Shyam Singh**, R Shakila†, Dhruv Arora*, V R Arun Kumar*, Santosh Anand*, Balaji J*

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Abstract
Fabrication of complete denture consists of numerous clinical and laboratory procedures. Any effort made by the dentist to reduce the number of appointments will be appreciated by the patient. Combining one or more clinical appointments reduces the total duration of treatment. This is more helpful in cases of complete denture patients who are physically and psychologically compromised. This case report is a clinical evaluation of a previously described technique which combines final impression and centric relation recording to one appointment. The feasibility of the technique, its reliability, advantages and its limitations are described based on clinical findings.

Key words: Single appointment technique, final impressions, centric jaw relation.

Any effort made to improve the treatment outcome while reducing the time required will be welcomed by the patients. This is more relevant in cases of complete denture patients who are physically and psychologically compromised.1,2,3 Fabrication of dentures requires numerous laboratory and clinical procedures. A complete denture patient is usually required to make five to six appointments for completion of his treatment. Combination of two or more clinical steps into a single appointment thus helps to reduce the number of appointments.

A critical search for methods to reduce the number of appointments for complete dentures revealed some techniques previously described in literature.4,5,7 Helft M. et al. described a technique of combining maxillomandibular relations (using intra-oral tracers) and final impressions into one appointment.5 The disadvantage of this technique was that the impressions were made after the Gothic arch tracings were recorded. Thus the record bases remained unstable during the tracing procedure. The final impressions and the final jaw relations were made using this gothic tracing as a guide, which could be a potential source of error.6 Ansari IH described a technique of using detachable occlusal rims and detachable handles on the same record base.7 This facilitated recording centric relation on the same record base after the final impressions were made. This article is a clinical evaluation of the technique described by Ansari IH to check for the feasibility and reliability of this technique.

The Technique
The technique is described in brief here. The technique can be divided into three basic steps for convenience:

  • Fabrication of detachable handles and occlusal rims on record bases.
  • Impression procedure and jaw relations.
  • Pouring the master casts and articulation.

a) Fabrication of detachable handles and occlusal rims on record bases:

  • Primary maxillary and mandibular impressions and casts were made.
  • Acrylic resin record bases were fabricated with thepins and sleeves in position. The final length of the pins and sleeves were trimmed to just 2mm above the bases (Fig 2).
  • Aluminum foil was adapted over the record bases as shown (Fig 3).
  • An occlusal rim base was made over the record base using acrylic resin, with the pins and sleeves in position (Fig 4).
  • Wax occlusal rims were made over the occlusal rim bases (Fig 5). It should be noted that now these occlusal rims could be removed from the record bases (Fig 6).
  • The occlusal rims were removed and two pins and sleeves were fixed on the anterior part of the record bases and removable handles were made in a similar method (Fig 7).

b) Impression procedure and jaw relations:

  • The detachable handles were fixed to the record bases and thus the border molding and final impressions were made in a conventional manner (Fig 8). Impressions were verified for accuracy and fit in patient’s mouth.
  • The handles were removed and replaced with the occlusal rims.
  • The rims were adjusted and the centric record was obtained.
  • Entire assembly was removed from the patient’s mouth. This centric record could now be detached from the bases and the impressions (Fig 9).

C) Pouring the master casts and articulation:

  • The centric record was detached from the impressions. Beading and boxing was done and the casts poured.
  • After the casts were set the record bases with the impressions were not removed from the casts.
  • The centric record was repositioned over record bases (Fig 10). The casts were articulated.
  • After articulation only the maxillary rim was removed and the maxillary impressions separated from casts (Fig 11).
  • Keeping the mandibular rim as reference, new record bases and rims were fabricated over the maxillary casts (Fig 12).
  • Similar procedure was used for mandibular rims. Teeth were set on the rims and denture completed in conventional manner.



Clinical results of the procedure:
The total number of appointments for the patient was as follows:

  • Appointment 1: Primary impressions
  • Appointment 2: Final impressions and jaw relations
  • Appointment 3: Try-in
  • Appointment 4: Denture insertion.


Discussion
a) Perceived advantages of the procedure:

  • Patient received his trial denture on his third visit rather than on the fourth or fifth visit as in conventional method.
  • Record bases were stable while making the jaw relations.
  • Error in the jaw relation was minimal.
  • Patient showed a positive response to treatment and was satisfied with the treatment.

b) Perceived limitations of the procedure:

  • This technique cannot be used in patients with limited inter-arch space. Fabrication of removable occlusal rims requires adequate inter-arch space.
  • Laboratory procedures in between appointments are cumbersome.
  • The technique requires adequate operator skill to complete border molding and final impression in short time.
  • If this is not achieved the duration of the appointment will be frustrating for the patient – which in turn leads to errors in jaw relations.


Conclusion
The above described procedure has its own advantages with limitations as it cannot be applied to all patients. The laboratory procedures involved may not be provided by all dental technicians due to lack of familiarity with this technique and may result in higher treatment cost.

References

  • Sheldon Winkler: Essentials of complete denture Prosthodontics, 2nd edition, AITBS Publishers, India , 2000.
  • George A. Zarb: Boucher’s Prosthodontic treatment for edentulous patients, 12th edition, Mosby Company, 2003.
  • Detroit Dental Clinic Club, Complete Denture Section. Nutrition for the denture patient. J Prosthet Dent 1960; 10(1):53-60.
  • Krantz WA et al. Combining final impressions and the centric jaw relation records into one appointment by using an irreversible hydrocolloid blockout technique. J Prosthet Dent 1991; 66(6):821-822.
  • Helft M et al.Combining final impressions with maxillomandibular relation records in stabilized record bases. J Prosthet Dent 1978; 39(2):135-138.
  • Tucker KM. Accurate record bases for jaw relation procedures. J Prosthet Dent 1966; 16(2):224-226.
  • Ansari IH. A one-appointment impression and centric relation record technique for compromised complete denture patients. J Prosthet Dent 1997; 78(3):320-323.


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