Tratamiento Protésico para Pacientes Edéntulos

Front cover
Inside front cover
Prosthodontic Treatment for Edentulous Patients
Copyright page
Dedication
Contributors
Preface
Acknowledgments
Table of Contents
I The Patient
	1 The Edentulous State
		Historical Context and Current Considerations
		Biomechanical Support for  the Natural Dentition
		Biomechanical Support Mechanisms for  Complete Dentures
			Mucosal Support and Masticatory Loads
			The Residual Ridges
		Natural and Prosthetic Dental Occlusion: Functional and Parafunctional Considerations
			Function: Mastication and Other Mandibular Movements
			Parafunctional Considerations
		Changes in Morphological  Face Height and  the Temporomandibular Joints
			Temporomandibular  Joint Changes
		Esthetic Changes
		Behavioral and  Adaptive Responses
		Treatment Options:  Complete Dentures
		Treatment Options:  Implant Prosthodontics
		Bibliography
	2 Systemic Health Aspects and Nutritional Considerations for Edentulous Patients
		Mucosal Conditions
			Vesiculoerosive
			Systemic Lupus  Erythematosus (SLE)
			Burning Mouth Syndrome
		Oral Movement Disorders
		Salivary Dysfunction
			Sjögren’s Syndrome
			Hypersalivation/Hyposalivation
		Diabetes
		Nutrition and the Impact of Dental Status on Food Intake
			Dietary Counseling of  Patients Undergoing Prosthodontic Treatment
		Summary
		References
	3 The Aging Edentulous Patient
		The Aging Population
		Distribution and Impact of Edentulism in Old Age
			Distribution
			Impact
		The Impact of Age on  the Edentulous Mouth
			Mucosa
			Bone
			Saliva
		Jaw Movements in Old Age
		Taste and Smell
		Nutrition
		Aging Skin and Teeth
			Skin
			Teeth
		Concerns for Personal Appearance in Old Age
		Summary
		References
	4 Sequelae Caused by Wearing Complete Dentures
		Control of Sequelae with  the Use of Complete Dentures
		Dentures in Their  Oral Environment
		Direct Sequelae: Changes in Local Mucosal Morphology
			Traumatic Ulcers and  Cheek Biting
			Denture Irritation Hyperplasia
			Denture Stomatitis
				Candida-Associated Denture Stomatitis  (Fig. 4-5)
				Etiology and Predisposing Factors
				Management and Preventive Measures
			Flabby Ridge and Pendulous Maxillary Tuberosities  (See Also Chapter 5)
			Hyperkeratosis and Oral Cancer
			Residual Ridge Reduction
		Indirect Sequelae: Changes  in Functional Morphology
			Atrophy of Masticatory Muscles
			Nutritional Status and Masticatory Function
		Control of Sequelae with  the Use of Complete Dentures
		Summary
		References
		Bibliography
II Treatment Options
	5 History Taking, Treatment Planning, and Improving Denture-Bearing Areas for Edentulous Patients
		On History Taking and Treatment Planning for Edentulous Patients
			The First Visit
				Patient Attitude
				General Health and  Dental History
			Treatment Planning
				Social and Behavioral Information
				Psychological Considerations
				Systemic Health Status
			Extraoral Examination
				Temporomandibular Joint
					Cheeks and Lips (Fig. 5-1)
			Intraoral Examination
				Mucosa (Figs. 5-2 and 5-3)
				Infection (Fig. 5-5)
				Tongue (Fig. 5-6)
				Saliva (See Also Chapter 2)
				Bone Ridge Morphology
				Tori (See Figs. 5-2 and 5-3)
				Bony Undercuts (Fig. 5-8)
				Arch Relations
				Enlarged Maxillary Tuberosities (Fig. 5-9)
			Existing Dentures (Fig. 5-10)
			Additional Considerations with the Partially  Dentate Patient
			Radiographs, Photographs, Measurements
				Radiographic Images (Fig. 5-13)
				Photographic Images
				Measurements
			Diagnostic/Study Casts
