Prosthetic treatment steps
In the maxilla, accurate recording of the implant positions is required using a customized tray and a primary open-tray type I plaster impression. In the mandible, the approach is the same for a conventional complete removable prosthesis. A preliminary Type 1 plaster impression was completed by a second impression using an individual adjusted tray, thermoplastic paste border molding, and surface treatment with regular viscosity polysulphides.
The patient presented atypical facial and oral anatomical landmarks which challenged the options for VDO and occlusal plane orientation. Phonation tests were inconclusive due to the low facial and lingual muscle mobility. Despite the labial inocclusion (due to tissue sclerosis), we recorded the VDO at a height equivalent to that of the medium face stage.
The occlusal plane goes through the patient’s left lip corner (non operated side) leaving the prosthetic teeth partially apparent. Then, the CB was fabricated according to the mounting of the teeth. The bar has a 2mm diameter round section, and is spaced 2 mm away from the mucosa. It was validated clinically and radiographically.