Prosthetic insertion
- Introduction
The last and final stage of treatment for total edentulism, the insertion phase should in no case be considered as a simple delivery phase.
TENCH wrote: “The adjustment of a total prosthesis upon delivery is a step as important as the other steps in its construction.”
- Checking prostheses in the patient’s absence:
Prostheses must be delivered in airtight packaging that retains moisture to prevent distortion.
Porosity is sought by transparency. Their presence causes significant secondary distortions, sources of fracture. They most often reflect a too sudden rise in temperature of the resin.
- The intrados and the edges
Any roughness on the intrados or even the edges is looked for with the fingertip, the end of a probe or, better still, a compress which, by clinging to all the irregularities, reveals their presence. The areas or points which catch are delicately removed, using a fine-grained point, then the area is repolished with a small brush coated with descaling paste. The edges, whose thickness is perfectly preserved, must have a smooth appearance.
- The extrados
The polished surfaces must meet the conditions defined by FISH, namely, fill the useful passive space between cheeks, tongue, and lips, and be modeled in such a way that the play of the muscles in action stabilizes the prosthesis.
- Occlusion
At this stage, the assessment of occlusion is limited. It consists of manually establishing the occlusion between the prostheses and then assessing the occlusal stability obtained.
- Mouth checks
The mandibular prosthesis, maxillary prosthesis, occlusion, aesthetics and phonation will be checked successively.
- Mandibular prosthesis control
- The mandibular prosthesis is inserted first to stabilize the tongue in a low position and not create nausea. The practitioner firmly applies the prosthesis to the support surface to uncover all areas likely to trigger pain. If the pressure is accompanied by an analgesic response, the affected point(s) are corrected. These points are highlighted by coating the intrados with a low-viscosity material (silicone).
- Static stability: the prosthesis must not rise while the lips and tongue are at rest, any defect in the orientation of the polished surfaces must be eliminated, and the muscular and frenal insertions cleared.
- Dynamic stability: all these tests will have been carried out during the functional test, light digital pressure exerted on the incisors, canines and molars on one side then the other must not mobilize the prosthetic base.
Then, while the prosthesis is held in place at the center of balance, the patient is asked to perform lingual movements of moderate amplitude; the prosthesis should not move.
- Retention: if the sublingual seal is sufficient, retention should be appreciable, otherwise it will be corrected.
Prosthetic insertion
- Checking the maxillary prosthesis:
It is inserted, centered and applied with sufficient pressure to expel the air trapped underneath and reveal any painful spots, which must be removed with a grinder.
The sequences are comparable to those performed during the mandibular prosthesis check. If the patient is very nauseous, premedication is essential, whether they involve medication or contact anesthesia in cream deposited directly or indirectly at the level of the veil. Stability is tested by bilateral molar pressure, feelings of instability, painful points are immediately highlighted and corrected in the same way as on the mandibular prosthesis.
The edges are then analyzed: release of the brakes, profiles of the extrados, thickness of the edges. Corrections are made then carefully repolished.
Prosthetic insertion
- Inter-arch relationship control
Both prostheses are in the mouth, the patient is asked to clench his teeth on two rolls of cotton for a few minutes. Once the cottons are removed, the patient is asked to clench his teeth, no slippage should be seen. Immediate equilibration is undertaken.
- Aesthetics control
The aesthetic assembly must be consistent with that approved by the patient during the functional and aesthetic trial session. In some cases, the teeth may appear too visible, grinding of the free edges may be considered during a later session.
- Phonetic control
Potentially, each patient is able to adapt phonetically to their new prosthesis . However, some defects can be corrected during this session:
- If the prostheses clash when pronouncing the dento-dentals: che, je, the sibilants: se, ze or the bilabials: pe, be. It will be necessary to reduce the vertical dimension which is too high.
- If a whistling sound occurs when producing the “s”, it is advisable to add material (resin) to the upper retro-incisal region.
- If, on the contrary, a lisp is heard, the thickness of the base at the retro-incisal level is reduced.
- The alteration of the “k” and the “gue” reflects an overextension at the level of the soft palate region.
- Directions for use
We must explain to the patient what is going to happen, that he will have to get used to his prosthesis little by little and that we will be available as long as he has any complaints.
The patient should be advised to eat a soft but not sticky diet for the first few days, with small bites and slow chewing.
Hygiene should be similar to that of natural teeth: brushing twice a day, then immersion in mouthwash (chlorhexidine) or in water, 1 hour per day.
Prosthetic insertion
Untreated cavities can reach the nerve of the tooth.
Porcelain veneers restore a bright smile.
Misaligned teeth can cause headaches.
Preventative dental care avoids costly treatments.
Baby teeth serve as a guide for permanent teeth.
Fluoride mouthwash strengthens tooth enamel.
An annual checkup helps monitor oral health.