			Financial Implications
			Development of  the Treatment Plan
			Summary
		Improving Denture-Bearing Foundations for  Edentulous Patients
			Preprosthetic Nonsurgical Methods
				Managing Traumatized Tissues
				Occlusal Correction of  the Old Prostheses
			Preprosthetic Surgical  Methods
				Surgical Correction of Conditions that Preclude Optimal Prosthetic Function
					Hyperplastic Ridge, Epulis Fissuratum,  and Papillomatosis (Fig. 5-17)
					Frenular Attachments and Pendulous Maxillary Tuberosities
					Bony Prominences, Undercuts,  Spiny Ridges, and Tori
					Pressure on the Mental Foramen
					Ridge Parallelism
				Enlargement of Denture- Bearing Areas
					Vestibuloplasty
					Ridge Augmentation
				Discrepancies in Jaw Size
				Replacement of Tooth Roots with Osseointegrated  Dental Implants
			Summary
		Bibliography
			On History Taking and Treatment Planning for  Edentulous Patients
			Improving Denture-Bearing Foundations for  Edentulous Patients
	6 Additional Treatment Planning Options for Both Edentulous and Potentially Edentulous Patients
		Considerations for Implant Prosthodontic Treatment
			Maladaptive Denture Behavior
			The Scientific Era in Implant Prosthodontics
			Patient Considerations
			Treatment Outcome Considerations
			Summary
		The Potentially Edentulous Patient to be Treated with Overdentures
			Advantages and Disadvantages of the Overdenture Technique
			Indications and  Treatment Planning
				Group 1
				Group 2
			Selection of Abutment Teeth
			Methods and Techniques for Enhancing the Overdenture’s Retentive Role
			Loss of Abutment Teeth
			Summary: Treatment  Outcome Studies
		The Potentially Edentulous Patient to be Treated with Immediate Dentures
			Advantages and Disadvantages of Immediate Denture  Treatment
			Contraindications to Immediate Denture Treatment
			Treatment Planning the Choice of the Immediate Denture Clinical Technique  or Protocol
				Explanation to the Patient
				Oral Examination
				Examination of Any Existing Prosthesis If it is to be  Included in an Iid
				Tooth/Teeth Modifications
				Prognosis
				Referrals/Adjunctive Care
				Oral Prophylaxis
				Other Treatment Needs
		Bibliography
			Considerations for Implant Prosthodontic Treatment
			The Potentially Edentulous Patient to Be Treated  with Overdentures
			Immediate Dentures for Potentially Edentulous Patients
III The Materials Used
	7 Materials Used in the Management of Edentulous Patients
		Impression Materials
			Nonelastic Impression Materials
				Impression Plaster
				Zinc Oxide Eugenol (ZOE) Impression Paste
				Dental Impression Compound  (Types I and II)
					Important Considerations for Proper Use  of Impression Compound
			Elastic Impression Materials
				Hydrocolloids
					Agar (Reversible Hydrocolloid).
						Composition and Manipulation of Agar (Box 7-5).
					Alginate (Irreversible) Hydrocolloid Material (Box 7-6).
						Technical Considerations in the Manipulation  of Alginates
			Elastomeric Impression Materials
				Recommended Technique for Final Elastomeric Impressions
				Points of Importance When  Handling Elastomers
				Polysulfide Rubber
				Condensation Silicone (Box 7-8)
				Addition Silicones (Box 7-9)
				Polyether Impression Materials
				Disinfection of Elastomeric  Impression Materials
			Summary of Impression Material
		Polymeric Denture  Base Materials
			Technical Considerations  and Properties of Denture  Base Resins
				Heat-Activated PMMA
					The Polymerization Cycle.
					Denture Base Porosity.
