Utilization of the neutral zone technique for a maxillofacial patient

Unveiling the Realm of Denture Fabrication: Revitalizing Aesthetics and Optimizing Efficiency for Geriatric Patients

Disfigurement of the face has a significant impact not only on the appearance and function but also on the psychological well-being of an individual. Due to tooth loss, various psychological problems can occur. Dentures can help patients regain a sense of normalcy and also boost their confidence to live in society. Complete denture restores phonetics, esthetics, and mastication. A 63-year-old male patient reported to the Department of Prosthodontics with the chief complaint of total loss of teeth and wanted to get treated for the same. The purpose of this article is to describe changes in impression techniques, dental material, methodologies in teeth setting, and novel approaches to enhance the esthetics to optimize the results in a final complete denture. To reestablish the patient's masticatory, apparatus steps of complete denture fabrication were revisited accompanied by the modern application of innovative techniques with the base of historical concept.

The Neutral Zone Approach with CAD/CAM Record Bases

Lack of adequate retention, support, and stability in the complete denture can be attributed to a poor fit or incorrect shape of the polished surfaces. This article presents a case using the neutral zone technique effectively with the fabrication of computer-aided design and computer-aided manufacturing (CAD-CAM) record bases in an edentulous patient with severely resorbed alveolar ridges and discusses the overall treatment steps and clinical implications of this technique. A stable neutral zone and an accurate jaw relation were recorded using CAD-CAM record bases and stability of complete denture was optimized by arranging denture teeth and reforming polishing surfaces in the neutral zone. A new complete denture was fabricated for a patient with atrophic alveolar ridges by a technique utilizing the neutral zone with CAD-CAM record bases. This article is protected by copyright. All rights reserved.

Effectiveness of denture space recording method in the prosthetic treatment of edentulous patients

PURPOSE

To present a clinical rationale for the effectiveness of denture space recording methods for the prosthetic treatment of edentulous patients through a review of the literature.

STUDY SELECTION

A total of 3167 studies were extracted from a search of four terms, namely denture space, neutral zone technique, flange technique, and piezography using PubMed and J-STAGE databases. A total of 57 documents that matched the inclusion and exclusion criteria were selected.

RESULTS

From the extracted articles, the clinical application of denture space recording methods was found to be effective in edentulous patients with severe ridge resorption. The relationship between the labiolingual and buccolingual pressure in patients with neuromuscular problems or with mandibular or lingual defects differs from those without it, so a stable prosthesis ca n be easily fabricated by locating the neutral zone using denture space recording methods.

CONCLUSIONS

The literature on denture space recording methods suggests that its application on challenging cases of edentulous patients is useful in providing prostheses with improved retention and stability.

Partial Mandibulectomy Rehabilitation of Keratocystic Odontogenic Tumour Case in Neutral Zone

Restoring the patient's missing dentition secondary to partial mandibulectomy of KCOT is important to improve function and aesthetics. The patient presented with a significant loss of alveolar bone which makes the fabrication of rehabilitation prosthesis a significant challenge. A neutral-zone impression technique is helpful in determining the exact space to be restored without compromising aesthetics and it avoids functional muscle displacement that may displace the prosthesis. This article describes the neutral zone impression technique to record a patient's functional muscular movement in guiding the setting of acrylic teeth and denture flange in the neutral zone area. This technique is very useful for postsurgical cases with significant loss of alveolar bone.

Customized Cheek Plumper with Friction Lock Attachment for a Completely Edentulous Patient to Enhance Esthetics: A Clinical Report

Prosthetic rehabilitation of a completely edentulous patient should never be restricted to the replacement of missing teeth. The ultimate aim of complete denture treatment should be restoration of the full range of oral functions and esthetics. Slumped cheeks are always a concern for esthetically demanding complete denture patients. This article describes a simple, scientific, cost-effective technique to improve facial esthetics in a completely edentulous patient with the help of a cheek plumper. The technique used here implements the concept of neutral zone to precisely determine the amount of space available for the cheek plumper. The simple friction lock attachments that retained the cheek plumpers on the prosthesis were also fabricated after determining the space available in the appropriate areas. Thus an effort was made to keep the cheek plumpers unobtrusive yet effective to ensure complete integration of the prosthesis into the stomatognathic system.

Managing the Unstable Mandibular Complete Denture – Tooth Placement and the Polished Surface

Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures. Clinical relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.

Cross-arch arrangement in complete denture prosthesis to manage an edentulous patient with oral submucous fibrosis and abnormal jaw relation

A patient with oral submucous fibrosis and resorbed ridges poses a challenge for prosthodontic rehabilitation because of the limited mouth opening and fibrotic mucosa. The fabrication of prosthesis is very difficult due to abnormal jaw relations, influencing the long-term prognosis of the patient. To present a case of oral submucous fibrosis with severely resorbed edentulous ridges which was successfully managed by adopting a modified technique in fabricating a complete denture prosthesis. A 55-year-old female patient with completely edentulous maxillary and mandibular arches diagnosed with oral submucous fibrosis was rehabilitated with complete dentures by recording neutral zone for resorbed mandibular ridge and by arranging the posterior teeth in cross arch relation for compensation of the abnormal jaw relations. The cross-arch arrangement of posterior teeth provides a more stable and retentive complete denture prosthesis for patients with severely resorbed ridges and a wider mandibular arch.

