Application of the Neutral Zone in Prosthodontics

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  

Table of Contents:
Foreword ix Preface  xi About the Companion Website xiii 1 Assessment of Edentulous Patients 1 Introduction  1 The Patient Interview 1 Patient Interview: Age 2 Patient Interview: Attitude 2 Patient Interview: Expectations 2 Patient Interview: Chief Complaint 3 Patient Interview: General Health 3 Patient Interview: Complete Denture Experience 3 Patient Interview: Denture Remake Frequency 4 Patient Interview: Patient Satisfaction 4 Patient Interview: Photographs, Diagnostic Casts, and Radiographs 4 The Facial Analysis  4 Facial Analysis: Facial Tissue Tone  5 Facial Analysis: Tooth and Denture Base Display  6 Facial Analysis: Midlines 6 Facial Analysis: Lip Mobility 7 Facial Analysis: Lip Dimension  7 Prosthetic Factors 8 Prosthetic Factors: Vertical Dimensions 8 Prosthetic Factors: Existing Dentures 8 Prosthetic Factors: Skeletal Relationship 9 Prosthetic Factors: Saliva 9 Prosthetic Factors: Oral Tolerance 10 Prosthetic Factors: Temporomandibular Joints 10 Prosthetic Factors: Oral Cancer Review 10 Oral Characteristics 11 Oral Characteristics: Palatal Throat Form 11 Oral Characteristics: Arch Size 11 Oral Characteristics: Maxillary Ridge Height 11 Oral Characteristics: The Palate 12 Oral Characteristics: Maxillary Ridge Contour 13 Oral Characteristics: The Maxillary Denture Foundation 13 Oral Characteristics: Mandibular Ridge Height 14 Oral Characteristics: Mandibular Ridge Contour 14 Oral Characteristics: Mandibular Muscle Attachments 14 Oral Characteristics: Mandibular Denture Foundation  15 Oral Characteristics: Maxillary Tuberosity Curve 15 Oral Characteristics: Vestibule 16 Oral Characteristics: Frenula Attachments 16 Oral Characteristics: Pterygomandibular Raphe 16 Oral Characteristics: Denture Bearing Soft Tissues 16 Oral Characteristics: Retromolar Pads 17 Oral Characteristics: Maxillary Ridge Crest to Resting Lip Length (Esthetic Space) 17 Oral Characteristics: Mandibular Ridge Crest to Resting Lip Length (Esthetic Space) 17 Oral Characteristics: Maximal Oral Opening 17 Oral Characteristics: Retromylohyoid Space 18 Oral Characteristics: Tongue Size 19 Oral Characteristics: Tongue Position 19 Oral Characteristics: The Neutral Zone 20 Summary  21 References  21 2 Orthopedic Resolution of Mandibular Posture 25 Introduction 25 Conditioning Abused Tissues and Stabilizing the Existing Prosthesis 26 Materials Properties and Technique 26 Technique 26 Re?-establishing Orthopedic Mandibular Position 28 Summary  33 References  33 3 Definitive Impressions 35 Preimpression Considerations 35 Background  35 Impression Fundamentals 35 Impression Materials 36 Edentulous Impression Trays 37 Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures 37 Tray Selection and Tray Adaptation 37 Fabrication of Tray Stops 38 Border Molding the Impression Tray 39 Final (Definitive) Impression  41 Techniques for Making Single Appointment Definitive Impressions for Implant?-Assisted Complete Dentures and Immediate Dentures  43 Attachment Selection 43 Implant?-Retained Overdentures 43 Tray Selection 43 Impression Technique 44 Implant?-Retained and Supported Overdentures 45 Immediate Dentures 46  Master Cast Production 47 Summary  48 References  48 4 Fabricating Record Bases, Occlusal Rims, and Mounting a Central Bearing Device 51 Introduction 51 Fabrication of Record Base and Occlusal Rims 51 Fabrication of Maxillary Wax Occlusal Rim 52 Fabrication of Neutral Zone Mandibular Occlusal Rim 56 Technique 56 Jaw Recorder Device (Central Bearing Device) 59 Jaw Recorder Device Assembly  59 Mounting the Jaw Recorder Device on Record Bases 59 Mounting of the Jaw Recorder for Implant Overdentures 61 Mounting the Jaw Recorder Device on Partially Edentulous Arches 61 Procedure 62 Summary  62 References  64 5 Developing an Esthetic Blueprint  65 Introduction 65 Contouring and Shaping the Maxillary Occlusal Rim 65 Summary  72 References  72 6 Registering the Maxillo?-Mandibular Jaw Relationship 75 Introduction 75 Facebow Recording  75 Centric Relation Recording for the Edentulous Patient 76 Centric Relation Recording for the Partially Dentate Patient 83 Summary 86 References  86 7 Neutral?-Zone Registration  89 Introduction 89 Recording the Physiologic Neutral Zone for Edentulous Patients 89 Technique 90 Recording the Physiologic Neutral Zone for a Dentate Patient 94 Technique 94 Summary  96 References  96 8 Second Laboratory Procedure: Selection and Arrangement of Prosthetic Teeth 99 Introduction 99 Indexing the Esthetic Blueprint Record 99 Indexing the Neutral Zone Record 100 Selection of Anterior Teeth 101 Maxillary Anterior Teeth Arrangement 102 Mandibular Anterior Teeth Arrangement  103 Selection of Posterior Teeth 105 Mandibular Posterior Teeth Arrangement 106 Maxillary Posterior Tooth Arrangement 108 Tooth Selection and Arrangement for the Partially Edentulous Patient 109 Summary  111 References 111 9 Trial Placement Appointment 113 Trial Placement 113 Evaluation of Esthetics  113 Evaluation of Phonetics 114 Evaluation of Occlusal Vertical Dimension (OVD)  116 Evaluation of Centric Contact Position 116 External Impressions 117 Technique 118 Summary  124 References 125 10 Denture Placement 127 Introduction 127 Placement of Immediate Dentures 127 Placement Procedures 129 Evaluation and Adjustment of Intaglio Surface 129 Technique 129 Evaluation and Adjustment of Denture Borders 131 Evaluating the Cameo Surface 133 Occlusal Evaluation and Correction 133 Subtractive Correction Technique 135 Additive Correction Technique 136 Patient Education and Instructions 137 Technique for Adhesive Application 138 Technique for Adhesive Removal 138 Home Care Instructions for Denture Patients 140 Postplacement Problems with New Dentures 140 Retention Problems 140 Soreness 141 Sore Throat 141 Speech Problems 141 Gagging 141 Summary  142 References 142 11 Use of CAD/CAM Technology for Recording and Fabricating Neutral?-Zone Dentures  145 Introduction 145 Registering the Neutral Zone during Impression Making 145 Technique 145 Registering the Neutral Zone during Maxillo?-Mandibular Records 147 Technique 147 Registering the Neutral Zone during the Trial Placement 147 Technique 147 Summary  150 References 151 Index 153

