Clinical Case Presentation One Ross Chapman Student Number: 20579504

1. Clinical Case Presentation One Ross Chapman Student Number: 20579504

2. Background • 84 yr old Female • Presenting Complaint • Poorly fitting F/F dentures • Poor retention on upper denture • Soft lining on lower has become hard • History of presenting complaint • Current dentures 4+ yrs old • Patient has lost weight in recent years • Dental History • Denture wearer 55+ yrs • Regular attendee at this practice

3. Background • Medical history • Macular degeneration : Patient registered blind • Benzofluorazide • Generally fit and well with limited dexterity due to visual impairment • Social history • Occasional alcohol consumption 4upw • Non smoker ( previous smoker gave up 25+ yrs ) • Widow, lives alone with regular family contact

4. Background • Family history • No history of dental or medical disease • Current OH regime • Cleans mouth and dentures twice daily with soft brush • Uses A/F mouthwash daily • Soaks denture weekly in “Steradent ” solution • Dentures in poor condition

5. Extra-Oral Examination • No facial asymmetry • Nil pain in trismus • No palpable lymph nodes • Lips and soft tissue all competent • TMJ – NAD • Nil clicking, pain, normal opening, deviation • Skeletal class I

6. Chart Key: = Acrylic Denture

7. Intra-oral Examination • Soft tissues • Lips – Nothing abnormal detected (NAD), Competent lips, medium lip line • Tongue – NAD • Floor of Mouth – NAD • Buccal Mucosa – NAD • Parotid Secretion - NAD • Palate – small sore and raised mucosa on posterior border of current denture. Pt reports flared up recently will check again at N/V

8. Intra-oral Examination • Upper and lower arches • Medium resorption on upper residual alveolar process • Gross resorption on lower residual alveolar process • Existing denture • F/F with deteriorated soft lining on lower • Chipped UR1 when patient dropped when cleaning • Under extended palatal border • Under extended sub lingual depth • Reduced OVD

9. Initial Photographs

10. Initial Photographs

11. Initial Photographs

12. Initial Photographs

13. Initial Photographs

14. Diagnosis/Treatment Plan • Diagnosis • Under extended upper denture • Under extended lower denture • Rough and deteriorated Soft lining through poor care • Reduced OVD • Treatment plan • Make new Full/Full denture • Improve Fit in highlighted areas • Increase OVD • Improve patients denture cleaning routine

15. Possible referral • Patient referred to patient liaison nurse within practice to instruct on cleaning routine for denture with impaired sight and limited dexterity • Patient referred into myself internally as routine for prosthetics cases

16. Appointment 1 • Consent taken • Consultation – C/O, History of complaint • MH, DH, SH documented • Exam E/O & I/O • Reline impression in current denture to asses posterior extension tolerance • Upper denture extended with green stick, light bodied silicone wash taken. • Consent to dental photographs given

17. Appointment 2 • Raised mucosal sore checked -NAD • Relined denture fitted • Extended to assess patients tolerance of posterior extension

18. Appointment 2 • Primary impressions • Taken using alginate in stock trays

19. Appointment 2 • Primary impressions • Taken using alginate in stock trays

20. Appointment 3 • Secondary impressions • Border moulded with medium silicone

21. Appointment 3 • Secondary impressions • Border moulded with medium silicone

22. Appointment 3 • Secondary impressions • Silicone “take one” body used

23. Appointment 3 • Secondary impressions • Silicone “take one” body used

24. Appointment 4 Occlusal registration • Registration rims made on clear base upper to asses retention and acrylic temporary base lower to act as even spacer for soft lining • Manchester block used on lower to asses neutral space • Shade discussed and taken • Facial aesthetics marked on registration blocks

25. Appointment 5 Try-in ready

26. Appointment 5 Try-in Stage • Enigma teeth used for set up at laboratory • Hard bases ensured we could take time and denture remained stable in the mouth • Bite checked and adjusted chair side for high spots • Extended upper posterior border tolerated well

27. Appointment 6 Denture fit Stage • Upper denture adjusted at labial extensions • No adjustment required to lower denture • No adjustment needed to bite

28. Appointment 7 Review Stage • 2 weeks post insertion review • Patient feels upper retention greatly improved and new soft lining making dentures more comfortable to eat with. • Adjusted the naso-labial extension once again as causing slight friction sore. • Patient happy with feel and function of dentures

29. Pre and post treatment photographs

30. Pre and post treatment photographs

31. Maintenance/Recall • Patient given instruction on cleaning the denture and maintaining the soft lining without damaging the soft material • Patient to continue annual check up at practice • Told TCA if any problems occur • Treatment complete

32. Reflection • Following mentors advice on extending the current denture first to ensure patient could tolerate before we proceeded further with the treatment worked well • As visually impaired, aesthetics were not a priority to the patient yet using good materials allowed us to get good result • Denture cleaning advice should ensure new dentures stay in good condition for longer