				Rapid-Cure Type Resins
				The Bond Between Heat-Cured Denture Bases and Resin Denture Teeth
				Biocompatibility of  Methacrylate-Based Resins
				Residual Monomer Content
				Radiopacity of Denture Bases
				Injection Molding Technique
				Chemically Activated Resins (Box 7-13)
				Pour or Fluid Resin Technique
				Microwave-Activated Resins (Box 7-14)
				Light-Activated (VLC) Resins (Box 7-15)
				Modified Resin Base Materials (Box 7-16)
		Materials Used in  the Fabrication of  Prosthetic Denture Teeth
			Methacrylate-Based (PMMA)  Resin Teeth
				Technical Considerations
				Esthetics of Methacrylate Resin Teeth
				Additional Advantages and Disadvantages  of Methacrylate Resin Teeth
			Composite Resin Denture Teeth
			Porcelain Teeth
				Additional Advantages and Disadvantages  of Porcelain Teeth
			Summary of Prosthetic Teeth
		Denture Lining Materials
			Short-Term Soft Liners  (Tissue Conditioners)
				Rheological and Viscoelastic Properties  of Tissue Conditioners
			Self-Administered Home Relines*
			Long-Term Soft Liners
				Methacrylate Resin and Heat-Activated Resilient Liners
				Chemically Activated Methacrylate Resins
				Silicone-Based Soft Liners
					Heat-Activated Silicone Liners.
					Chemically Activated Silicone Liners (Room Temperature Vulcanized [RTV] Silicones).
			Summary of Denture  Lining Material
		Cast Metal Alloys as  Denture Bases
			Technical Considerations
			Cobalt-Chromium Alloys
			Cobalt-Chromium Nickel Alloys
			Nickel-Chromium Alloys
			Properties of Base Metal Alloys Used in Removable Prostheses
				Physical Properties
				Mechanical Properties
				Chemical Properties
				Biocompatibility
			Commercially Pure Titanium  and Its Alloys
			Titanium Alloys
		Denture Cleansers
			Cleansing and Disinfecting
			Mechanical Techniques
			Chemical Denture Cleansers
				Oxygenating Cleansers
				Hypochlorite Solutions
			Other Techniques and Materials
				Ultrasonic Units
				Dilute Acids
				Enzyme-Containing Denture Cleansers
				Silicone Polymers
				Microwave Radiation
			Adverse Reactions  to Denture Cleansers
			Summary of Cleansers
		Denture Adhesives
			Adjunctive Retention by Using Denture Adhesives
			Indications and Contraindications  for Denture Adhesive
			Application of Denture  Adhesives
			Adverse Reactions  to Denture Adhesive
		Summary
		Bibliography
IV Clinical Protocols for Diverse Treatment Scenarios
	8 Maxillary and Mandibular Substitutes for the Denture-Bearing Area
		Anatomy Of Supporting Structures
			Mucous Membrane
			Residual Ridge
		Maxilla
			Peripheral Border Tissues  And Contours
		Mandible
			Peripheral Border Tissues  And Contours
		Principles And Objectives  Of Impression Making
			Impression Procedures
		Preliminary Impressions:  Trays, Materials, Technique
		Final Impressions: Trays, Materials, Technique
			Posterior Palatal Seal
			Boxing Impressions  And Making The Casts
		Summary
		Bibliography
	9 The Dentures’ Polished Surfaces, Recording Jaw Relations, and Their Transfer to an Articulator
		Neutral Zone or Arch  Form Design
			Mandibular Arch
			Maxillary Arch
		Level or Height of  the Occlusal Plane
		Establishing the Desired Vertical Dimension  of Occlusion
			Esthetics
			Phonetics (See Chapter 15)
			Mechanics
		The Preliminary Centric Relation Record (Box 9-1)
		Relating the Patient  to the Articulator
			Facebow
			Laboratory Steps
		Articulators
		Types of Patient Records
			Interocclusal Records
			Graphic Records
			Hinge-Axis Records
		On Selecting an Articulator for Making Complete Dentures
			Programming the Articulator
				Condylar Elements (Fig. 9-14, A)
