This case has really given me the opportunity to do lab work and improve my craft. The patient has had extractions of all the remaining maxillary teeth and presented with missing mandibular posterior teeth.
This was the first of many altered cast impressions taken to capture the posterior mandible, as well as my first RPD case in dental school.
I would be remiss if I didn't say I struggled, but I persevered, eventually adding border molding material to the under-extended portions of the impression shown here. Yet, the process was quite enjoyable
Here, we used a medium body PVS material to provide enough detail of the edentulous ridge and retromolar pad area.
This was the result- and the seating of the mandibular metal framework was confirmed shortly after.
After wax rims were made and a wax try-in was completed, it was time to mount the casts on the articulator.
A CR record was taken to mount the mandibular master cast.
The prosthodontics faculty working this case with me recommended to do two tooth try-in visits: an anterior tooth try-in and a full tooth try-in.
Here, the anterior teeth were set after esthetics and function (including VDO) had been evaluated.
At the anterior try in visit, CR record was verified first with a fast setting PVS material (Regisil).
Then, I learned to complete the esthetic evaluation of just the anterior teeth, including checking midlines, lip support, and evaluating phonetics.
The remaining teeth were set before the next visit.
CR record was verified again. All records, including anterior esthetics were re-evaluated at this stage.
Lingualized occlusion was used for this denture set-up. After seeing these pictures, maxillary posterior teeth were slightly adjusted so that the palatal cusps were more pronounced.
The processed dentures were returned from the laboratory and tried in the patient's mouth. PIP was used to adjust pressure spots until complete seating and equal was observed in primary stress bearing areas. The clinical remount procedure was completed chairside, including reducing the heal interference seen in the image here. Occlusal adjustments were made chairside using AccuFilm and Shimstock.
The denture was polished and delivered to the patient with instructions and to return for post-op visits.
