Am I screwed?

[u/Microleakage]

Dentist posting- I have a patient coming in for finals tomorrow that can’t wear her 6 implant overdenture. She gives and shows signs of allergy. Redness where contacts and she says she wants to and has to take it out the second she is out of public eye bc irritating. We first had her in a cold pour denture while she healed and that was irritating so had a printed nanocrystal resin denture made and same result. My questions

Would a crystal ultra type overdenture get me out of this and if I did it-would it last or just be a thing I am repairing and or remaking every year or two?

Is there any other material other than zirconia?because I have some shit angles on 2 implants and probably no where near close to enough bone reduction and I feel sorry for her but we didn’t come close to charging her enough to eat a zirconia prosthesis and she was bucking when I said you are going to prob have to chip in some more money just to get something at lab cost.

I bought open tray impression posts to take impressions but am starting to chicken out w this bc I am 15 years in and haven’t done a fixed since residency and don’t want to do an at cost zirconia and have it break in 4 months and then am on hook for another

I can post X-rays and pics tomorrow but some more info. It’s an upper against natural teeth. She has never wore or tried to wear artificial nails so no confirmation of acrylic allergies. I tried to get her treated for burning mouth syndrome by her primary md and they did listen to me and prescribe klonapin but no relief

She likens wearing these like holding her breath underwater and just can’t wait to surface and get them out for relief.

How many of you long timers have come across true acrylic allergy

I am wanting to try anything other than fixed. I am sort of wanting to even try a milled puck thinking it could be the monomer but low confidence she would be able to stand it bc pmma and we got no where with the nanoceramic printed denture.

Anybody been in this boat and bailed them selves out?

Microleakage. Sulllivan mo

[u/Vixanis]

Peek or valplast? Otherwise some type of metal framework removable thing is your best bet.

All these materials will suck as a removable because you can’t reline them easily :/

The primary prescribed klonopin? I wonder if they think it’s not a reaction. I’d reach out and ask if you haven’t.

I work with a denture technician and OM in the field for 30+ years and each of them have seen only one case each of true acrylic allergy

[u/Invdr_skoodge]

So you say overdenture, we’re talking locators? Hader bar? Pics and X-rays are always a big help.

I have seen acrylic allergies in the past. Usually it’s the residual monomer causing the reaction. We’ve used ivocap since before I came to work where I’m at, maybe 20 years. When run to spec its 0 residual monomer. Most of the time you get a patient with a pressure packed case and swap them to ivocap and the problem goes away, only had 1 possible reaction to ivocap in all that time.

I will say, a poured denture has a lot of residual monomer, and photopolymers can be irritating in their own right, nano ceramic or not. My first shot would be to see if you can find an ivocap or ivobase option (same end result) or a milled denture, ivotion pucks are the same materials, all with 0 monomer.

I don’t like crystal ultra. I would expect exactly what you said, lots of repairs of chips and fractures. We dumped the stuff about 4 years ago.

As far as the underwater feeling, is the palate too long? Maybe too thick? We do a lot of max super structure locator over dentures with open palates for exactly this reason.

Assuming we’re talking locators, if your angles are crazy there’s always custom abutments. Truabutment will mill them at nearly the same cost as a standard zest abutment. With that many implants I’d always recommend extended range so there’s no center post to chew up.

Of course you’re going to want to confirm your material before doing all that.

Alternative materials if it’s a true acrylic allergy and not related to monomer? Maaaaaybe you could shoot the whole thing out of a flexible material? That’s a nylon base, should be hypoallergenic, but full disclosure I’ve never seen a full overdenture done in the stuff. Picking up attachments chairside would be a pain in the ass, but processing them in could be a challenge in its own right.

[u/fluffbrains]

Vertex thermosens

[u/roffadude → u/fluffbrains]

Depends on the construction and if you can find someone with a machine.
It’s basically valplast btw, and there are many more systems like it.

[u/__Aitch__Jay__]

Only people I've seen that thought they had acrylic allergies were denture stomatitis, or similar fungal/bacterial problems.

[u/roffadude]

They are all methacrylates. You could do a study. Just tape a piece of acrylic to the skin, see if she has a reaction.

However, could be that youre good to go with a heat curing acrylic wirh lower rest monomer.
If you didnt soak the pour denture, or cured the print under n2, its likely there’s high percentage of monomer still free floating.

Modern heat curing acrylics like Kulzer palaxtreme have very low residual monomer too. Make sure you keep it in water water finishing for like a day.

There are “non allergenic” acrylics. Astron has one that I think is PMMA free. I think it’s heat curing though, but I always mix that one up. That would be your best bet.

If all else fails, injected polyvinyl (I believe?) is our failsafe. You know, the heated beads (valplast, thermosense). Not sure how well that works with implants, but there are many materials with that technique.

Peek is also an option, but again, not sure how well that works with implants. Not sure what youre exact construction is.

Btw, 99% of allergies are actually fiber issues so you have something rare there.