				Incisal Elements (Fig. 9-14, B and C)
				Arbitrary Settings
		Bibliography
	10 The Occlusal Surfaces:
		On Meeting Patient  Expectations When  Selecting Teeth
		On Guiding Patient Decisions
		Additional Clinical and Technical Considerations  in Anterior Tooth Selection
			Patient Preferences
			Overdentures and  Implant Dentures
			Opposing Natural Teeth
		Materials for Denture Teeth
		Posterior Tooth Molds  and Cuspal Anatomy
		Ten Landmarks for Complete Denture Teeth Setup
		The “Standard Anterior” Arrangement
			Arranging the Mandibular Anterior Teeth (Fig. 10-9)
				Mandibular Central Incisor Positions
				Mandibular Lateral Incisors
				Mandibular Canines
			Setting The Maxillary  Anterior Teeth (Fig. 10-10)
				Maxillary Central Incisors
				Maxillary Lateral Incisors
				Maxillary Canines
			“Anteriors Only” Try-In
			Arranging Posterior Teeth
				Number of Posterior Teeth Set
		Occlusal Concepts for Complete Denture Occlusion
			Lingualized Articulation
				Arranging Maxillary Posterior Teeth  to Lingualized Articulation (Fig. 10-15)
			Arranging Anatomical Teeth  to a Balanced Articulation  (Fig. 10-16)
				Setting the Mandibular Teeth First
				Evaluating Bilateral Balanced Articulation
			Arranging Nonanatomical Teeth To Monoplane Articulation (Fig. 10-17)
			Arranging Nonanatomical Teeth With A Balancing Ramp  (Fig. 10-18)
			Arranging Nonanatomical Teeth To Balanced Articulation (Fig. 10-19)
		Setups For Retrognathic and Prognathic Facial Skeletons
			The Lingual Look Test (Fig. 10-23)
			Completing The Wax-Up For  The Try-In Appointment (Fig. 10-24)
		Summary of Tooth Selection and Arrangement
		Bibliography
	11 The Try-in Appointment
		Before The Try-In Appointment
		At The Try-In Appointment
			Explanation
			Chairside Comparison
			Denture Comparison
		The Real Try-In
			Speaking And Phonetic Assessment
			Vertical Dimension Of Occlusion
			Check the Dental Occlusion
			Relaxing and Rehearsal  of a Relaxed Jaw Closure
			Single-Base Stabilization  for Try-In Assessment  (Fig. 11-13)
			Double-Base Stabilization  for Try-In Assessment  (Fig. 11-14)
			When Is A Remount Needed?
				Remount at Increased Vertical  Dimension (Fig. 11-17)
				Remount at Correct Vertical Dimension  (Fig. 11-18)
				The Interappointment Laboratory Procedure for the Wax Try-in Remount (Fig. 11-19)
				Resetting the Dentition for Try-in
			Try-In For Esthetics
				The Next Level: Characterization of Individual Tooth Colors and Position
		Establishment of the Posterior Palatal Seal (PPS)
		Final Decision Making  and Closure
			The Laboratory Prescription
		Summary
		Bibliography
	12 Prosthesis Insertion and Follow-up Appointments
		Waxing and Processing  the Dentures
			Development of the Proper Forms of the Polished Surfaces
			Completion of Wax-Up  and Festooning
			Formation and Preparation  of the Mold
			Packing the Mold
			Fabrication of Facebow Transfer Jig
			Laboratory Remount  and Equilibration (As # 2 Remount in Table 11-2)
			Removing Processed Dentures from the Master Casts
			Finishing and Polishing Dentures
			Fabrication of Clinical Remount Casts
			Hydrate the Dentures
		Delivery of the Completed Dentures
			Elimination of Basal  Surface Errors
			Adjustment of Denture Base
			Adjustment of Denture Borders
			Errors in Occlusion
			Clinical Remount and  Occlusal Equilibration  (As #3 Remount in Table 11-2)
			Centric Relation Record
			Remount the Mandibular Denture
			Verifying Centric Relation
			Protrusive Record (Optional)
				Eliminating Occlusal Errors  in Anatomical Teeth
				Eliminating Occlusal Errors  in Nonanatomical Teeth
