Pre-prosthetic treatment in PTA
Introduction :
When a patient comes to our consultation with a view to being fitted with a complete removable prosthesis, it is rare that he is ready, psychologically and physiologically, to undergo all the stages of the construction of a prosthesis and to adapt to it without difficulty.
Pre-prosthetic treatment consists of preceding the prosthetic treatment with a conditioning , a transitional prosthesis and in certain cases when it is recommended, pre-prosthetic surgery.
Definition of pre-prosthetic treatment:
Corresponds to all the preliminary therapies intended to correct certain anomalies or alterations of the bones and mucous membranes of the support surfaces, but also to resolve occlusal, aesthetic, phonetic problems, bone base shifts and the management of psychological problems.
When to perform pre-prosthetic treatment:
- Nervous, aggressive, angry, emotional, pessimistic patient.
- Patient who has already had unfortunate prosthetic experiences.
- Non-existent support surfaces.
- Shallow, slightly depressible mucous reflection line.
- Muscle or ligament insertions located too close to the ridge line.
- Ridge line is painful at the slightest touch.
- Narrow, agitated tongue, in a high or retracted position.
- Traumatized supporting tissues.
- Gag reflex.
Aggravating factors:
- The impact of general unrest.
- Drug treatments.
- Side effects of certain therapeutic actions.
- Lack of hygiene in life.
The pre-prosthetic treatment stage can be surgical or non-surgical, more particularly conditioning.
Definition :
Conditioning consists of all the preparations and therapies intended to place the patient in ideal psychological and physical conditions to receive a prosthesis.
Indications:
- bruised or displaced tissue resulting from a prosthetic base that is too narrow and too small.
- An underestimation of the vertical dimension of occlusion. Changing the position of the tongue and the orbiculo-buccinator girdle causes mandibular progression, to compensate for this the mandible will occupy a higher and more advanced position than normal.
- An overestimation of the vertical dimension of occlusion, resulting in abnormal compression of the supporting tissues; to compensate for this, the mandible will occupy a lower and more backward position, which leads to disorders at the ATM level.
The different aspects of conditioning
A. Psychic aspect of MEC
-General approach: Psychic MEC will preferably take the form of a cordial conversation.
Anamnesis: Patient’s state of mind
Cooperation is often an expression of the patient’s sense of security.
-Specific approach: based on three points:
Relaxation: (absence of muscular, nervous, mental tension), relaxation,……….
Psychoanalysis: it is a method of psychological investigation aimed at clarifying the causes of refusal to be fitted with a device.
Sophrology: it is a relaxation technique based on hypnosis.
B. Tissue aspect of conditioning:
Indicated in the case of:
- Very resorbed crest.
- Inoperable floating crest.
- Crushing of tubercles or tuberosities.
- Hyperemic, sensitive tissues, injured by a poorly designed prosthesis.
- Toothless patient never fitted with a device.
- Current prosthesis with reduced dimensions.
- After surgery.
Goals :
- Restore all tissues to natural behavior.
- Increase the extent of the support surfaces.
- Reduce occlusion errors.
- Participate in the organic integration of prostheses.
Tissue conditioning technique: used in pre-prosthetic and post-prosthetic situations
General approach: Confiscation of poorly designed prostheses, medication, massage of the support surface, wearing of the prosthesis, special diet.
Approach using conditioners:
A conditioner is a tissue conditioning material. Any plastic or elastic material applied temporarily to the intrados, edges or extrados of a prosthesis to allow the tissues in contact with it to regain their histological, anatomical and physiological characteristics as close as possible to normal.
Composed of :
Powder: polymethylmethacrylate or polyethylmethacrylate.
Liquid: ethanol + aromatic esters (plasticizers).
Its chemical reaction goes through 4 stages: viscous, active plastic, elastic and granular desiccation
Qualities required of an ideal material
- High initial creep to gently mold to mucosal tissues.
- Deform to accommodate changes in tissues.
- Absorb functional pressures and distribute them over the support surface.
Actions:
Directly on the mucous membrane
- Elimination of prosthetic stomatitis or other lesions.
- Allows the body to regenerate these tissues.
- Achievement of clinically healthy mucosa.
Indirectly on the bone
- Helps create a bone organization that is structurally capable of responding effectively to occlusal loads.
- Preserve the bone after extraction.
Pre-prosthetic treatment in PTA
Advice to be given to the patient:
- Do not eat foods that leave grains that could stick to the delayed resin (raspberries, figs, strawberries, etc.).
- Clean the appliance by running it under water.
- Do not use a denture brush.
- Do not use cleaning products that damage the delayed resins.
- Do not place the device on a Kleenex type paper.
2nd session :
- Taking into account the patient’s complaints.
- Examination of the edges, intrados and occlusion.
- Corrections and additions of delayed setting resin.
3rd session :
- Taking into account the patient’s complaints.
- Examination of the edges, intrados and occlusion.
- Corrections and additions of delayed setting resin.
Before last session:
Renovation impression made using Permlastic light at the intrados level.
Post-prosthetic conditioning:
- Recommend removing the prosthesis as often as possible
- Recommend mouthwashes and brushing.
C. Neuromuscular and neuroarticular conditioning:
- Muscle problems: pain, trismus.
- Joint problems: pain, noise, trismus.
- In the presence of a laterodeviation.
- Blockage or pain during propulsion and laterality.
- Mandibular progression.
Goals :
- Forgetting an incorrectly acquired mandibular position.
- Regain normal muscle strains.
- Restore the tongue to a low, balanced position.
- Reorient the POP and restore the DV.
- Facilitate the recording of a RC close to that existing before the loss of dental organs.
- Corrections of condylar trajectories.
Treatment :
a- The role of the tongue in the position of the mandible and in the instability of lower prostheses is preponderant.
Lowering the position of the tongue is sought: muscular exercises.
- protraction-retraction in its lowest position
- Rotate mouth wide open
- Roughness at the level of the extrados of the lower prosthesis in the retroincisal region.
The muscles of facial expression will need to be considered to restore facial balance:
- Exercises in front of the mirror
- Facial massages.
b-Transitional prosthesis:
Allows you to gradually change the height of the prosthesis that the patient wears.
- Underestimated DV: Physiological RIM can be gradually found by addition
- DV overvalued: the cusp reliefs will be unloaded (shaved) and will be replaced by horizontal planes.
D. Aesthetic conditioning:
Conducted simultaneously with other aspects of MEC.
Pre-extraction documents are valuable allies.
Directions:
- current prostheses have not replaced the alveolo-dental wall in its original situation.
- Front teeth too small and too light, giving the smile an artificial appearance
Pre-prosthetic treatment in PTA
E. Phonetic conditioning:
- The aim is to restore the tongue and the organs playing a role in phonation to a physiological position.
- The conditioning prosthesis facilitates the adaptation of the tongue to its new limits.
Pre-prosthetic treatment in PTA
Cracked teeth can be healed with modern techniques.
Gum disease can be prevented with proper brushing.
Dental implants integrate with the bone for a long-lasting solution.
Yellowed teeth can be brightened with professional whitening.
Dental X-rays reveal problems that are invisible to the naked eye.
Sensitive teeth benefit from specific toothpastes.
A diet low in sugar protects against cavities.