About the Author :
The authors Joseph J. Massad, DDS, is Associate Professor in the Department of Prosthodontics at the University of Tennessee Health Center, School of Dentistry in Memphis, Tennessee, USA; Adjunct Associate Professor in the Department of Prosthodontics and Operative Dentistry at Tufts University School of Dental Medicine in Boston, Massachusetts, USA; Adjunct Associate Professor in the Department of Comprehensive Dentistry at the University of Texas Health Science Center, School of Dentistry in San Antonio, Texas, USA; Adjunct Associate Professor in the Department of Restorative Dentistry at Loma Linda University School of Dentistry, in Loma Linda, California, USA; Clinical Assistant Professor at the University of Oklahoma College of Dentistry in Oklahoma City, Oklahoma, USA; and Private Practice in Tulsa, Oklahoma, USA. David R. Cagna, DMD, MS, is a Professor in the Department of Prosthodontics, Associate Dean of Postgraduate Affairs & Director of Advanced Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry, Memphis, Tennessee, USA; Diplomate & Director of the American Board of Prosthodontics; and Fellow of the American College of Prosthodontists. Charles J. Goodacre, DDS, MSD, is Distinguished Professor in the Department of Restorative Dentistry at Loma Linda University School of Dentistry in Loma Linda, California, USA; and Diplomate and Past-President of the American Board of Prosthodontics. Russell A. Wicks, DDS, MS, is Professor and Chairman in the Department of Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry in Memphis, Tennessee, USA. Swati A. Ahuja, BDS, MDS, is Adjunct Assistant Professor in the Department of Prosthodontics at the University of Tennessee Health Science Center, College of Dentistry in Memphis, Tennessee, USA; and Prosthodontic Consultant at Lutheran Medical Center in New York City, New York, USA.