			Advantages of Balanced Occlusion in Complete Dentures
			Special Instructions  to the Patient
				Individuality of Patients
				Appearance with New Dentures
				Mastication with New Dentures
				Speaking with New Dentures
				Oral Hygiene with Dentures
				Preserving the Residual Ridges
				Educational Material  for Patients
		Follow-Up Appointments
			Twenty-Four-Hour Oral Examination and Treatment
				Examination Procedures
				Adjustments Related  to the Occlusion
				Adjustments Related  to the Denture Bases
			Subsequent Oral Examinations and Treatments
				Periodic Recall for  Oral Examination
		Bibliography
	13 Modified Protocols for Immediate Dentures, Overdentures, and Single Dentures
		Immediate Dentures
			Preliminary Impressions
			Final Impression
			Posterior Palatal Seal
			Maxillomandibular  Relationship Records
			Denture Teeth Arrangement
			Laboratory Procedures
			Teeth Removal and  Denture Insertion
			Postoperative Care
		Overdentures
			Treatment Planning  for Overdentures
			Retention
			Insertion
		Clinical and Laboratory Procedures
			Tooth-Supported Complete Denture
			Tooth-Supported Immediate Complete Denture
			Maintenance
		Single Denture
			Diagnosis and Treatment Planning
			Teeth Arrangement
		Summary
		Bibliography
	14 Prolonging the Useful Life of Complete Dentures:
		Rebasing/Relining
		Treatment Rationale
		Diagnosis
		Preliminary Treatment
		Clinical Impression Procedures
			Static Impression Technique
			Functional Impression Technique
			Chairside Technique
			Relining/Rebasing Materials
		Repairs
		Denture Duplication  (see Chapter 23)
		Bibliography
	15 Speech Considerations with Complete Dentures
		Speech Production
		Speech Production: The Role  of Teeth and Other  Oral Structures
			Bilabial Sounds
			Labiodental Sounds
			Linguodental Sounds
			Linguoalveolar Sounds
				Articulatory Characteristics
				Acoustic Characteristics
				Auditory Characteristics
			Linguopalatal and  Linguovelar Sounds
		Methods for Speech Analysis
		Prosthetic Considerations
		Special Consideration  in Implant Prosthodontics
		Summary
		Bibliography
V Clinical Protocols Specific to Implant-Retained and Implant-Supported Prosthodontic Management
	16 The Science of Osseointegration
		Osseointegrated Interface
		Factors That Determine  Success and Failure of Osseointegration
			Implant Biocompatibility
			Implant Design
			Implant Surface
			Host Bed
			Surgical Technique
			Loading Conditions
		Summary
		Bibliography
	17 Implant Overdentures
		General Overdenture  Treatment Considerations
		Inclusion and Exclusion Criteria
		Presurgical Evaluation  and Treatment Planning
		Surgical Protocol and  the Osseointegration Phase
		Prosthodontic Protocol
			Guidelines for Selecting Attachment Systems
				Indications for Ball or  Magnetic Attachments
				Indications for Bar Attachments
			Implant Overdenture Design
			Clinical and Laboratory Procedures
		Maintenance
		Bibliography
	18 Fixed Full Arch Implant-Supported Prostheses for the Edentulous Patient
		Patient Selection
		Considerations Specific  to the Edentulous Mandible
			Immediate Load Rehabilitation of the Edentulous Mandible
				Step-by-Step Procedures
		The Edentulous Maxilla
		Summary
		References
	19 Maxillofacial Prosthodontics for the Edentulous Patient
		Form and Function
			Anatomic and Physiologic Considerations:  Normal Function
			Functional Deficits of Speech and Swallowing
		Prosthetic Considerations  for Edentulous Maxillofacial Prosthesis
			Facial Form
			Loss of Vertical Opening and Altered Mandibular Movements
			Processed Bases
		Border Molding Soft Palate and Maxillary Defects
