October 13, 2025 • 12 mins
An extensive overview of a dental technique called Suction-Effective Mandibular Complete Denture (SEMCD), developed by Jiro Abe of Abe Dental Clinic, and its integration with the Biofunctional Prosthetic System (BPS). The material is structured into chapters that cover the fundamentals of BPS, the combination of SEMCD and BPS through analog and digital workflows, and the mechanisms of mandibular and maxillary denture suction. Significant attention is paid to the impression and bite registration techniques, including the innovative Frame Cut Back (FCB) Tray, necessary for achieving effective denture suction. Furthermore, the text details the procedures for final impression, tooth set-up, wax denture fabrication, and finishing, emphasizing the importance of securing a peripheral seal to ensure the stability and success of complete dentures.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back to the deep dive. If you've ever found
yourself really frustrated by a mandibular complete denture that just
refuses to stay put, slipping, daring functions, Yeah, breaking the seal,
the moment the patient even tries to talk, Well, this
dive is definitely for you.
Speaker 2 (00:16):
We're getting into some specifics here we are.
Speaker 1 (00:18):
We're dissecting giro abess system, the suction of a mandibular
complete denture SEMCD and looking at how it integrates with
the biofunctional prosthetic system BTS, which is kind of the bedrock.
Speaker 2 (00:30):
It really is.
Speaker 1 (00:31):
So for clinicians, students listening in our mission today is simple,
cut through the jargon, get to the practical stuff. What anatomy,
what clinical engineering makes mandibular section actually.
Speaker 2 (00:43):
Predictable and moving beyond just hoping it sticks right towards
actively creating.
Speaker 1 (00:47):
That seal exactly, Passive retention versus dynamic ceiling.
Speaker 2 (00:51):
That difference is well, it's everything. So let's define suction
in this context. Okay, it's about creating a partial vacuum
negative pressure. This happens when the patient bites down accludes
from their rest position from rest. Yes, that movement pushes
saliva out, and this is critical. It has to seal
the entire denture border all the way.
Speaker 1 (01:12):
Around, using the mobile tissue.
Speaker 2 (01:14):
Using the mobile oral mucosa. Precisely. The absolute, non negotiable
rule from ABE is seal.
Speaker 1 (01:21):
All borders, every single bit.
Speaker 2 (01:23):
Every bit. If there's even a tiny leak, the vacuum's gone. Wow.
And getting this needs three things working together dynamically. First,
the actual border seal right, Second, creating that negative pressure
through the biting force, and third keeping that seal during function, swallowing, resting,
even slight mouth opening.
Speaker 1 (01:41):
It sounds less like just fitting a denture and more
like fluid dynamics.
Speaker 2 (01:45):
Huh, it kind of is. It's engineering within the mouth.
Speaker 1 (01:48):
The old thinking was always mandible. Has got a small area.
It's a losing battle. But ABE says it's solvable.
Speaker 2 (01:55):
Solvable, Yes, but only if you follow the system, which
brings us back to DPS.
Speaker 1 (01:59):
Why is b PS considered so fundamental, almost mandatory as
the starting point here?
Speaker 2 (02:04):
Well, BPS gives us that essential hierarchy, you know, the
inviolable rules for success. We often want to jump straight
to the lower impression.
Speaker 1 (02:11):
Guilty is charged, sometimes we all.
Speaker 2 (02:13):
Are, But BPS makes a step back it says, look
maxillary dinger stability first, proper jaw relationship first. These are foundational,
like building a house.
Speaker 1 (02:24):
Can't put up tricky walls on a shaky foundation, exactly that.
Speaker 2 (02:28):
You can't stabilize the tricky mandible if the maxilla isn't
rock solid and the bite isn't right.
Speaker 1 (02:34):
So stabilize the top, confirm the relationship, then worry about
the dynamic lower border.
Speaker 2 (02:39):
Precisely that hierarchy actually puts things like the impression method
itself or tooth selection occlusion, they come later.
Speaker 1 (02:47):
They're secondary to getting the upper arch and the bite.
Speaker 2 (02:50):
Correct in this philosophy, yes, because if the upper moves
or the jaw relationship is off, the force you need
to activate that lower section just won't trans smit correctly.
