CE: Set Yourself Up for Success by Dr. Leif Stromberg

 

Use the initial consultation/ examination to glean essential information about candidates for complete dentures

Short description
This course focuses on how to effectively acquire critical patient information at the consultation/examination appointment for success with all types of tissue-supported complete dentures. It covers effective patient communication, the clinical examination and managing patient expectations for predictable and satisfying denture outcomes.

Abstract
This course focuses on essential elements of the consultation/ examination appointment for enhancing the predictability and success of complete denture fabrication. It breaks down this initial appointment into three phases: preexamination consultation, clinical edentulous examination and postexamination consultation.

• In the preexamination consultation phase, the emphasis is on actively listening to the patient. Understanding their previous experiences with dentures, their adaptability to prostheses, and their specific desires and expectations for new dentures is essential.
• The clinical examination involves an assessment of the patient’s oral conditions. This helps determine their restorative needs in alignment with their desires and expectations. The dentist evaluates oral health, anatomy and factors that may affect the success of the dentures, such as stability of the temporomandibular joints and potential airway obstructions.
• The final phase, the postexamination consultation, includes a discussion of the findings from the consultation and examination. Here, various options and recommendations are presented, tailored to the patient’s individual needs, wants and expectations.

Learning objectives
After completing this course, readers should be able to:

1. Conduct a preexamination consultation that establishes open communication and patient rapport, leading to a better understanding of patient wants and expectations..
2. Provide a practical clinical edentulous examination, including evaluating the patient’s oral health and identifying anatomic factors influencing denture success to determine the patient’s needs.
3. Discuss the importance of patient-centered care, including: active listening and empathetic communication to create a comfortable environment where patients can express their wants, expectations and concerns; and incorporating information from the findings of the clinical examination to perform appropriate treatment.
4. Conduct a thorough informed consent process, including a discussion of treatment options, risks, benefits and fees, and the recognition of the patient's right to choose no treatment.

• Preexamination consultation: Patient interview before the visual clinical examination. Establish a foundation for open communication and understanding patient expectations.
• Visual clinical examination of the edentulous stomatognathic system: Comprehensive evaluation of patient oral health and anatomical factors influencing denture success.
• Postexamination consultation: Patient consultation after the visual clinical examination. Discuss findings, thoughts, options and recommendations based on patient expectations and oral examination results.

Fig. 1a

Fig. 1b

Fig. 2

Fig. 3

Fig. 4

• Abundant keratinized attached tissue. Thick denture-supporting tissues make wearing dentures more comfortable for the patient.
• Palate U-shaped in cross-section.
• Absence of undercuts and tori.
• Adequate residual alveolar ridge bone for denture retention, stability and support.
• Frenum and muscle attachments below the crest of the ridge.
• Well-formed tuberosities.
• Well-defined hamular notches, which indicate the location of the posterior extension of the denture and help with denture retention.

• Well-defined retromolar pads.
• A well-formed buccal shelf to support the mandibular denture.
• Frenum and muscle attachments below (apical to) the crest of the alveolar ridge.
• Absence of undercuts and tori.
• Abundant attached keratinized mucosa.
• Adequate residual alveolar ridge vertical height and buccolingual thickness, similar to the cast in Fig. 5.

Fig. 5

• Placing dental implants after the dentures have been fabricated. However, inform the patient that bone reduction may be needed if implants and attachments are placed. Ensure they are aware of the additional costs for these added services.
• The denture base will weaken in the areas of implants and attachments, and denture fracture may require repair or refabrication of the denture.
• The patient may need to have the current new dentures remade or rebased after bone reduction when implants and attachments are added.

• The option of no treatment and its consequences. (Note that this option was presented but is not recommended.)
• The option of small-diameter (less than 3 mm) implants or root-form (3 mm or more) implants in the maxilla and mandible to retain dentures.
• The option of All-on-4-6 fixed (dentist-removable) restorations.
• The option of implants with fixed bridges.
• Benefits/advantages, risks/disadvantages and fees of all options.
• The fact a denture can fracture and need repairs or replacement at additional fees.
• The fact denture teeth can wear, necessitating replacement of teeth or remaking of the denture at additional fees.
• The fact a patient should not attempt to repair their own denture but instead should return to the dentist for evaluation and discussion of repair options.
• The fact the American Dental Association reports that, over time, dentures may need relining, rebasing, or replacing. The typical life of dentures is between five and 10 years.

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