Prosthetic treatment steps
In the maxilla, accurate recording of the implant positions is required
using a customized tray and a primary open-tray type I plaster
impression. In the mandible, the approach is the same for a conventional
complete removable prosthesis. A preliminary Type 1 plaster impression
was completed by a second impression using an individual adjusted tray,
thermoplastic paste border molding, and surface treatment with regular
viscosity polysulphides.
The patient presented atypical facial and oral anatomical landmarks
which challenged the options for VDO and occlusal plane orientation.
Phonation tests were inconclusive due to the low facial and lingual
muscle mobility. Despite the labial inocclusion (due to tissue
sclerosis), we recorded the VDO at a height equivalent to that of the
medium face stage.
The occlusal plane goes through the patient’s left lip corner (non
operated side) leaving the prosthetic teeth partially apparent. Then,
the CB was fabricated according to the mounting of the teeth. The bar
has a 2mm diameter round section, and is spaced 2 mm away from the
mucosa. It was validated clinically and radiographically.