Mandibular arch - occlusal view.

Pretreatment panoramic radiograph, mandible.

Surgical template on cast.

Close view of ball abutments.

Frontal view of mandibular overdenture.

0 Evaluation & Diagnosis
1 Treatment Planning
2 Progress & Completion
3 Follow-Up & Outcome

Patient cases:

Complete-arch treatments

(Maxilla / Mandible / Edentulous)

Maxillary complete denture with a mandibular implant overdenture

Lead:

Charles Goodacre

This patient was unable to wear her existing dentures. There was no residual ridge in the maxilla, only soft tissue. In the mandible, there was extensive resorption with the inferior alveolar canal close to/on the residual ridge. The patient was looking for a comfortable and functionally stable solution.

Evaluation & Diagnosis

Maxillary arch - occlusal view.

Mandibular arch - occlusal view.

Panoramic radiograph - maxillary arch before surgery.

Pretreatment panoramic radiograph, mandible.

Treatment Planning

Surgical template on cast.

Progress & Completion

Osteotomy template in place before implant placement.

Osteotomies for implant placement in the mandibular canine region.

Close view of ball abutments.

Panoramic radiograph (healing abutments placed).

Periapical radiograph of abutment placement.

Mandibular impression.

Excess impression material removed from occlusal surface of mandibular impression.

Neutral zone impression made by having patient swallow 3 times consecutively with medium body impression material on the occlusal surface.

View showing the occlusally expressed material that was squeezed between the tongue and cheek muscles during swallowing.

The lingual surface has a concavity produced by the lateral border of the tongue.

The impression material was trimmed at the level of the lingual tongue depression.

The height of the lingual tongue depression very closely approximates the middle of the retromolar pad and therefore closely represents the height of the occlusal plane.

Putty polyvinyl siloxane impression material pressed around the buccal and lingual surfaces to the height of the trimmed neutral zone impression.

Removal of the impression reveals with neutral zone and the area where the wax occlusion rim should be positioned.

Facial view of wax rim formed in accordance with the neutral zone.

Lingual view of neutral zone wax rim.

Occlusal view of completed neutral zone wax rim.

Lingual view of completed neutral zone wax rim.

Mandibular teeth arranged so their positions coincide with the neutral zone to enhance mandibular denture stability.

Maxillary complete denture made using a Cameo surface impression to record the tissue contacting surfaces of the denture to add stability and facial soft tissue support to the denture. See the Cameo surface impression video from Dr. Massad shown below.

Frontal view of mandibular overdenture.

Mandibular implant overdenture.

How to make a mandibular cameo surface impression. Courtesy of Dr. Joe Massad.

How to make a maxillary cameo surface impression. Courtesy of Dr. Joe Massad.

How to make neutral zone impressions

Follow-Up & Outcome

Maxillary complete denture, occlusal view after 9 years of use.

Mandibular implant overdenture, occlusal view after 9 years of use.

Intaglio view of mandibular implant overdenture after 9 years of use.

Implant left side, 9-year follow-up.

Implant right side, 9-year follow-up.

Questions

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Team members

Charles Goodacre

Prosthodontist

Joseph Kan

Surgeon and Prosthodontist

Luis Calvillo

Dental Technician

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