The 'gasket' or 'window' denture - provision of a maxillary cobalt chromium based partial denture

Diagnoses:

  1. Poorly fitting cobalt chromium based maxillary partial denture, which has been added to. This exhibited poor retention, stability and tissue fit (support). Unable to wear a new acrylic based denture.
  2. UR7 - occlusal amalgam. 10- 20% alveolar bone loss. Healthy periodontium with reduced attachment level. No mobility.
  3. Eight mandibular anterior teeth worn incisal edges from now extracted maxillary anterior crowns. Gingivitis - owing to inadequate oral hygiene.
  4. LL6 with large amalgam restoration - healthy periodontium.
  5. Bruxism.

Treatment options discussed with the patient to replace the missing maxillary teeth:

  1. Do nothing. The patient did not want this option.
  2. Cobalt chromium reinforced gasket denture - using a Molloplast B "O" ring to retain and stabilise the denture. This was my professional preference as this was the least invasive and simplest solution to this dental problem. Should the UR7 require removal in the future - an artificial tooth could be added - resulting in a complete denture. The patient would have adapted to the denture fully by this stage and have good neuromuscular control of the prosthesis.
  3. Full upper denture fitted at the extraction of the remaining upper back tooth. 
  4. Complete upper denture supported by dental implants.
  5. Fixed upper teeth supported by dental implants.

Following consultation and second discussion appointment the patient chose to have option 2 namely, a window denture - maxillary cobalt chromium based partial denture. The clinical situation and treatment process is shown in detail below with photographs. The patient was successfully rehabilitated with this and her quality of life considerably improved. The clinical work was provided by Finlay and the technical work by Rowan.