Speaker 1 (03:01):
Makes sense. And BPS isn't just for full uppers and lowers, No.
Speaker 2 (03:04):
It's versable, used for single dentures you plant over ensures,
conventional overt ensers too. It's a really solid framework.
Speaker 1 (03:09):
So when we integrate SEMCD into this BPS workflow, how
different does it actually look day to day in the clinic.
Speaker 2 (03:18):
Clinically, the steps, you know, the sequence, It looks pretty
similar to traditional BPS. Okay, but how the execution of
each step. That's where it changes. Fundamentally, everything is geared
towards achieving that active section.
Speaker 1 (03:31):
And what about digital versus analog? Does that change the
clinical side?
Speaker 2 (03:35):
Good question. The sources are clear. Digital mostly changes the
lab side, think pre polymerization discs milling.
Speaker 1 (03:42):
Right, the fabrication exactly.
Speaker 2 (03:44):
But the clinical requirements what the dentist needs to capture
to get the seal that stays the same. Digital doesn't
change the necessary clinical information.
Speaker 1 (03:52):
Okay, So we have the system BPS and the systematic approach.
Now let's face the beast, the mandibular anatomy. Why is
it such a nightmare for retention? Typically?
Speaker 2 (04:01):
Oh, the list is significant and it mostly comes down
to movement. Okay. First, obviously the tongue, constant presence, dynamic movement.
It's the number one seal.
Speaker 1 (04:09):
Break, always in the way, always.
Speaker 2 (04:12):
Second, just less real escape, yeah, smaller denture bearing area,
less immobile tissue to grip onto. Third, those retromolar pads,
they're deformable. They squish under pressure, so they change shape,
they do. But the really big one, the factor that
makes it so tough is the volume of mobile tissue
in the lower cheek and lip fold, the mucibilicle fold.
Speaker 1 (04:33):
How much bigger?
Speaker 2 (04:34):
It's about two to three times the volume of the
upper fold. Wow that much. Yeah, So if you don't
actively use that mobility, it will work against you and
break the seal.
Speaker 1 (04:43):
So the source material talks about four specific types of
closure needed, like cracking a combination lock.
Speaker 2 (04:49):
That's a perfect analogy, he really is. You need all
four working together.
Speaker 1 (04:52):
Okay, break them down for us. What's the first one?
Speaker 2 (04:54):
First is the interior exterior double closure. This happens out
front in the lay by abulical area. The idea is
the denture base gets sandwiched between the chiclip mucosa on
the outside and the denture surface on the inside. It
gives you lateral stability, a clamp sort of. Yeah. Then second,
and this is critical, is the seal in the sublingual area,
(05:15):
the lingual.
Speaker 1 (05:15):
Seal under the tongue.
Speaker 2 (05:17):
Right. Two key regions here, the anterior sublinkal fold and
the posterior area the retromyle hyode fasa. Now that anterior
fold is really interesting. Success there heavily depends on how
much spongy tissue is present.
Speaker 1 (05:29):
Spongy tissue.
Speaker 2 (05:30):
Yeah, if there isn't much if it's thin or firm,
the seal there is really weak when the tongue moves.
That immediately flags a potentially difficult case.
Speaker 1 (05:39):
Okay, So if that anterior seal is weak because of
sparse spongy tissue, how do you compensate further back?
Speaker 2 (05:46):
Ah? That leads right into the third mechanism, the compensatory
closure in the retromylo hiode fasa. This is pure functional engineering.
To stand up to the tongue's pressure back there, you
must extend the denture base two to three millimeters past
the mile hyodridge itself.
Speaker 1 (06:00):
Past the ridge.
Speaker 2 (06:01):
Really, yes, intentionally, this creates what Abe calls a resistant wall.
It builds the necessary pressure seal back there and stops
the tone from just pushing the denture up, so.
Speaker 1 (06:12):
You're not just resting on the ridge, You're actively using
the space beyond it to create a barrier.
Speaker 2 (06:17):
Precisely, if you don't build that two to three millimeters
deep wall in that specific spot, the tongue just lifts
the denture game over.
Speaker 1 (06:25):
That's a huge shift in thinking it.
Speaker 2 (06:27):
Is, and the fourth mechanism ties it all together. Poststeriorly
ceiling in the retromolar pad region.
