Finlay's Case Presentation

Welcome to my May 2021 Newsletter Case Presentation

This newsletter describes in step by step detail Angela's transition through immediate partial dentures to crown supported definitive metal based dentures.

This 58 year old woman was referred to me by her general dental practitoner for treatment.

Dental concerns

  • “Terrified of losing my teeth”
  • “Worried about implant failure - Type 1 diabetes”
  • “My dentist has recommended that dentures are probably the best option.”
  • “Don’t like teeth colour”
  • “Worried about the effects of existing bridgework failure”
  • “Need excellent dental work to maintain and keep my self esteem and my job as a registrar”

Medical History

  • Type 1 Insulin dependant diabetes

Social history

  • Registrar

Dental wish list

  • “Perfect smile”
  • “Clean white teeth”
  • “No one knowing I may have dentures.”
  • “No discomfort wearing dentures”
  • “No future problems caused by gum disease”
  • “Honest truthful recommendation”
  • “All of the treatment done quickly and at the same time if possible with minimum time off work.”

Diagnoses

  1. Generalised Periodontitis; Stage 4, Grade C, Currently Unstable. Risk Factors: Type 1 diabetes. 16, 17 - hopeless prognosis. 14, 24, 26, 27, 34, 37, 44 - guarded prognosis
  2. Poor marginal fit and poor appearance of crowns and bridgework
  3. Yellowing teeth

Treatment options discussed for the upper arch

  1. Do nothing
  2. Partial denture with new crowns (this is what the patient wanted - owing to the increased risk of implant failure due to type 1 diabetes)
  3. Implant supported fixed teeth

The clinical situation and treatment process is shown in detail below with photographs. I (Finlay Sutton) provided the clinical work and Rowan Garstang provided the technical work.