Figure 1 a & b. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 1 a & b. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 2. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 2. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 3. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 3. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 4. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 4. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture
Figure 5. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture - this was currently worn with the assistance of denture fixative
Figure 5. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture - this was currently worn with the assistance of denture fixative
Figure 6. Pre-treatment with poorly fitting acrylic based maxillary partial denture - this denture was not worn by the patient
Figure 6. Pre-treatment with poorly fitting acrylic based maxillary partial denture - this denture was not worn by the patient
Figure 7. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture - this was currently worn with the assistance of denture fixative
Figure 7. Pre-treatment with poorly fitting cobalt chromium based maxillary partial denture - this was currently worn with the assistance of denture fixative
Figure 8. Pre-treatment - poorly fitting acrylic based maxillary partial denture - this denture was not worn
Figure 8. Pre-treatment - poorly fitting acrylic based maxillary partial denture - this denture was not worn
Figure 9. Pre-treatment - irregular mandibular occlusal plane. UR7 - occlusal and buccal amalgam.
Figure 9. Pre-treatment - irregular mandibular occlusal plane. UR7 - occlusal and buccal amalgam.
Figure 10. Pre-treatment - irregular mandibular occlusal plane. UR7 - occlusal and buccal amalgam.
Figure 10. Pre-treatment - irregular mandibular occlusal plane. UR7 - occlusal and buccal amalgam.
Figure 11. Pre-treatment - occlusal view - upper arch. Midline maxillary torus. - UR7 - occlusal amalgam. Healthy periodontium with reduced attachment level. No mobility.
Figure 11. Pre-treatment - occlusal view - upper arch. Midline maxillary torus. - UR7 - occlusal amalgam. Healthy periodontium with reduced attachment level. No mobility.
Figure 12. Pre-treatment - occlusal view - lower arch. Worn incisal edges. Oral hygiene inadequate. Calculus on lingual surface of lower anterior teeth. Mandibular torus - can indicate bruxism. Reference given.
Figure 12. Pre-treatment - occlusal view - lower arch. Worn incisal edges. Oral hygiene inadequate. Calculus on lingual surface of lower anterior teeth. Mandibular torus - can indicate bruxism. Reference given.
Figure 13. Pre-treatment radiograph - UR7 - occlusal amalgam. 10- 20% alveolar bone loss. Healthy periodontium with reduced attachment level. No mobility.
Figure 13. Pre-treatment radiograph - UR7 - occlusal amalgam. 10- 20% alveolar bone loss. Healthy periodontium with reduced attachment level. No mobility.
Figure 14. The patient brought in this photo of her natural teeth to assist with positioning of the artificial teeth
Figure 14. The patient brought in this photo of her natural teeth to assist with positioning of the artificial teeth
Figure 15. The patient wanted this model's teeth arrangement in her new denture
Figure 15. The patient wanted this model's teeth arrangement in her new denture
Figure 16. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 16. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 17. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 17. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 18. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 18. Visit 1. Maxillary primary impression made in two stages using Accudent XD, Ivoclar. This allows full extension to record the sulcus - particularly around the UL7
Figure 19. Visit 1. Mandibular impression made in alginate for opposing model.
Figure 19. Visit 1. Mandibular impression made in alginate for opposing model.
Figure 20. Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 20. Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 21. Visit 2. Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 21. Visit 2. Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 22. Visit 2 Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 22. Visit 2 Mock up of cobalt chromium base in pattern resin to try in so that patient can assess where there will be visible metal in final denture.
Figure 23. Intaglio surface of maxillary special tray spaced for definitive impression in alginate.
Figure 23. Intaglio surface of maxillary special tray spaced for definitive impression in alginate.
Figure 24. Maxillary special tray with greenstick stops to allow accurate location of the tray and giving space for the alginate.
Figure 24. Maxillary special tray with greenstick stops to allow accurate location of the tray and giving space for the alginate.
Figure 25. Maxillary special tray with application of greenstick to buccal surface prior to border moulding.
Figure 25. Maxillary special tray with application of greenstick to buccal surface prior to border moulding.
Figure 26. Maxillary special tray with application of greenstick to buccal surface after to border moulding in the mouth.
Figure 26. Maxillary special tray with application of greenstick to buccal surface after to border moulding in the mouth.
Figure 27. Maxillary special tray with alginate adhesive added prior to air drying to remove excess adhesive.
Figure 27. Maxillary special tray with alginate adhesive added prior to air drying to remove excess adhesive.
Figure 28. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 28. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 29. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 29. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 30. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus..
Figure 30. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus..
Figure 31. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 31. Maxillary special tray definitive impression made in alginate (Dentsply Blueprint) recording depth and width of sulcus.
Figure 32. Visit 2 - Primary rim carved approximately to the desired occlusal vertical dimension, allowing the definitive casts to be mounted on the articulator, for construction of the central bearing apparatus (gothic arch tracing).
Figure 32. Visit 2 - Primary rim carved approximately to the desired occlusal vertical dimension, allowing the definitive casts to be mounted on the articulator, for construction of the central bearing apparatus (gothic arch tracing).
Figure 33. Visit 2 - Primary rim carved approximately to the desired OVD, allowing the definitive casts to be mounted on the articulator, for construction of the central bearing apparatus (gothic arch tracing) - Futar D bite registration material.
Figure 33. Visit 2 - Primary rim carved approximately to the desired OVD, allowing the definitive casts to be mounted on the articulator, for construction of the central bearing apparatus (gothic arch tracing) - Futar D bite registration material.
Figure 34. Technical work for visit 3. Central bearing apparatus to record centric relation. Wax rim to prescribe the maxillary tooth positions. Cobalt chromium base reinforcement for the maxillary partial denture.
Figure 34. Technical work for visit 3. Central bearing apparatus to record centric relation. Wax rim to prescribe the maxillary tooth positions. Cobalt chromium base reinforcement for the maxillary partial denture.
Figure 35. Technical work for visit 3. Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK.
Figure 35. Technical work for visit 3. Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK.
Figure 36. Technical work for visit 3. Central bearing apparatus to record centric relation (Gerber Condylator, Switzerland).
Figure 36. Technical work for visit 3. Central bearing apparatus to record centric relation (Gerber Condylator, Switzerland).
Figure 37. Technical work for visit 3. Central bearing apparatus to record centric relation (Gerber Condylator, Switzerland).
Figure 37. Technical work for visit 3. Central bearing apparatus to record centric relation (Gerber Condylator, Switzerland).
Figure 38. Visit 3 - maxillary wax rim carved with reference to photos - figures 14 and 15.
Figure 38. Visit 3 - maxillary wax rim carved with reference to photos - figures 14 and 15.
Figure 39. Visit 3 - maxillary wax rim carved with reference to photos - figures 14 and 15. Please note this is only for tooth position prescription and occlusal vertical dimension. The central bearing apparatus records centric relation.
