Wee Neutral Zone
Wee Neutral Zone
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The use of a neutral zone technique to fabricate a more stable complete mandibular denture for
a maxillofacial patient is presented. The technique incorporates an altered sequence from
traditional denture fabrication, resulting in a shortened treatment period.
J Prosthod 2000;9:2-7. Copyright r 2000 by The American College of Prosthodontists.
speech clarity with the dentures fabricated using the tended mandibular denture was modified and relined with
neutral zone technique compared with their conven- a tissue conditioner (Lynol; Kerr, Romulus, MI). He was
tionally prepared dentures. These studies suggest then advised not to wear his dentures 2 days before the
that the neutral zone strategy for denture fabrication final denture impressions.28
may be helpful in certain edentulous situations.
The purpose of this article is to present the use of First Appointment
the neutral zone technique for the fabrication of a
complete mandibular denture for a maxillofacial The final maxillary impression was made using Type
patient with a continuity mandibular defect and I impression compound (Red Compound, 132°C;
severely resorbed ridges. Kerr) with a nonperforated metal tray. The com-
pound impression was removed from the oral cavity,
and the borders were trimmed to a length 2 to 3 mm
Clinical Report short of the active sulcus. Border molding was per-
formed with a Type I impression compound (Green
A 65-year-old white man was referred from the
Compound, 123°C; Kerr; Fig 2), and a final wash
Department of Otolaryngology to the Dental Maxil-
impression was made with a silicone impression
lofacial Unit at the Veteran’s Affairs Medical Center
material (Elasticone; Kerr). Impression wax (Iowa
in Pittsburgh, PA. The patient presented with a
Wax; Kerr) was used to make a functional impres-
history of squamous cell carcinoma in the left man-
sion of the posterior palatal seal. A slightly overex-
dibular molar area and tumor removal that resulted
tended mandibular irreversible hydrocolloid impres-
in a healed, continuity defect. Before the surgery, the
sion was also made using a prefabricated impression
patient had been wearing complete maxillary and
tray.
mandibular dentures for the last 20 years. The
patient did not wear his previous mandibular denture
after surgery. Laboratory Procedure
In the laboratory, the maxillary impression was
Procedure beaded and boxed. Both impressions were poured in
American Dental Association type III dental stone. A
Consultation Appointment and Treatment close-fitting custom mandibular impression tray was
Planning Considerations made from a light polymerization composite resin
The patient’s chief complaint was that he could not wear (Triad; Dentsply, York, PA). The tray border was
his previous dentures after the surgery and desired new fabricated 2 to 3 mm short of the active sulcus. Metal
denture treatment. A detailed examination was com- loops for the retention of a compound rim were
pleted, and his previous dentures were evaluated for incorporated (Fig 3). A maxillary occlusal wax rim
retention and stability. Extra-oral examination revealed was formed over a record base made from clear
asymmetrical lip retraction with reduced excursion on the autopolymerizing polymethylmethacrylate resin
left side of the face. This was not unexpected, given the (Orthoresin; Dentsply, Milford, DE).
patient’s prior surgical history (ie, removal of tumor and
muscle in the left mandibular molar area). Intraorally, the
left mandibular region presented atypical anatomy with a Second Appointment
reduced retro-molar pad area. A low mandibular alveolar
ridge height was also evident (Fig 1). The maxillary occlusal rim was adjusted for proper
The use of dental implants to achieve improved stability esthetics, occlusal plane, phonetics, and support of
and retention for this patient’s planned mandibular pros- the upper lip. Appropriate lines (midline, canine
thesis was a recommended treatment modality.26,27 Unfor- lines, smile line) were marked. A facebow record was
tunately, the patient did not meet appropriate criteria that made.
would allow him treatment with dental implants in the
The mandibular custom tray (Fig 3) was adjusted
federally funded institution where he was being treated.
Financial constraints also precluded implant rehabilitation
intraorally to ensure that it was short of the active
in private or academic settings. Because of his atypical sulcus. A Type I impression compound (Grey Com-
intra- and extra-oral anatomy, the neutral zone technique pound, 126°F; Kerr) was applied in the area of the
was considered the best means to determine the most mandibular ridge on the acrylic resin tray. The
stable position for the mandibular denture teeth. compound occlusal rim was reheated in the water
With the patient’s permission, his previously overex- bath. Use of denture adhesive (Fixodent; Procter and
4 Neutral Zone Technique ● Wee, Cwynar, and Cheng
ship. The dentures were then processed, and a new (University of Pittsburgh Medical Center) for initiating his
laboratory and clinical remount were accomplished interest in the neutral zone technique. Dr. Alan B. Carr’s
to refine the occlusion.32 The dentures were polished (Ohio State University) review of the manuscript was also
and delivered (Fig 8). The patient was recalled at 1 appreciated.
day, 1 week, and 6 months.
References
Discussion
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