The role of oral soft tissues in swallowing function: what can tongue pressure tell us?

Tongue pressure data taken from healthy subjects during normal oral activities such as mastication, speech and swallowing are providing us with new ways of understanding the role of the tongue in craniofacial growth and function. It has long been recognized that the sequential contact between the tongue and the palate plays a crucial role in the oropharyngeal phase of swallowing. However, because the focus of most research on intraoral pressure has been on the generation of positive pressure by the tongue on the hard palate and teeth, generation and coordination of absolute intraoral pressures and regional pressure gradients has remained unexplored. Ongoing research in our laboratory has uncovered highly variable individual pressure patterns during swallowing, which can nonetheless be divided into four stages: preparatory, primary propulsive, intermediate and terminal. These stages may further be sub-classified according to pressure patterns generated at the individual level as tipper or dipper patterns in the preparatory stage, roller or slapper in the primary propulsive and monophasic or biphasic during the intermediate stage. Interestingly, while an increase in bolus viscosity can result in significant changes to pressure patterns in some individuals, it has little effect in others. Highly individual responses to increased viscosity are also observed with swallowing duration. The above, together with other findings, have important implications for our understanding of the aetiology of widely differing conditions such as protrusive and retrusive malocclusions, dysphagia and sleep apnoea, as well as the development of novel food products.

Setting up of teeth in the neutral zone and its effect on speech

Rational goals for denture construction are basically directed at the restoration of esthetics and masticatory function and the healthy preservation of the remaining natural tissues. Little concern has been given to the perfection and optimization of the phonetic quality of denture users. However, insertion of prosthodontic restorations may lead to speech defects. Most such defects are mild but, nevertheless, can be a source of concern to the patient. For the dental practitioner, there are few guidelines for designing a prosthetic restoration with maximum phonetic success. One of these guidelines involves the setting up of teeth within the neutral zone. The aim of this study was to evaluate, subjectively and objectively, the effect on speech of setting up teeth in the neutral zone. Three groups were examined: group I (control) included 10 completely dentulous subjects, group II included 10 completely edentulous patients with conventional dentures, and group III included the same 10 edentulous patients with neutral zone dentures. Subjective assessment included patient satisfaction. Objective assessment included duration taken for recitation of Al-Fateha and acoustic analysis. Subjectively, patients were more satisfied with their neutral zone dentures. Objectively, speech produced with the neutral zone dentures was closer to normal than speech with conventional dentures.

Rehabilitation of a marginal mandibulectomy patient using a modified neutral zone technique: a case report

Anterior edentulous areas usually display unusual soft tissue configurations and compromised bone support in patients with marginal mandibulectomy. There are several treatment modalities for these patients. A removable partial denture may be the treatment of choice. Maximum stability of the partial denture base for mandibulectomy patients may be accomplished by the application of the neutral zone concept, which helps providing stability to the base. This case report describes the fabrication of a removable partial denture for a patient with marginal mandibulectomy using a modified neutral zone technique.

Effect of adding impression material to mandibular denture space in Piezography

The purpose of the study was to examine the effect of adding impression material on denture space using a piezographical record. Subjects were ten voluntary edentulous patients, aged from 61 to 84 years old. A maxillary trial denture with anterior artificial teeth and a mandibular base plate with a keel were inserted into the oral cavity. Three ml of tissue-conditioning materials was injected on the base plate for each trial. Afterwards, the patients were instructed to pronounce various phonemes, so that tongue, cheeks and lips conformed to the denture space. The impression complexes were cut at the level of the estimated occlusal plane. Occlusal analogues were made by duplicating the impression complexes. Measurements were performed for five analogues from the first to fifth additions for each subject. The data were compared using analysis of variance (ANOVA), and a Friedman's test followed by a Bonferroni test for multiple comparisons with a level of significance at 5%. At the molar and premolar positions, the bucco-lingual widths of the occlusal table increased significantly at incremental injection of impression materials from P1 to P4. The midpoints of the analogues were located at a distance of 1.5 mm buccally at the molar position and at a distance of 1.9 mm buccally at the premolar position from the top of the alveolar crest, independent of the addition of impression material. It was concluded that denture space was regulated by volume of material and was located slightly on the buccal side from the crest of the residual alveolar ridge.

Arrangement of artificial teeth in the neutral zone after surgical reconstruction of the mandible: a clinical report

This clinical report describes the fabrication of a fixed partial denture, supported and retained by implants, for a patient with unfavorable tongue movement caused by movable grafted skin on the floor of the mouth after surgical reconstruction of the mandible. The neutral zone technique was used, and successful results were obtained.