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Figure 1 Pre - treatment.
Figure 1 Pre - treatment.
Figure 2 Pre - treatment.
Figure 2 Pre - treatment.
Figure 3 Pre - treatment.
Figure 3 Pre - treatment.
Figure 4 Pre - treatment.
Figure 4 Pre - treatment.
Figure 5 Pre - treatment.
Figure 5 Pre - treatment.
Figure 6 Pre - treatment.
Figure 6 Pre - treatment.
Figure 7 OPG radiograph supplied by the referring GDP showing reduced bone levels on posterior teeth.
Figure 7 OPG radiograph supplied by the referring GDP showing reduced bone levels on posterior teeth.
Figure 8 Radiograph - hopeless teeth 17, 16
Figure 8 Radiograph - hopeless teeth 17, 16
Figure 9 treatment planning card containing sequenced treatment plan and quotation. This is how I plan all of my patients treatments
Figure 9 treatment planning card containing sequenced treatment plan and quotation. This is how I plan all of my patients treatments
Figure 10 Treatment plan letter for this patient.
Figure 10 Treatment plan letter for this patient.
Figure 11 Dental concerns with my responses in the treatment plan letter.
Figure 11 Dental concerns with my responses in the treatment plan letter.
Figure 12 Dental wish list with my responses in the treatment plan letter. Fulfilment of the wishes are addressed as a yes, no or maybe - at the beginning of treatment to avoid over promising.
Figure 12 Dental wish list with my responses in the treatment plan letter. Fulfilment of the wishes are addressed as a yes, no or maybe - at the beginning of treatment to avoid over promising.
Figure 13 A3 shade of teeth prior to commencing treatment and whitening
Figure 13 A3 shade of teeth prior to commencing treatment and whitening
Figure 14 Upper primary impression made with Dentsply Blueprint
Figure 14 Upper primary impression made with Dentsply Blueprint
Figure 15 Custom trays for the definitive impression for Mk 1 dentures
Figure 15 Custom trays for the definitive impression for Mk 1 dentures
Figure 16 Custom trays for the definitive impressions. Greenstick added to create a stop on the palate to avoid the tray touching the teeth. Border moulded in the UL area.
Figure 16 Custom trays for the definitive impressions. Greenstick added to create a stop on the palate to avoid the tray touching the teeth. Border moulded in the UL area.
Figure 17 Alginate adhesive added. Dentsply Blueprint placed, glazed with running water and gloved finger.
Figure 17 Alginate adhesive added. Dentsply Blueprint placed, glazed with running water and gloved finger.
Figure 18 Working impression for Mk 1 denture.
Figure 18 Working impression for Mk 1 denture.
Figure 19 Working impression lower in custom tray with greenstick and alginate
Figure 19 Working impression lower in custom tray with greenstick and alginate
Figure 20 Mounted working cast with teeth/pontics removed in ICP for Mk 1 dentures
Figure 20 Mounted working cast with teeth/pontics removed in ICP for Mk 1 dentures
Figure 21 Over impression in alginate to record the teeth using over tray
Figure 21 Over impression in alginate to record the teeth using over tray
Figure 22 Finished upper immediate denture. Schottlander Enigmalife teeth.
Figure 22 Finished upper immediate denture. Schottlander Enigmalife teeth.
Figure 23 Finished lower immediate denture. Schottlander Enigmalife teeth.
Figure 23 Finished lower immediate denture. Schottlander Enigmalife teeth.
Figure 24 Finished immediate dentures - intaglio surfaces.
Figure 24 Finished immediate dentures - intaglio surfaces.
Figure 25 Mounted working cast for Mk 1 immediate denture. Teeth removed from cast - minimal preparation of the cast to reduce adjustments at fit
Figure 25 Mounted working cast for Mk 1 immediate denture. Teeth removed from cast - minimal preparation of the cast to reduce adjustments at fit
Figure 26 Finished upper immediate denture - 0.9mm stainless steel wire. UR gingivally approaching UL occlusally approaching
Figure 26 Finished upper immediate denture - 0.9mm stainless steel wire. UR gingivally approaching UL occlusally approaching
Figure 27 Finished immediate dentures and preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 27 Finished immediate dentures and preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 28 Preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 28 Preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 29 Preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 29 Preparation guides for sectioning the bridges to create guide surfaces allowing accurately fitting immediate dentures
Figure 30 Sectioned bridge pontics.
Figure 30 Sectioned bridge pontics.
Figure 31 Occlude spray is used to check the fit of the collets
Figure 31 Occlude spray is used to check the fit of the collets
Figure 32 Seating the immediate denture to check the fit with light bodied silicone and Occlude spray
Figure 32 Seating the immediate denture to check the fit with light bodied silicone and Occlude spray
Figure 33 Adjusting the collets with high speed diamond bur to allow full seating of the denture
Figure 33 Adjusting the collets with high speed diamond bur to allow full seating of the denture
Figure 34 Occlusion check - Natural teeth to occlude in ICP in the same way with and without the denture.
Figure 34 Occlusion check - Natural teeth to occlude in ICP in the same way with and without the denture.
Figure 35 Occlusion adjusted on the collets. Natural teeth to occlude in ICP in the same way with and without the denture.
Figure 35 Occlusion adjusted on the collets. Natural teeth to occlude in ICP in the same way with and without the denture.
Figure 36 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 36 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 37 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 37 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 38 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 38 Immediate dentures fitting in ICP. Schottlander Enigmalife teeth.
Figure 39 Immediate dentures fitted - no gaps between collets and teeth. Schottlander Enigmalife teeth.
Figure 39 Immediate dentures fitted - no gaps between collets and teeth. Schottlander Enigmalife teeth.
Figure 40 Night time tooth whitening carried out with 10% Carbamide Peroxide over 2 weeks.
Figure 40 Night time tooth whitening carried out with 10% Carbamide Peroxide over 2 weeks.
Figure 41 Mk 1 working casts with silicone matrices for temporary crowns.
Figure 41 Mk 1 working casts with silicone matrices for temporary crowns.
Figure 42 Mk 1 working casts with silicone matrices for temporary crowns. Wax rims for recording the occlusion in ICP. Denture teeth to be copied by the technician making the porcelain fused to zirconia crowns.
Figure 42 Mk 1 working casts with silicone matrices for temporary crowns. Wax rims for recording the occlusion in ICP. Denture teeth to be copied by the technician making the porcelain fused to zirconia crowns.
Figure 43 Temporary crowns and Mk 1 dentures fitted.
Figure 43 Temporary crowns and Mk 1 dentures fitted.
Figure 44 Porcelain fused to zirconia crown preparations (previously bridge abutment crowns).
Figure 44 Porcelain fused to zirconia crown preparations (previously bridge abutment crowns).
Figure 45 Doric - silicone impressions for the crowns.
Figure 45 Doric - silicone impressions for the crowns.
Figure 46 Upper and lower wax registration rims trimmed with space between them and the anterior teeth contact in ICP.
Figure 46 Upper and lower wax registration rims trimmed with space between them and the anterior teeth contact in ICP.
Figure 47 Futar D registration material - fixing together in ICP.
Figure 47 Futar D registration material - fixing together in ICP.
Figure 48 Communication with the laboratory for the porcelain fused to zirconia crown crowns. To mimic the Schottlander Enigmalife teeth in colour. To incorporate guiding surfaces, ledges and rest seats for the metal based partial dentures. Loom video ema
Figure 48 Communication with the laboratory for the porcelain fused to zirconia crown crowns. To mimic the Schottlander Enigmalife teeth in colour. To incorporate guiding surfaces, ledges and rest seats for the metal based partial dentures. Loom video ema
