Application of the Neutral Zone in Prosthodontics

Joseph J. Massad, David R. Cagna, Charles J. Goodacre, Russell A. Wicks, Swati A. Ahuja

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781119158141
• eBook ISBN: 9781119158585
• Edition: 1
• Topic: Physical Sciences
• Subtopic: Geography
• Index: Geography

Application of the Neutral Zone in Prosthodontics offers a step-by-step guide to successfully designing and placing complete and implant-retained dentures using neutral zone concepts.

• Illustrates every technique described with more than 300 color photos
• Covers all phases of complete denture therapy
• Presents a step-by-step assessment and examination protocol
• Details the importance of accurate diagnosis and prognosis prior to committing to treatment
• Describes an alternative to traditional impressioning procedures that can be accomplished in a single appointment
• Includes access to a companion website with video clips and student handouts, with teaching PowerPoints available for instructors

1
Assessment of Edentulous Patients

Introduction

A critical and somewhat perplexing aspect of the management of the edentulous condition is the prediction of therapeutic outcomes and patient satisfaction. The most fundamental factor determining a precise prognosis is a thorough and accurate pretreatment examination [1–3]. Even though patients may receive the best therapy, the treatment will fail if underlying conditions remain undiagnosed.

This chapter reviews a method for the pretreatment evaluation of edentulous patients and existing prostheses to arrive at a sound understanding of factors that will affect therapy and the probability that the treatment’s objective can be achieved. Using appropriate assessment tools, the practitioner can better determine if the patient’s expectations can be met.

Much has been published in the dental literature regarding anatomic [4, 5] and psychological variations [6, 7] in edentulous patients. Before considering management of these challenging patients, objectives include thorough examination, diagnosis of existing conditions, consideration of available therapy, and assessment of the prognosis of each available treatment option [1, 2]. Both subjective and objective patient factors must be taken into consideration [1]. A rational stepwise pretreatment protocol will help to prevent critical diagnostic information from being overlooked. Detailed documentation of findings is essential from a dento‐legal standpoint.

The pretreatment protocol provided is relatively easy to follow, quick to perform, and easy to reproduce. It yields summary findings that correspond with specific prognostic conclusions. The protocol is divided into: (i) patient interview; (ii) examination of existing facial characteristics; and (iii) examination of edentulous conditions, i.e., anatomic, morphologic, and muscular status.

The Patient Interview

Successful therapy is facilitated by the provider coming to know the patient, from both personal and logistical perspectives; this includes how the patient arrived in the practice. If the patient was referred, the referral source should be known and contacted, and the reason for the referral noted. If the patient arrived due to marketing of the practice, care must be taken to investigate if the patient’s needs are consistent with therapy provided by the practitioner.

The initial patient interview permits the patient and the practitioner to know one another [8]. Quality time spent at the beginning sets the stage for an optimized patient‐provider relationship. Both the physical and psychological status of the patient should be triaged during the first appointment [8]. Anticipation of communication problems and interception of commonly encountered interpersonal problems are frequently as important as clinical findings. Discerning the primary etiology of existing patient dissatisfaction is essential for breaking the cycle of unsuccessful treatment attempts. Complaints and expectations expressed by the patient, and treatment obstacles encountered by previous dentists, can provide a critical influence on the acceptance of the patient into the practice and the treatment offered.

Be aware that the pretreatment protocol provided might initially appear to consume an inordinate amount of time and effort. Some might say that this is financially unjustifiable. However, once understood and skillfully conducted, the protocol reduces overall management time, permits appreciation of the treatment rendered, and significantly contributes to overall therapeutic success.

Some patients may be fearful, nervous, or shy, and inadvertently fail to respond directly to questions. Recognition of these individuals early in the interview process is critical. In many cases, a dental auxiliary can better elicit patient responses than the practitioner. Obtaining honest and accurate patient responses will affect outcomes. The pretreatment protocol and associated electronic documentation presented incorporate data‐gathering processes designed to elicit thorough, concentrated, and accurate answers from patients.

Patient Interview: Age

The patient’s chronological age should be critically compared with general physical health and existing oral conditions. Older patients may be afflicted with poor neuromuscular coordination [9, 10], suboptimal nutritional status [11, 12], diminished adaptability [9, 10], and salivary secretion (both quantity and quality) [11], and highly vulnerable denture‐bearing tissues [10, 11]. These factors adversely influence aging edentulous patients’ ability successfully to tolerate and function with conventional complete dentures, which should be discussed prior to initiating treatment [8]. Analogies such as “when dentures move and there’s limited saliva, the pink plastic acts like sand paper against your gums creating irritation” help patients to understand better the problems that they face.

Patient Interview: Attitude

Coming to appreciate patient attitude may be as simple as presenting nonleading questions and permitting the patient time to respond. Questions that may be used to gauge patient attitude include:

• How are you feeling today?
• How was your experience with the previous dentist that treated you?
• What do you think about your current and previous dentures?

Based on patient responses and ensuing discussions, qualifications of patient attitude as good, average, or poor may be made. Of course, additional questioning may be necessary to arrive at a reasonable determination.

Patient Interview: Expectations

If not thoroughly investigated prior to initiating treatment, patient expectations may not be apparent until problems unexpectedly emerge in the course of therapy, and the patient’s demeanor begins to decline [9, 13]. Direct and sp...

Table of contents

• Cover
• Title Page
• Table of Contents
• Foreword
• Preface
• About the Companion Website
• 1 Assessment of Edentulous Patients
• 2 Orthopedic Resolution of Mandibular Posture
• 3 Definitive Impressions
• 4 Fabricating Record Bases, Occlusal Rims, and Mounting a Central Bearing Device
• 5 Developing an Esthetic Blueprint
• 6 Registering the Maxillo-Mandibular Jaw Relationship
• 7 Neutral-Zone Registration
• 8 Second Laboratory Procedure
• 9 Trial Placement Appointment
• 10 Denture Placement
• 11 Use of CAD/CAM Technology for Recording and Fabricating Neutral-Zone Dentures
• Index
• End User License Agreement