For this case, the patient had a surgical resection from the right inferior alveolus squamous cell carcinoma. The patient is not interested in implant therapy. The only thing I can do is to offer her a standard cast RPD. Even though this patient had cancer, my prosthetic treatment for her is not all that different from someone who needs a conventional cast RPD.
In this case, the tissue is very displaceable. So my thought process is to maximize teeth support and to minimize tissue support. For the mouth preparation, I had to add a bit of composite resin on the posterior abutment 47 for the ideal depth of undercut and to ensure I had prepared enough clearance for the rest seats and embrasure clasps. In my final impression technique, instead of doing the standard border moulding, I elected to have a very underextended custom tray using very low viscosity impression material allowing the impression material to passively go wherever it goes while asking the patient to engage in different border moulding movements.
After that, I also decide to perform a teeth try in first to idealize the aesthetic and the occlusal relationship. The tooth set up allows me to fabricate an index so the wax pattern for the cast RPD can be designed more precisely to support the prosthetic teeth.
After doing a conventional metal try in and a subsequent teeth try in with the metal framework, I deliver the cast partial denture.
My initial design did not involve clasping the lateral incisor. However, in balancing aesthetic and ideal mechanical retention, I retroactively added a clasp to the lateral incisor.
After one week of function, the patient reported to have no discomfort and was able to tolerate this cast RPD a lot better than her initial acrylic partial denture. To me, this is a great outcome for someone who cannot have anything but an RPD.
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