Figure 49 Porcelain fused to zirconia crown crowns mimicking Schottlander Enigmalife teeth in colour. Incorporating guiding surfaces, ledges and rest seats for the metal based partial dentures.
Figure 49 Porcelain fused to zirconia crown crowns mimicking Schottlander Enigmalife teeth in colour. Incorporating guiding surfaces, ledges and rest seats for the metal based partial dentures.
Figure 50 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures.
Figure 50 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures.
Figure 51 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 51 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 52 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 52 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 53 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 53 Porcelain fused to zirconia crown crowns incorporating parallel guiding surfaces, ledges and rest seats for the metal based partial dentures - fitted with Fuji plus cement.
Figure 54 Preparation of rest seats in the upper canines so that the rests on the canines do not prop open the bite - maintaining ICP contacts on the natural upper and lower teeth.
Figure 54 Preparation of rest seats in the upper canines so that the rests on the canines do not prop open the bite - maintaining ICP contacts on the natural upper and lower teeth.
Fig 55 Greenstick compound stops are placed on the fitting surface of the custom tray to ensure repeatable positioning of the tray. Border moulded greenstick compound on the custom tray ready for the working impression in alginate.
Fig 55 Greenstick compound stops are placed on the fitting surface of the custom tray to ensure repeatable positioning of the tray. Border moulded greenstick compound on the custom tray ready for the working impression in alginate.
Fig 56 The finalised working impression in alginate. The patient was encouraged to exaggerate the tongue movements by “really pushing” the tongue out and moving it from “side to side” to limit excess alginate over optimally border moulded greenstick compo
Fig 56 The finalised working impression in alginate. The patient was encouraged to exaggerate the tongue movements by “really pushing” the tongue out and moving it from “side to side” to limit excess alginate over optimally border moulded greenstick compo
Fig 57 Greenstick compound stops are placed on the fitting surface of the custom tray to ensure repeatable positioning of the tray. Border moulded greenstick compound on the custom tray ready for the working impression in alginate.
Fig 57 Greenstick compound stops are placed on the fitting surface of the custom tray to ensure repeatable positioning of the tray. Border moulded greenstick compound on the custom tray ready for the working impression in alginate.
Figure 58 Working impression in custom tray with greenstick and alginate
Figure 58 Working impression in custom tray with greenstick and alginate
Figure 59 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 59 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 60 Teeth try in on pattern resin bases intaglio surfaces. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 60 Teeth try in on pattern resin bases intaglio surfaces. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 61 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 61 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 62 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 62 Teeth try in on pattern resin bases. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 63 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 63 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 64 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 64 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 65 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 65 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 66 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 66 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 67 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 67 Teeth try in on pattern resin bases in the mouth. These help to confirm the accuracy of the working casts and the amount of metal work which will be visible in the final dentures
Figure 68 The patient assesses a video of the try in, still photographs and in a mirror.
Figure 68 The patient assesses a video of the try in, still photographs and in a mirror.
Figure 69 cobalt chromium framework - Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin.
Figure 69 cobalt chromium framework - Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin.
Figure 70 cobalt chromium framework - Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin.
Figure 70 cobalt chromium framework - Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin.
Figure 71 cobalt chromium framework - Scandinavian design - keeping the denture components 3mm away from the gingival margin.
Figure 71 cobalt chromium framework - Scandinavian design - keeping the denture components 3mm away from the gingival margin.
Figure 72 cobalt chromium framework - Scandinavian design - keeping the denture components 3mm away from the gingival margin.
Figure 72 cobalt chromium framework - Scandinavian design - keeping the denture components 3mm away from the gingival margin.
Figure 73 Cobalt chromium framework trial insertion, checking the fit onto the natural teeth and soft tissues
Figure 73 Cobalt chromium framework trial insertion, checking the fit onto the natural teeth and soft tissues
Figure 74 Cobalt chromium framework trial insertion, checking the fit onto the natural teeth and soft tissues
Figure 74 Cobalt chromium framework trial insertion, checking the fit onto the natural teeth and soft tissues
Figure 75 Cobalt chromium framework trial insertion, checking the occlusion - ensuring no propping of the bite. ICP tooth to tooth contact maintained - occlusion identical with and without the framework in-situ
Figure 75 Cobalt chromium framework trial insertion, checking the occlusion - ensuring no propping of the bite. ICP tooth to tooth contact maintained - occlusion identical with and without the framework in-situ
Figure 76 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 76 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 77 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 77 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 78 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 78 Finished definitive partial denture. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 79 Finished definitive partial denture intaglio surface. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 79 Finished definitive partial denture intaglio surface. Scandinavian design - keeping the denture components 3mm away from the gingival margin
Figure 80 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 80 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 81 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 81 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 82 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 82 Finished definitive partial denture. Scandinavian design with sublingual bar - keeping the denture components 3mm away from the gingival margin
Figure 83 Definitive dentures fitted 9 months after extractions
Figure 83 Definitive dentures fitted 9 months after extractions
Figure 84 Definitive dentures fitted.
Figure 84 Definitive dentures fitted.
Figure 85 Definitive dentures fitted.
Figure 85 Definitive dentures fitted.
Figure 86 Definitive dentures fitted.
Figure 86 Definitive dentures fitted.
Figure 87 Definitive dentures fitted.
Figure 87 Definitive dentures fitted.
Figure 88 Testimonial
Figure 88 Testimonial
Figure 89 gifts from the patients
Figure 89 gifts from the patients
Figure 90 Delighted patient following tooth whitening, replacement crowns and metal based partial dentures.
Figure 90 Delighted patient following tooth whitening, replacement crowns and metal based partial dentures.
Finlay's fixed and removable prosthodontic case presentation of crowns and partial dentures