Speaker 1 (06:34):
The trickiest part.
Speaker 2 (06:35):
Often Yes. The key here is what Abe calls the
BTC point BTC sands for bucomi, kosa, tongue and central
side contact. Okay, it means the design has to let
the lingle, fold, tissue, and the side of the tongue
touch the inside of the denture border. Uh huh. Well,
at the same time the cheek muscle the bucinator pushes
(06:55):
inward over the posterior border.
Speaker 1 (06:57):
Wait, the tongue and the cheek have to compress the
border some ultaneously. That sounds incredibly delicate. How does that
not just pop the denture out?
Speaker 2 (07:04):
That's why the impression and the fit are so critical.
If you get it right, the tongue's action helps hold
the seal by contacting that inner surface. It works with
the cheek muscle. Ah.
Speaker 1 (07:14):
I see cooperative ceiling exactly.
Speaker 2 (07:16):
And this brings us to the common mistake over extension.
Speaker 1 (07:20):
What breaks the seal over extending the base.
Speaker 2 (07:23):
Especially too far back into that retromylohyoide space or impinging
on the boucinator muscle. That interferes with the muscle function,
which disrupts the BTC point and poof the seal is gone.
We need to capture those mobile tissues accurately in their
relaxed state.
Speaker 1 (07:40):
So if anatomy is the challenge, diagnosis must be the roadmap.
How does ABE actually assess if a patient is even
a candidate for this?
Speaker 2 (07:48):
It starts with a really detailed intro oral exam. There's
a specific checklist focusing on eight suction inhibiting factors. Each
factor is rated good, fair, or poor. Things like rid
shape that ructial spongy tissue in the sublingual fold, the
actual space available for that two three milimeters extension back
in the retromile Hoyd Fassa, the shape of the retromolar
(08:09):
pad ideally pear shaped, how much the tongue retracts when
they move, the jaw relationship TMJ function.
Speaker 1 (08:15):
It's comprehensive, and how do you use that score?
Speaker 2 (08:17):
The guideline is pretty clear. If a patient gets more
than two poor marks on those eight factors, uh uh yeah,
they're classified as a difficult case. Predictable section becomes highly
unlikely without some kind of pre prosthetic help like surgery.
Speaker 1 (08:32):
But if the factors look okay, the success.
Speaker 2 (08:34):
Rate is actually quite high. The sources mentioned about eighty
seven percent satisfactory section when dentists are well trained and
follow the protocol strictly.
Speaker 1 (08:41):
Eighty seven percent. That's impressive for mandibular dentures. It really
shows the power of the system.
Speaker 2 (08:47):
It does. It validates all that careful preparation.
Speaker 1 (08:49):
Okay, let's talk impressions. Then the critical preliminary stage MAXILLA
uses acuten xd right, dual viscosity, correct.
Speaker 2 (08:58):
Heavy body for the base body, syringed for the mobile tissues,
specific ways to handle flabby ridges or Tory two.
Speaker 1 (09:05):
But the mandible that's where the SEMCD specific technique really starts.
Speaker 2 (09:10):
Absolutely. The mandibular polemary impression is step one towards that seal.
It needs a special tray, the frame cut back or
FCB tray. And here's the key. This impression must be
taken with the mandible and the rest position rest.
Speaker 1 (09:23):
Position, not open wide like usual. Why is that so vital.
Speaker 2 (09:26):
Because opening wide stretches and distorts all those mobile tissues
we just talked about, especially around the retromolar pad and
in the folds.
Speaker 1 (09:33):
Ah. So an open mouth impression captures a tense, unnatural
border exactly.
Speaker 2 (09:39):
Capturing it at rest gets the tissues in their natural,
relaxed form. Then when the patient functions later closes swallows
the muscles activating compress the border, creating the seal dynamically.
Speaker 1 (09:51):
Instead of fighting against a border that was already stretched
tight in the impression.
Speaker 2 (09:55):
Precisely, it's quite counterintuitive to traditional methods, but dential for SEMCD.
Speaker 1 (10:02):
So you capture the anatomy when it's slack, knowing function
will activate the retention. That makes the custom trade design
absolutely critical, doesn't it.
