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Clinical Case Presentation One Ross Chapman Student Number: 20579504.

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Presentation on theme: "Clinical Case Presentation One Ross Chapman Student Number: 20579504."— Presentation transcript:

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2 Clinical Case Presentation One Ross Chapman Student Number:

3 Background 84 yr old Female Presenting Complaint Poorly fitting F/F dentures Poor retention on upper denture Soft lining on lower has become hard History of presenting complaint Current dentures 4+ yrs old Patient has lost weight in recent years Dental History Denture wearer 55+ yrs Regular attendee at this practice

4 Background Medical history Macular degeneration : Patient registered blind Benzofluorazide Generally fit and well with limited dexterity due to visual impairment Social history Occasional alcohol consumption 4upw Non smoker ( previous smoker gave up 25+ yrs ) Widow, lives alone with regular family contact

5 Background Family history No history of dental or medical disease Current OH regime Cleans mouth and dentures twice daily with soft brush Uses A/F mouthwash daily Soaks denture weekly in “Steradent ” solution Dentures in poor condition

6 Extra-Oral Examination No facial asymmetry Nil pain in trismus No palpable lymph nodes Lips and soft tissue all competent TMJ – NAD Nil clicking, pain, normal opening, deviation Skeletal class I

7 Chart Key:= Acrylic Denture

8 Intra-oral Examination Soft tissues Lips – Nothing abnormal detected (NAD), Competent lips, medium lip line Tongue – NAD Floor of Mouth – NAD Buccal Mucosa – NAD Parotid Secretion - NAD Palate – small sore and raised mucosa on posterior border of current denture. Pt reports flared up recently will check again at N/V

9 Intra-oral Examination Upper and lower arches Medium resorption on upper residual alveolar process Gross resorption on lower residual alveolar process Existing denture F/F with deteriorated soft lining on lower Chipped UR 1 when patient dropped when cleaning Under extended palatal border Under extended sub lingual depth Reduced OVD

10 Initial Photographs

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15 Diagnosis/Treatment Plan Diagnosis Under extended upper denture Under extended lower denture Rough and deteriorated Soft lining through poor care Reduced OVD Treatment plan Make new Full/Full denture Improve Fit in highlighted areas Increase OVD Improve patients denture cleaning routine

16 Possible referral Patient referred to patient liaison nurse within practice to instruct on cleaning routine for denture with impaired sight and limited dexterity Patient referred into myself internally as routine for prosthetics cases

17 Appointment 1 Consent taken Consultation – C/O, History of complaint MH, DH, SH documented Exam E/O & I/O Reline impression in current denture to asses posterior extension tolerance Upper denture extended with green stick, light bodied silicone wash taken. Consent to dental photographs given

18 Appointment 2 Raised mucosal sore checked -NAD Relined denture fitted Extended to assess patients tolerance of posterior extension

19 Appointment 2 Primary impressions Taken using alginate in stock trays

20 Appointment 2 Primary impressions Taken using alginate in stock trays

21 Appointment 3 Secondary impressions Border moulded with medium silicone

22 Appointment 3 Secondary impressions Border moulded with medium silicone

23 Appointment 3 Secondary impressions Silicone “take one” body used

24 Appointment 3 Secondary impressions Silicone “take one” body used

25 Appointment 4 Occlusal registration Registration rims made on clear base upper to asses retention and acrylic temporary base lower to act as even spacer for soft lining Manchester block used on lower to asses neutral space Shade discussed and taken Facial aesthetics marked on registration blocks

26 Appointment 5 Try-in ready

27 Appointment 5 Try-in Stage Enigma teeth used for set up at laboratory Hard bases ensured we could take time and denture remained stable in the mouth Bite checked and adjusted chair side for high spots Extended upper posterior border tolerated well

28 Appointment 6 Denture fit Stage Upper denture adjusted at labial extensions No adjustment required to lower denture No adjustment needed to bite

29 Appointment 7 Review Stage 2 weeks post insertion review Patient feels upper retention greatly improved and new soft lining making dentures more comfortable to eat with. Adjusted the naso-labial extension once again as causing slight friction sore. Patient happy with feel and function of dentures

30 Pre and post treatment photographs

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32 Maintenance/Recall Patient given instruction on cleaning the denture and maintaining the soft lining without damaging the soft material Patient to continue annual check up at practice Told TCA if any problems occur Treatment complete

33 Reflection Following mentors advice on extending the current denture first to ensure patient could tolerate before we proceeded further with the treatment worked well As visually impaired, aesthetics were not a priority to the patient yet using good materials allowed us to get good result Denture cleaning advice should ensure new dentures stay in good condition for longer


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