I.

Patient Work-up
Personal Information
1. Name: Federico Cabero
2. Age: 55 years old
3. Sex: Male
4. Address: GMA, Cavite
5. Occupation: Painter

II. Chief Complaint

“Wala na akong ngipin sa itaas at wala na ring bagang sa ibaba.”

III. History of Present Illness

28 years PTC, the patient had his first extraction done by a private dentist. He claims
to have had his teeth extracted due to caries. His last extraction was done at the
college 3 months PTC due to caries as well.

D. Dental History
 Date of last visit: October 2019 for restoration and extraction
 Frequency of dental visit: rarely
 Exposure and response to local anesthesia: + exposure, no adverse reaction
 Complications during and/or after dental procedure: n/a
 Previous denture experience: 10 years PTC

E. Physical Assessment (General)

Gait and appearance are normal. There are no apparent defects.

F. Medical History
The patient claims to have had lung disease around 10 years PTC. However, he
cannot remember exactly what the diagnosis had been and the medications he took.
Upon consult, he claims not to have any illnesses or allergies or to be taking any
medications.

He has no history of recent hospitalization. He claims to not remember whether he

had any childhood diseases.

G. Social History
The patient claims to have stopped smoking 10 years PTC. He still occasionally
drinks alcoholic beverages. He claims to have tried marijuana 25 years PTC.

H. Extraoral Examination
The patient’s head, neck, TMJ, thyroid, and lymph nodes are within normal limits. His
upper lip is slightly collapsed due to edentulism in the maxilla. He also has prominent
nasolabial folds.
The patient has a concave facial profile indicating a prognathic mandible (class III).
The patient exhibits normal tension, tone and placement of the muscles of
mastication and facial expression. No degenerative changes are present. Vital signs
are also within normal limits.

I. Intraoral Examination
 Saliva
- The patient has neither dry mouth nor excessive salivation.
- Saliva aids in retention of the denture through the mechanism of cohesion
and adhesion. Water molecules in the saliva cohere to each other and
water molecules adhere to the denture, and the resulting interfacial
 surface tension does not allow the passage of air between the prosthesis
and the underlying structures, thus preventing them from separating.
- It also acts as lubricant to prevent drying of mucosa that could result to
irritation.

 Maxillary Edentulous Arch

1. Arch Size
The maxilla has a medium arch size which would provide acceptable surface
area for retention, stability, and support.

2. Arch Form
The maxilla present a tapering arch form which may provide resistance…

3. Palatal Vault
The palatal vault is v-shaped, which is the least favorable in terms of retention
and stability because of the presence of tapering slopes or walls. This could
be addressed by ensuring that extension of the denture borders are limited to
the functional limit.
The soft palatal drop is Class II, meaning there is about a 45 degree transition
from the hard palate to the soft palate. This is favorable because there is
adequate space for denture coverage and the palatal configuration is not too
shallow or not too steep.

4. Height of the Residual Ridge

The maxilla appears to be only moderately resorbed. There is enough bone
remaining for resistance against lateral displacement of the denture.

5. Ridge Form
The maxillary ridge form generally presents with rounded crest with moderate
ridge height. This is expected to be favorable in terms of support. The slopes
are also nearly parallel, which is favorable for retention and stability.

6. Bony Undercuts
There is a slight undercut in the anterior segment which does not seem to
pose problems with the path of insertion.

7. Ridge Defects
There are no apparent ridge defects.

8. Mucosal Condition
The mucosal condition is generally healthy.

9. Firmness of Underlying Tissues

The mucoperiosteum is generally firm but not tense upon palpation.

 Mandibular Arch
Only the anteriors and first premolars remain in the mandibular arch. All other
teeth were extracted due to caries. Pocket probing depths of remaining teeth
are within normal limits, except for tooth 31. Tooth 34 has a Class V
composite restoration. The residual ridge is moderately resorbed.
Load Management

A. Load Assessment
The patient’s diet consists of meat, rice, and vegetables. He has no parafunctional
habits but his remaining teeth have wear facets on the incisal and occlusal. His
muscle tonicity is within normal limits.

B. Load Distribution
The idea of broad stress distribution is central on creating the denture design which
stresses on the importance of distributing the functional loads throughout the dental
arch so that no area receives excessive stress. A lingual plate allows loads
generated on one side of the arch to be transmitted through the major connector to
that of the opposite side resulting in a reduction of stress developed within a portion
of the arch.

The denture will have two cingulum rests on resin-bonded cingulum rest seats on the
canines. By placing the rest farther from the edentulous space, the load will be
distributed to more teeth. Thus, less load will be received by the abutment tooth.

C. Load Reduction
Cusps of the denture teeth will be made sharper and the buccolingual occlusal tables
narrower. By doing these, load exerted on the denture teeth will be reduced.

Pre-prosthetic Mouth Preparations

 Guide planes on distal of 34 and 44
 Resin-bonded cingulum rest seats on 33 and 43
 Retentive dimple on DB of 34

RPD Framework Design

Major Connector
A lingual plate would be used as there is not enough clearance (functional depth <8mm)
between the gingival margins and the floor of the mouth for a lingual bar.

Rests
The primary purpose of a rest is to provide vertical support to prevent the tissue-ward
movement of the denture, which can cause impingement of the soft tissues. It also directs
and distributes the occlusal load along the long axis of the tooth to provide the most effective
resistance, which is obtained when the tooth is stressed along the long axis. It also
maintains the components in their planned positions.

Rests will be placed on resin-bonded cingulum rest seats on the mesial of 33 and 43. The
canines are the chosen abutments as they have a crown:root of 1:2. The premolars are not
the ideal abutment as they have short, conical roots and their crown:root is 1:1.

Clasps
A gingivally approaching clasp will be used as direct retainer and placed on the MB of 44. It
is acceptable because there would be more than 5 mm clearance between the gingival
margin and the planned superior border of the clasp. For the left residual ridge, the
gingivally-approaching clasp cannot be used due to the position of the buccal frenum. A
reverse circlet clasp would be utilized instead and placed on 34 to aid in stability. The clasp
would be modified by putting relief between the clasp and the tooth surface, instead of it
being closely adapted to the tooth. This is to minimize the effects of torque on the tooth
when upward movement of the denture base occurs, since the c-clasp engages the
suprabulge of the tooth thus creating a fulcrum (axis of rotation).

Proximal Plates
Proximal plates guide the insertion and removal of the denture. They also aid in the stability
of the denture as they are broad and in contact with the proximal surface of the selected
teeth. They also tend to provide reciprocation to retentive forces. When the clasp produces
force on one side of the proximal plate, the other side counteracts the force and neutralizes
it. Proximal plates will be placed on the distal of the premolars. Guide planes will be
prepared as it is expected to have a small contact area between the tooth and the future
proximal plate, which may create an axis of rotation that can cause denture dislodgment.
The guide planes will also minimize the undercut or plaque-retentive triangular space
between the tooth and the proximal plate.
Acrylic Retention Areas
An open lattice type will be used as acrylic retention areas as it exhibits greater width and
thickness compared to a mesh type, and offers superior retentive potential. The larger
spaces allow more bulk for the acrylic, making it stronger. A tissue stop will be placed on the
posterior portion of the lattice to maintain the orientation of the acrylic retention area and
prevent movement and tilting.

J. Treatment Plan
1. Case Presentation
2. Scaling and polishing, Pre-prosthetic mouth preparations, Oral Hygiene
Instruction
3. Maxillary Single Denture and Mandibular RPD Fabrication
4. Post-installation Recall