Reference material

Full access PDF to my published scientific papers which explain my philosophy and clinical techniques. Please click on the link below and scoll down this page to find lots of useful clinical techniques, reference material and previous lectures:

https://www.finlaysutton.co.uk/resources

Thursday 4th November 2021 from 5.45pm at Garstang Country Hotel and Golf Club. Clinical Updates – in fixed prosthodontics, dentures, orthodontics endodontics and periodontics
Thursday 4th November 2021 from 5.45pm at Garstang Country Hotel and Golf Club. Clinical Updates – in fixed prosthodontics, dentures, orthodontics endodontics and periodontics
Immediate dentures - Impression Club Live with Finlay Sutton and Rupert Monkhouse
I am giving three lectures for the World Dental Conference on the topic of "Healing the human spirit with removable dentures (that work and look like their own departed teeth)"
I am giving three lectures for the World Dental Conference on the topic of "Healing the human spirit with removable dentures (that work and look like their own departed teeth)"
VIDEO - Finlay's fixed and removable prosthodontic case presentation of crowns and metal partial dentures
VIDEO - Finlay's fixed and removable prosthodontic case presentation of crowns and metal partial dentures

Finlay's Blog

Garstang Dental Referral Practice 2021 Open Evening

Clinical Updates – in fixed prosthodontics, dentures, orthodontics endodontics and periodontics

Immediate dentures - Impression Club Live with Finlay Sutton and Rupert Monkhouse

Finlay Sutton answers questions about immediate dentures put to him by Rupert Monkhouse in Rupert's Impression Club Live - Instagram.

I am the Keynote lecturer at the World Dental Congress - Special Edition - 26-29 September 2021

I am giving three lectures for the World Dental Conference on the topic of "Healing the human spirit with removable dentures (that work and look like their own departed teeth)"

VIDEO - Finlay's fixed and removable prosthodontic case presentation of crowns and metal partial dentures

Finlay presents treatment of a patient with high aesthetic demands using immediate partial dentures, followed by metal based partial dentures supported with crowns. This is practical and clinically useful; abundantly illustrated with photographs and videos showing how Finlay and his dental technician, Rowan Garstang, produce removable dental prostheses. The lecture aims to show how we can change our patients’ lives with beautifully made dentures.

Learning objectives:

1. To learn how to make accurate impressions

2. To learn how to make partial dentures fit perfectly

3. To learn how to incorporate crowns into a partial denture

4. To learn a new system of partial denture design, including planning for future support teeth failure by designing the cobalt chromium minor connectors with tooth additions in mind.

5. To see the management of challenging cases where implants are not wanted/indicated

6. To appreciate that good quality removable dentures are a valid alternative to implant supported restorations

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