Speaker 2 (10:10):
It has to be meticulously designed based on that preliminary
impression and the four ceiling mechanisms we need.
Speaker 1 (10:15):
Okay, so what does that mandibular custom tray look like.
Speaker 2 (10:19):
It needs to cover the retromolar pad completely for that
BPC point right, It needs specific clearance for something called
the sinew string, a little fibrous band that helps pull
the cheek mucosa in. And crucially, it must incorporate that
deep extension two to three millimeters past the mile hyoid
ridge to frame out the area for the resisted wall
(10:40):
in the retromilohoid fossa.
Speaker 1 (10:43):
So the custom tree itself builds in the potential for
those key ceiling zones exactly.
Speaker 2 (10:47):
It sets the stage for the final functional impression to
capture everything.
Speaker 1 (10:50):
Correctly Okay, let's try and tie this all together. Then
what's the big takeaway?
Speaker 2 (10:54):
Well, achieving mandibular section the SEMCD way, it isn't magic,
it's it's system. It's about respecting the dynamic moving anatomy,
the BTC point, those foreclosures, and using very specific functional techniques,
especially that crucial FCB tray impression taken at rest. It
shifts the whole game from just trying to cover area
(11:15):
to actively sealing the borders using the patient's own function.
Speaker 1 (11:19):
That idea, that reliance on dynamic anatomy, it really does
change the perspective on treating identialist patients, particularly the lower arch.
It takes something historically difficult. It makes it seem solvable, repeatable.
Speaker 2 (11:30):
Even when done correctly.
Speaker 1 (11:31):
Yes, So for you listening, what stands out most about
this About using the patient's own muscle movements to create
the seal, it's a fascinating concept.
Speaker 2 (11:40):
It really shifts the paradigm definitely.
Speaker 1 (11:42):
Okay, here's a final exercise for you, tom all over
to really solidify this.
Speaker 2 (11:46):
Let's test that understanding.
Speaker 1 (11:48):
Based on those suction inhibiting factors we discussed. Imagine you
examine a patient, you find they have severe tongue retraction
whenever they open or close.
Speaker 2 (11:56):
Okay, a common issue.
Speaker 1 (11:58):
And you've also noticed they have in a mole really
non spongy tissue in that anterior sublingual fold. So describe
an intra ural finding for this patient that would definitely
classify their situation as difficult, and then explain which of
those four ceiling mechanisms we talked about would be most
compromised by that specific combination of tongue retraction and poor
(12:19):
anterior tissue quality. Think about where the seal would likely
fail first
Welcome back to the deep dive. If you've ever found
yourself really frustrated by a mandibular complete denture that just
refuses to stay put, slipping, daring functions, Yeah, breaking the seal,
the moment the patient even tries to talk, Well, this
dive is definitely for you.
Speaker 2 (00:16):
We're getting into some specifics here we are.
Speaker 1 (00:18):
We're dissecting giro abess system, the suction of a mandibular
complete denture SEMCD and looking at how it integrates with
the biofunctional prosthetic system BTS, which is kind of the bedrock.
Speaker 2 (00:30):
It really is.
Speaker 1 (00:31):
So for clinicians, students listening in our mission today is simple,
cut through the jargon, get to the practical stuff. What anatomy,
what clinical engineering makes mandibular section actually.
Speaker 2 (00:43):
Predictable and moving beyond just hoping it sticks right towards
actively creating.
Speaker 1 (00:47):
That seal exactly, Passive retention versus dynamic ceiling.
Speaker 2 (00:51):
That difference is well, it's everything. So let's define suction
in this context. Okay, it's about creating a partial vacuum
negative pressure. This happens when the patient bites down accludes
from their rest position from rest. Yes, that movement pushes
saliva out, and this is critical. It has to seal
the entire denture border all the way.
Speaker 1 (01:12):
Around, using the mobile tissue.
Speaker 2 (01:14):
Using the mobile oral mucosa. Precisely. The absolute, non negotiable
rule from ABE is seal.
Speaker 1 (01:21):
All borders, every single bit.
Speaker 2 (01:23):
Every bit. If there's even a tiny leak, the vacuum's gone. Wow.
And getting this needs three things working together dynamically. First,
the actual border seal right, Second, creating that negative pressure
through the biting force, and third keeping that seal during function, swallowing, resting,
even slight mouth opening.