			Border Molding The Velopharyngeal Area:  Patient Movements
			Border Molding Peripheries  of Maxillary Resections  and Hard Palate Defects:  Patient Movements
			Testing The Prosthetic “Seal” Between The Oral Cavity  and The Nasal Cavity
		Maxillary Obturator  Prosthesis
			Immediate Surgical  Obturator Prosthesis
			Interim Obturator Prosthesis
			Definitive Obturator Prosthesis
			Troubleshooting An  Obturator Prosthesis
				Lack of Retention
				Nasal Reflux
				Hypernasality
		Soft Palate Obturator Prosthesis
			Troubleshooting The Soft  Palate Obturator Prosthesis
				Prosthesis Feels Too Long
				Hypernasality
		Palatal Augmentation Prosthesis
			Clinical Examination
			Informing The Patient
		Mandibular Resection Prostheses
			Marginal Mandibulectomy Prostheses
			Discontinuity Mandibulectomy Prostheses
			Troubleshooting Prostheses  For The Patient With An Edentulous Mandibulectomy
				Unstable Mandibular Denture
				Inability to Chew or Inability to  Chew Beyond a Soft Diet
			Prostheses For Reconstructed Mandibles
		Maxillofacial Implant-Assisted Prostheses For The  Edentulous Patient
			Risks and Benefits  Assessment of Implants  In Irradiated Tissues
				Risk of Osteoradionecrosis
				Hyperbaric Oxygen Therapy
				Irradiation of Existing Implants
			Prosthodontic Treatment Considerations For The Irradiated Edentulous Patient
				Timing of Denture Placement
				Salivary Consideration for the Irradiated Edentulous Patient
				Occlusal Forms
				Delivery and Postinsertion Care
		Bibliography
	20 Managing Problems and Complications
		Problems
		Complications
			Surgically Related Complications
				At Stage I Surgery
				Interval Between Stage I and Stage II
				At Stage II Surgery
			Prosthodontic-Related Complications (Table 20-2)
				Abutment Related
				Impression Related
				Try-in of Tooth Arrangement
				Framework Try-in
			Insertion Of Prosthesis
				Implant-Supported Fixed Prosthesis
				Implant-Supported Overdenture
			Postinsertion
				Biological Complications
				Mechanical/Prosthodontic Complications
		Summary
		Bibliography
	21 Immediately Loaded Complete Dental Prostheses
		Immediate Load Complete Denture Technique
		References
	22 Current and Possible Future Directions in Implant Prosthodontics
		Systemic Health and Host  Bone Response
			Smoking
			Osteoporosis
			Bisphosphonate Therapy
			Irradiation Therapy
			Other Systemic Conditions
		Imaging Protocol
		Surgical Protocols
			Bone Quality
			Bone Quantity And  Site Improvement
		Prosthodontic Loading
		Oral Ecological Concerns
		Summary
		Bibliography
VI Additional Considerations in the Management of Edentulous Patients
	23 The Impact of Socioeconomic, Cultural, and Technological Changes and the Notion  of Standards of Care and Alternative Protocols
		Standards Of Care
		Minimum Acceptable Protocols
		An “Appropriatech” Method  For Complete Dentures In  Four Clinical Sessions
			First Clinical Session
				Impressions
				Position of Maxillary Anterior Teeth
				First Laboratory Session
			Second Clinical Session
				Establishing the Vertical Dimension  of Occlusion
				Recording the Horizontal Jaw Relationship
				Second Laboratory Session
			Third Clinical Session
				Remount and Occlusal Adjustment
				Counseling the Patient
			Fourth Clinical Session
			Summary
		Reproducing Complete Dentures
			First Clinical Session
			First Laboratory Session
			Second Clinical Session
			Second Laboratory Session
				Third Clinical Session
		Adaptation And Advancing Technology
		Summary
		References
		Bibliography
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	X
	Z