Initial Diagnosis
A 75-year-old male patient presented to Dr Maria Avis at Akoya Dental Boutique requiring replacement of an existing prosthesis.
The patient had diabetes, high blood pressure, and obesity, and was considered unsuitable for a general anaesthetic. He also presented with several treatment challenges, including very limited mouth opening, an inability to tolerate being supine, a strong gag reflex, mouth breathing due to limited nasal breathing, and difficulty tolerating water in the mouth. These factors made the case clinically demanding and required a careful, controlled approach to planning, impression-taking, fit verification and final delivery.
As the patient was unsuitable for general anaesthetic and had limited tolerance for chairside procedures, each stage needed to be approached with efficiency and precision. The treatment pathway also needed to account for the patient’s limited mouth opening, gag reflex, breathing limitations, and difficulty tolerating water in the mouth.
Treatment Plan
The patient’s original prosthesis had been made 15 years earlier. It included a stainless-steel plate with titanium cylinders wrapped in acrylic. Over time, the prosthesis had required several acrylic repairs. The existing prosthesis had served the patient for many years, but the extent of the latest break meant another acrylic repair was no longer the preferred approach. Dr Avis decided the case required a more complete upgrade while still preserving useful information from the previous prosthesis where possible.
While many contemporary prosthetic workflows are digital, this case required an analogue pathway because of the componentry involved. This made the accuracy of each physical record especially important. In this context, the old prosthesis was not simply a failed appliance. It also provided a practical reference for the upgraded prosthesis, particularly because the patient’s tolerance for treatment was limited. Retaining and transferring useful information from the existing prosthesis helped keep the workflow focused, controlled, and appropriate to the constraints of the case.
The workflow needed to support a predictable transfer of information from the existing prosthesis into the upgraded prosthesis:
- Case assessment: Dr Avis assessed the existing prosthesis, the extent of acrylic loss, and the patient’s clinical limitations.
- Impression-taking: A new impression was taken to support fabrication of the upgraded prosthesis.
- Prosthesis copy: A copy of the old denture was created using a suck-down process.
- Indexing: The copied prosthesis was indexed to help transfer the established fit and occlusal information into the new prosthesis.
- Fit and occlusion verification: Fit and occlusion were verified using a PMMA mill before proceeding to the final prosthesis. This verification stage was particularly important because the patient’s clinical limitations reduced the opportunity for extensive chairside adjustment. Confirming fit and occlusion before the final prosthesis helped support a more controlled delivery process.
Treatment Summary
This case required careful planning due to the patient’s medical background, limited tolerance for treatment, and the condition of the existing prosthesis:
- The patient’s existing prosthesis had been in service for 15 years.
- Several acrylic repairs had been completed over time.
- The latest break was extensive, with most acrylic lost.
- An analogue workflow was selected due to the available componentry.
- A new impression, copied denture, indexing process and PMMA mill were used to verify fit and occlusion.
Final Outcome
The final prosthesis achieved an immaculate fit. Dr Avis reported that no occlusal adjustments were required. It also reinforced the importance of verification before final delivery. In a case where chairside adjustment needed to be minimised, effective communication between the dentist and lab ensured accurate fit and occlusion were confirmed earlier in the workflow. This close dentist/lab relationship supported a precise result and helped reduce the need for further modification or other issues for the patient overall.
This outcome was especially significant given the complexity of the case. The patient’s medical background, limited treatment tolerance, damaged existing prosthesis, and analogue workflow all placed greater importance on clear communication with the lab partner to ensure accurate planning and verification before final delivery. For a case involving significant patient limitations and an extensively damaged existing prosthesis, the result demonstrated the value of careful planning, accurate information transfer, and close attention to fit and occlusion.
This case also demonstrates how careful analogue prosthetic planning can remain valuable when case requirements, componentry, or patient limitations make a fully digital approach unsuitable.
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All case studies presented by Avant Dental are done so with permission from the ordering dentist. No patient details are shared, and all representations are true and accurate to the case.