Speaker 1 (01:41):
It sounds less like just fitting a denture and more
like fluid dynamics.
Speaker 2 (01:45):
Huh, it kind of is. It's engineering within the mouth.
Speaker 1 (01:48):
The old thinking was always mandible. Has got a small area.
It's a losing battle. But ABE says it's solvable.
Speaker 2 (01:55):
Solvable, Yes, but only if you follow the system, which
brings us back to DPS.
Speaker 1 (01:59):
Why is b PS considered so fundamental, almost mandatory as
the starting point here?
Speaker 2 (02:04):
Well, BPS gives us that essential hierarchy, you know, the
inviolable rules for success. We often want to jump straight
to the lower impression.
Speaker 1 (02:11):
Guilty is charged, sometimes we all.
Speaker 2 (02:13):
Are, But BPS makes a step back it says, look
maxillary dinger stability first, proper jaw relationship first. These are foundational,
like building a house.
Speaker 1 (02:24):
Can't put up tricky walls on a shaky foundation, exactly that.
Speaker 2 (02:28):
You can't stabilize the tricky mandible if the maxilla isn't
rock solid and the bite isn't right.
Speaker 1 (02:34):
So stabilize the top, confirm the relationship, then worry about
the dynamic lower border.
Speaker 2 (02:39):
Precisely that hierarchy actually puts things like the impression method
itself or tooth selection occlusion, they come later.
Speaker 1 (02:47):
They're secondary to getting the upper arch and the bite.
Speaker 2 (02:50):
Correct in this philosophy, yes, because if the upper moves
or the jaw relationship is off, the force you need
to activate that lower section just won't trans smit correctly.
Speaker 1 (03:01):
Makes sense. And BPS isn't just for full uppers and lowers, No.
Speaker 2 (03:04):
It's versable, used for single dentures you plant over ensures,
conventional overt ensers too. It's a really solid framework.
Speaker 1 (03:09):
So when we integrate SEMCD into this BPS workflow, how
different does it actually look day to day in the clinic.
Speaker 2 (03:18):
Clinically, the steps, you know, the sequence, It looks pretty
similar to traditional BPS. Okay, but how the execution of
each step. That's where it changes. Fundamentally, everything is geared
towards achieving that active section.
Speaker 1 (03:31):
And what about digital versus analog? Does that change the
clinical side?
Speaker 2 (03:35):
Good question. The sources are clear. Digital mostly changes the
lab side, think pre polymerization discs milling.
Speaker 1 (03:42):
Right, the fabrication exactly.
Speaker 2 (03:44):
But the clinical requirements what the dentist needs to capture
to get the seal that stays the same. Digital doesn't
change the necessary clinical information.
Speaker 1 (03:52):
Okay, So we have the system BPS and the systematic approach.
Now let's face the beast, the mandibular anatomy. Why is
it such a nightmare for retention? Typically?
Speaker 2 (04:01):
Oh, the list is significant and it mostly comes down
to movement. Okay. First, obviously the tongue, constant presence, dynamic movement.
It's the number one seal.
Speaker 1 (04:09):
Break, always in the way, always.
Speaker 2 (04:12):
Second, just less real escape, yeah, smaller denture bearing area,
less immobile tissue to grip onto. Third, those retromolar pads,
they're deformable. They squish under pressure, so they change shape,
they do. But the really big one, the factor that
makes it so tough is the volume of mobile tissue
in the lower cheek and lip fold, the mucibilicle fold.
Speaker 1 (04:33):
How much bigger?
Speaker 2 (04:34):
It's about two to three times the volume of the
upper fold. Wow that much. Yeah, So if you don't
actively use that mobility, it will work against you and
break the seal.
Speaker 1 (04:43):
So the source material talks about four specific types of
closure needed, like cracking a combination lock.
Speaker 2 (04:49):
That's a perfect analogy, he really is. You need all
four working together.
Speaker 1 (04:52):
Okay, break them down for us. What's the first one?
Speaker 2 (04:54):
First is the interior exterior double closure. This happens out
front in the lay by abulical area. The idea is
the denture base gets sandwiched between the chiclip mucosa on
the outside and the denture surface on the inside. It
gives you lateral stability, a clamp sort of. Yeah. Then second,
and this is critical, is the seal in the sublingual area,
(05:15):
the lingual.