Figure 39. Visit 3 - maxillary wax rim carved with reference to photos - figures 14 and 15. Please note this is only for tooth position prescription and occlusal vertical dimension. The central bearing apparatus records centric relation.
Figure 40. Visit 3 - maxillary wax rim carved with reference to photos supplied by the patient. These images are sent to Rowan (dental technician) to set up the artificial teeth.
Figure 40. Visit 3 - maxillary wax rim carved with reference to photos supplied by the patient. These images are sent to Rowan (dental technician) to set up the artificial teeth.
Figure 41. Visit 3 - mandibular plate/pin for the central bearing apparatus to record centric relation
Figure 41. Visit 3 - mandibular plate/pin for the central bearing apparatus to record centric relation
Figure 42. Visit 3 - Central bearing apparatus to record centric relation accurately. The mandibular pin is the only point of contact between the maxilla and mandible. The patient performs excursive movements - forwards, backwards and all over.
Figure 42. Visit 3 - Central bearing apparatus to record centric relation accurately. The mandibular pin is the only point of contact between the maxilla and mandible. The patient performs excursive movements - forwards, backwards and all over.
Figure 43. Visit 3 - Central bearing apparatus to record centric relation accurately - maxillary plate. The patient has scribed an arrow shape - the apex is centric relation. A plastic countersink hole is placed and fitted over the apex.
Figure 43. Visit 3 - Central bearing apparatus to record centric relation accurately - maxillary plate. The patient has scribed an arrow shape - the apex is centric relation. A plastic countersink hole is placed and fitted over the apex.
Figure 44. Visit - 3 Central bearing apparatus guided into a countersink hole on the maxillary plate.
Figure 44. Visit - 3 Central bearing apparatus guided into a countersink hole on the maxillary plate.
Figure 45. Visit - 3 Central bearing apparatus fixed together with Futar D.
Figure 45. Visit - 3 Central bearing apparatus fixed together with Futar D.
Figure 46. Visit - 3 Central bearing apparatus fixed together with Futar D taken out of the mouth showing pin in countersink hole over apex of the arrow.
Figure 46. Visit - 3 Central bearing apparatus fixed together with Futar D taken out of the mouth showing pin in countersink hole over apex of the arrow.
Figure 47. Visit - 3 Central bearing apparatus fixed together with Futar D taken out of the mouth.
Figure 47. Visit - 3 Central bearing apparatus fixed together with Futar D taken out of the mouth.
Figure 48. Visit 3 - Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK.
Figure 48. Visit 3 - Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK.
Figure 49. Visit 3 - Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK..
Figure 49. Visit 3 - Cobalt chromium base reinforcement for the maxillary partial denture - Chris Hesketh, Bespoke Frameworks, Chorley, UK..
Figure 50. Post visit 3. This is the lab work sent to the dental technician. - central bearing apparatus, facebow transfer made on carved maxillary rim and cobalt chromium base. This enables construction of the try in - mock up.
Figure 50. Post visit 3. This is the lab work sent to the dental technician. - central bearing apparatus, facebow transfer made on carved maxillary rim and cobalt chromium base. This enables construction of the try in - mock up.
Figure 51. Definitive maxillary cast.
Figure 51. Definitive maxillary cast.
Figure 52. Teeth wax try in with Schottlander Enigmalife teeth.
Figure 52. Teeth wax try in with Schottlander Enigmalife teeth.
Figure 53. Wax try in intaglio surface.
Figure 53. Wax try in intaglio surface.
Figure 54. Teeth wax try in with Schottlander Enigmalife teeth in centric relation position determined by central bearing apparatus.
Figure 54. Teeth wax try in with Schottlander Enigmalife teeth in centric relation position determined by central bearing apparatus.
Figure 55. Teeth wax try in with Schottlander Enigmalife teeth in centric relation position determined by central bearing apparatus.
Figure 55. Teeth wax try in with Schottlander Enigmalife teeth in centric relation position determined by central bearing apparatus.
Figure 56. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 56. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 57. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 57. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 58. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 58. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth in centric relation position.
Figure 59. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth.
Figure 59. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth.
Figure 60. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth.
Figure 60. Visit 4 Teeth wax try in with Schottlander Enigmalife teeth in mouth.
Figure 61. Visit 4 Patient verified mock up, using video trial insertion, still photographs and mirror.
Figure 61. Visit 4 Patient verified mock up, using video trial insertion, still photographs and mirror.
Figure 62. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 62. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 63. Definitive denture finished - Schottlander Enigmalife teeth
Figure 63. Definitive denture finished - Schottlander Enigmalife teeth
Figure 64. Definitive denture finished - Schottlander Enigmalife teeth
Figure 64. Definitive denture finished - Schottlander Enigmalife teeth
Figure 65. Definitive denture finished - Schottlander Enigmalife teeth
Figure 65. Definitive denture finished - Schottlander Enigmalife teeth
Figure 66. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 66. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 67. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 67. Definitive denture finished with Molloplast B "O" ring around UR7
Figure 68. Definitive casts mounted in centric relation.
Figure 68. Definitive casts mounted in centric relation.
Figure 69. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 69. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 70.Definitive casts mounted in centric relation.
Figure 70.Definitive casts mounted in centric relation.
Figure 71. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 71. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 72. Definitive casts mounted in centric relation.
Figure 72. Definitive casts mounted in centric relation.
Figure 73. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 73. Definitive denture finished with Molloplast B "O" ring around UR7.
Figure 74. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 74. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 75. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 75. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 76. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 76. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 77. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 77. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 78. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 78. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 79. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 79. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 80. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 80. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 81. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 81. Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 82.Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 82.Visit 5 Fitted definitive denture - Schottlander Enigmalife teeth
Figure 83. Fitted definitive denture
Figure 83. Fitted definitive denture
Figure 84. Fitted definitive denture
Figure 84. Fitted definitive denture
Figure 85. Fitted definitive denture
Figure 85. Fitted definitive denture
Figure 86. I warn the patient prior to commencing treatment that the denture will accelerate the demise of the remaining support tooth.
Figure 86. I warn the patient prior to commencing treatment that the denture will accelerate the demise of the remaining support tooth.
Figure 87. I warn the patient prior to commencing treatment that the denture will accelerate the demise of the remaining support tooth. In the event of failure an artificial tooth addition to the denture is simple.
Figure 87. I warn the patient prior to commencing treatment that the denture will accelerate the demise of the remaining support tooth. In the event of failure an artificial tooth addition to the denture is simple.
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