A male, 75 years old, presented at the Integrated Clinic of the Dentistry Course of the University of the West of Santa Catarina, Joaçaba-SC, complaining of severe pain in the lower teeth, which consequently had difficulty to to feed. The blood pressure was measured (120x80mmHg), he was calm, communicative and lucid. With regard to medical history, the patient described being in normal health and emphasized only Systemic Arterial Hypertension (SAH), and the continuous use of Captopril® 20mg/day. During the anamnesis, he reported that he does toothbrushing every day, however he denies the use of dental floss, and occasionally observes gingival bleeding. At the symptomatic moment, he informs that he has difficulty eating because of the intense pain in the region of the central and lower lateral incisors. No changes were found in the lymph nodes, glands, cheeks, tongue and other related parts during the physical examination; and on the initial intraoral clinical examination, total anadontics was observed in the upper jaw, where the patient had a complete prosthesis, and part of the lower arch with the absence of the elements 38, 37, 36, 35, 34, 33, 43, 44, 45, 46, 47 and 48 and removable partial denture. Elements 31 and 32 were treated endodontically and elements 41 and 42 showed mobility and fractures. There was marked wear on the incisal face, a large number of poorly adapted dental restorations, in addition to unsatisfactory periodontal condition of the 4 remaining teeth.

After carrying out the treatment plan, blood tests (complete blood count, coagulogram and fasting blood glucose) were requested, which are part of the protocol, and serve to verify general health problems that could contraindicate a surgical procedure. Radiographically, a periapical radiography of the region of elements 31,41,32 and 42 was requested to check bone availability in the area. After the development, there was a high loss of supporting bone tissue, due to advanced periodontal disease, extensive caries and root cysts.  Due to the clinical circumstances, a surgical planning was carried out, as well as a proposal for extraction of all the dental elements in question. The initial treatment plan consists of the preparatory phase for surgery, with an emphasis on promoting oral health based on instructions for oral hygiene and adaptation of the clinical environment [6].

The surgical procedure was performed, after anesthesia of nerve block: bilateral lingual, mental and incisor with Articaína 4% with adrenaline 1: 1000. The anesthetic in question has low toxicity, rapid onset of action and compared to other LA. The vasoconstrictor chosen is due to the systemic condition of hypertension, promoting a slightly milder vasoconstriction in the patient's vessels. Subsequently, the alveolus was sutured with 4-0 sterile silk thread and the patient was prescribed anti-inflammatory and analgesic, in addition to important post-surgical recommendations for proper healing.

Immediate partial prosthetic rehabilitation, part of the second phase of treatment, is important for the establishment of full masticatory function and preservation of the remaining tissues, since the masticatory effort of the patient's initial condition overloads the total and partial dentures present, in addition to generating a intense discomfort accompanied by pain when trying to eat. The upper and lower arch was molded with alginate for later obtaining the plaster study model, and on it the registration bases were made, which formed the matrices of the provisional prosthesis for the restoration of the patient's occlusion, being: lower central incisors and lower lateral incisors, both bilateral.

The orientation plan has been adjusted. The support of the lip, the exposure of the teeth in relation to the upper lip at rest, and posterior plane. Through the Metric Method, the patient was then asked to perform slow and deep breathing, moistening the lips with the tongue, swallowing and then, three times, pronouncing the letter “m”, remaining at the end of this sequence with the lips parted and at rest. Then, artificial teeth made of acrylic resin were assembled in the university laboratory. After this stage, the teeth in the mouth were tested, observing the aesthetics, phonetics, occlusion and comfort for the patient.

After the laboratory phase of making the provisional partial removable prosthesis was completed, it was installed. The patient's VOD was not adjusted as expected, and then the PPR reload was performed. This procedure is performed after the verification of a bad adaptation in the prosthesis, that is, they are adjustments that are made to improve the adaptation of the saddle to the rim. It is a clinical and laboratory procedure that will reestablish itself from the contact of the saddle with the fibromucosa (associated with the alveolar ridge), in addition to recovering the biomechanics by eliminating the tip and rotational movements, as the adaptation improves, recovering properties occlusal properties and mainly provide comfort.

The patient was informed of the provisional nature of the installed prosthesis, and the need for a time of adaptation of the organism to the new VOD, healing of tissues after surgery, in addition to the possibility of the appearance of small functional changes during this adaptation phase, such as an increase salivation, phonetic difficulties or chewing food. He was also instructed on how to clean the prosthesis, the time of use, the need for periodic returns, until the time to start the final treatment with the fixed partial prosthesis. Thus, the patient used this provisional PPR until the final prosthesis was made in the lower arch.