Speaker 1 (05:15):
Seal under the tongue.
Speaker 2 (05:17):
Right. Two key regions here, the anterior sublinkal fold and
the posterior area the retromyle hyode fasa. Now that anterior
fold is really interesting. Success there heavily depends on how
much spongy tissue is present.
Speaker 1 (05:29):
Spongy tissue.
Speaker 2 (05:30):
Yeah, if there isn't much if it's thin or firm,
the seal there is really weak when the tongue moves.
That immediately flags a potentially difficult case.
Speaker 1 (05:39):
Okay, So if that anterior seal is weak because of
sparse spongy tissue, how do you compensate further back?
Speaker 2 (05:46):
Ah? That leads right into the third mechanism, the compensatory
closure in the retromylo hiode fasa. This is pure functional engineering.
To stand up to the tongue's pressure back there, you
must extend the denture base two to three millimeters past
the mile hyodridge itself.
Speaker 1 (06:00):
Past the ridge.
Speaker 2 (06:01):
Really, yes, intentionally, this creates what Abe calls a resistant wall.
It builds the necessary pressure seal back there and stops
the tone from just pushing the denture up, so.
Speaker 1 (06:12):
You're not just resting on the ridge, You're actively using
the space beyond it to create a barrier.
Speaker 2 (06:17):
Precisely, if you don't build that two to three millimeters
deep wall in that specific spot, the tongue just lifts
the denture game over.
Speaker 1 (06:25):
That's a huge shift in thinking it.
Speaker 2 (06:27):
Is, and the fourth mechanism ties it all together. Poststeriorly
ceiling in the retromolar pad region.
Speaker 1 (06:34):
The trickiest part.
Speaker 2 (06:35):
Often Yes. The key here is what Abe calls the
BTC point BTC sands for bucomi, kosa, tongue and central
side contact. Okay, it means the design has to let
the lingle, fold, tissue, and the side of the tongue
touch the inside of the denture border. Uh huh. Well,
at the same time the cheek muscle the bucinator pushes
(06:55):
inward over the posterior border.
Speaker 1 (06:57):
Wait, the tongue and the cheek have to compress the
border some ultaneously. That sounds incredibly delicate. How does that
not just pop the denture out?
Speaker 2 (07:04):
That's why the impression and the fit are so critical.
If you get it right, the tongue's action helps hold
the seal by contacting that inner surface. It works with
the cheek muscle. Ah.
Speaker 1 (07:14):
I see cooperative ceiling exactly.
Speaker 2 (07:16):
And this brings us to the common mistake over extension.
Speaker 1 (07:20):
What breaks the seal over extending the base.
Speaker 2 (07:23):
Especially too far back into that retromylohyoide space or impinging
on the boucinator muscle. That interferes with the muscle function,
which disrupts the BTC point and poof the seal is gone.
We need to capture those mobile tissues accurately in their
relaxed state.
Speaker 1 (07:40):
So if anatomy is the challenge, diagnosis must be the roadmap.
How does ABE actually assess if a patient is even
a candidate for this?
Speaker 2 (07:48):
It starts with a really detailed intro oral exam. There's
a specific checklist focusing on eight suction inhibiting factors. Each
factor is rated good, fair, or poor. Things like rid
shape that ructial spongy tissue in the sublingual fold, the
actual space available for that two three milimeters extension back
in the retromile Hoyd Fassa, the shape of the retromolar
(08:09):
pad ideally pear shaped, how much the tongue retracts when
they move, the jaw relationship TMJ function.
Speaker 1 (08:15):
It's comprehensive, and how do you use that score?
Speaker 2 (08:17):
The guideline is pretty clear. If a patient gets more
than two poor marks on those eight factors, uh uh yeah,
they're classified as a difficult case. Predictable section becomes highly
unlikely without some kind of pre prosthetic help like surgery.
Speaker 1 (08:32):
But if the factors look okay, the success.
Speaker 2 (08:34):
Rate is actually quite high. The sources mentioned about eighty
seven percent satisfactory section when dentists are well trained and
follow the protocol strictly.
