Tuesday, April 28, 2009

First F/F Case – 1

While I have completed a few preliminary appointments and recalls with other patients, I finally seem to have roped in a committed and punctual patient that I will be treating from start to finish. It also happens to be a complete dentures case (full over full (F/F)). While I really didn’t enjoy the dentures course, I must have learned more than I thought, because reviewing the material didn’t seem so bad.

Obviously as I get into the more technical components, things might get interesting. The thing is, I am extremely motivated to make these things look awesome (much more motivated than I was for the fake patient in the pre-clinic course). I plan on getting a camera soon so that I can possibly upload photos of this entire process because those of you in school learning about dentures for the first time probably know how confusing things can seem.

So today was the first appointment I have had with Mrs. E. (HIPPA!!) The appointment was scheduled for 2 pm and she showed up at noon. She knew the appointment was at 2 also, she just didn’t want to be late…holy crap – talk about someone who actually wants treatment (unlike ½ my patients). I suppose if I had no teeth, I would be anxious to get that solved as well.

I set up my operatory, check out an exam kit from sterilization, grab my mixing bowl/spatula and BP cuff/stethoscope..time to go. I introduce myself to the patient and bring her back. She is EXTREMELY easy-going and well-mannered. Our initial conversation lasted about ten minutes. She told me how in January she had her remaining teeth extracted and palatal torus removed (all in preparation for the dentures). Many dentures patients already have a pair that simply are broken down or not working out. However, this patient has never experienced dentures before. So I try my best to make sure her expectations don’t get INSANELY high. Dentures will never be as good as real teeth, period. I also mentioned the option of converting the mandibular denture into an overdenture (implant-supported denture) once we finished the two arches. This is actually a GREAT deal at the school. An overdenture is created by placing two implants in the anterior region of the mandible and placing attachments on the parts that poke out of the gums which fit directly into the denture – greatly improving retention/stability. This will run you about 4k outside of the school. However, if you get them done at UIC, it will cost you 300 dollars – INSANE bargain. Mrs. E. is on a bit of a financial strain however, and she can only pay so much at a time. So in a rare way, the slow process of treatment at a dental school will actually work in her favor, she will be able to pay most of it off before I even finish.

OK, so I take her BP. I get a fairly high reading using the steth and cuff. However, I am still inexperienced and the clinic is loud so I take it again. Still around 160/90. She told me her BP is usually ‘good.’ I switch to the wrist BP cuff which reads 170/105. Pretty damn high. However, I really question the validity of those wrist readers as they are often all over the place. So I proceed with the med history/dental history/risk factor analysis. She has arthritis and takes a few meds for the pain, nothing else jumped out. It was nice that she was edentulous because I could skip the long process of odontogram charting and focus more on the clinical stuff. I took her BP again after all this talking (15 minutes or so) and it was 149/78 which is much better. However, if I continue to get high readings, I will probably get her a med consult.

So I proceed to the extra-oral and intra-oral exams. She has AWESOME ridges. As in huge, broad, tall, awesome - I really couldn’t have asked for a better patient in terms of success potential – not to mention we are required to do one overdenture case to graduate so it is a win-win (assuming she goes with the implants down the road).

I grab my instructor, he agrees that Mrs. E. has some amazing ridges and checks me off to take the initial impressions.

I was too slow on the first impression. I haven’t used the fast-set alginate enough yet so my speed needs a little work. The material was a little too hard so I didn’t get the tray seated deep enough. My second attempt is MUCH better and will work for custom-tray fabrication. I proceed to the mandible. The first impression was crap; I forgot to pull the lip out first and seated the thing too anteriorly. My second attempt was acceptable. Given the fact that I haven’t taken impressions forever, I was happy to get both arches done in four tries. Obviously won’t want to be doing that in a year, but I’ll take it for now.

I next slapped together a quick treatment plan for the dentures and had the patient sign off. I wrote up my note and escorted the patient out. The dentures will cost about 1000 total, the initial exam was 36, and the overdentures will be 300. Not a bad deal at all. She put down 336 and was on her way. I will be seeing her next at the end of May.

I cleaned up my unit and took the impressions upstairs to pour up. All the damn D-1’s were in the wet lab working on occlusion wax-ups..gross. I went back downstairs to the support lab by our clinic and poured the impressions up in microstone. Seeing as I have a lot of shit to study for, I didn’t do the second pour. I popped out initial models and they looked fine, so I will second pour and create the custom trays before her next appointment. And yes, I know I need to get more efficient doing lab work.

Whew, those initial appointments are exhausting.

I also plan on keeping a running total to see how horribly slow I am.

# of Appointments: 1
-COE, Initial Impressions (1)

Outside of class lab time: 45mins (1st pour, initial impressions upper/lower) - mostly just sitting around waiting for things to set.