Speaker 1 (08:41):
Eighty seven percent. That's impressive for mandibular dentures. It really
shows the power of the system.
Speaker 2 (08:47):
It does. It validates all that careful preparation.
Speaker 1 (08:49):
Okay, let's talk impressions. Then the critical preliminary stage MAXILLA
uses acuten xd right, dual viscosity, correct.
Speaker 2 (08:58):
Heavy body for the base body, syringed for the mobile tissues,
specific ways to handle flabby ridges or Tory two.
Speaker 1 (09:05):
But the mandible that's where the SEMCD specific technique really starts.
Speaker 2 (09:10):
Absolutely. The mandibular polemary impression is step one towards that seal.
It needs a special tray, the frame cut back or
FCB tray. And here's the key. This impression must be
taken with the mandible and the rest position rest.
Speaker 1 (09:23):
Position, not open wide like usual. Why is that so vital.
Speaker 2 (09:26):
Because opening wide stretches and distorts all those mobile tissues
we just talked about, especially around the retromolar pad and
in the folds.
Speaker 1 (09:33):
Ah. So an open mouth impression captures a tense, unnatural
border exactly.
Speaker 2 (09:39):
Capturing it at rest gets the tissues in their natural,
relaxed form. Then when the patient functions later closes swallows
the muscles activating compress the border, creating the seal dynamically.
Speaker 1 (09:51):
Instead of fighting against a border that was already stretched
tight in the impression.
Speaker 2 (09:55):
Precisely, it's quite counterintuitive to traditional methods, but dential for SEMCD.
Speaker 1 (10:02):
So you capture the anatomy when it's slack, knowing function
will activate the retention. That makes the custom trade design
absolutely critical, doesn't it.
Speaker 2 (10:10):
It has to be meticulously designed based on that preliminary
impression and the four ceiling mechanisms we need.
Speaker 1 (10:15):
Okay, so what does that mandibular custom tray look like.
Speaker 2 (10:19):
It needs to cover the retromolar pad completely for that
BPC point right, It needs specific clearance for something called
the sinew string, a little fibrous band that helps pull
the cheek mucosa in. And crucially, it must incorporate that
deep extension two to three millimeters past the mile hyoid
ridge to frame out the area for the resisted wall
(10:40):
in the retromilohoid fossa.
Speaker 1 (10:43):
So the custom tree itself builds in the potential for
those key ceiling zones exactly.
Speaker 2 (10:47):
It sets the stage for the final functional impression to
capture everything.
Speaker 1 (10:50):
Correctly Okay, let's try and tie this all together. Then
what's the big takeaway?
Speaker 2 (10:54):
Well, achieving mandibular section the SEMCD way, it isn't magic,
it's it's system. It's about respecting the dynamic moving anatomy,
the BTC point, those foreclosures, and using very specific functional techniques,
especially that crucial FCB tray impression taken at rest. It
shifts the whole game from just trying to cover area
(11:15):
to actively sealing the borders using the patient's own function.
Speaker 1 (11:19):
That idea, that reliance on dynamic anatomy, it really does
change the perspective on treating identialist patients, particularly the lower arch.
It takes something historically difficult. It makes it seem solvable, repeatable.
Speaker 2 (11:30):
Even when done correctly.
Speaker 1 (11:31):
Yes, So for you listening, what stands out most about
this About using the patient's own muscle movements to create
the seal, it's a fascinating concept.
Speaker 2 (11:40):
It really shifts the paradigm definitely.
Speaker 1 (11:42):
Okay, here's a final exercise for you, tom all over
to really solidify this.
Speaker 2 (11:46):
Let's test that understanding.
Speaker 1 (11:48):
Based on those suction inhibiting factors we discussed. Imagine you
examine a patient, you find they have severe tongue retraction
whenever they open or close.
Speaker 2 (11:56):
Okay, a common issue.
Speaker 1 (11:58):
And you've also noticed they have in a mole really
non spongy tissue in that anterior sublingual fold. So describe
an intra ural finding for this patient that would definitely
classify their situation as difficult, and then explain which of
those four ceiling mechanisms we talked about would be most
compromised by that specific combination of tongue retraction and poor
(12:19):
anterior tissue quality. Think about where the seal would likely
fail first
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