By Wendy Auclair Clark, DDS, MS; Ibrahim Duqum DDS, MS; with Chris Love, laboratory technician, CDT; at Absolute Dental Lab, Durham NC
Emerging technologies and developing workflows have completely changed the way that many clinicians and dental laboratory technicians approach complete dentures in the last decade. It is important to remember, however, that the fundamental prosthodontic concepts have not changed. One of the most exciting things about digital dentures is the flexibility of the workflows; once you grasp both the conventional and digital complete denture concepts, your toolbox becomes vast. This immediate denture case exemplifies the integration of conventional and digital complete denture concepts.
A 75-year-old patient presented with a maxillary partial denture. It had been repaired many times, and his chief concern was replacement due to a fractured tooth of the maxillary left canine (Fig. 1a-c). After clinical evaluation, it was determined that the remaining maxillary teeth were not sufficient to predictably support a removable partial denture long term. After discussion, the treatment plan was formed: immediate complete maxillary denture and mandibular immediate acrylic partial denture. Both will be replaced with definitive prostheses after healing. The patient had a deep, V-shaped palate – a possible challenge to process and maintain even thickness and patient comfort. A digital denture was selected for the final product to increase the predictability of the fit of the base.
While we often begin our removable cases with an intraoral scan, capturing the anatomy in the mandibular space, with its long span distal extensions, tend to present a clinical challenge. As such, we began this case with conventional impressions and utilising a record base and contoured occlusal rim to establish ideal tooth position, soft tissue support, the vertical dimension of occlusion and centric relation (Fig. 2).
The case was then digitised by our laboratory partner, Chris Love, CDT. Using the wax rim in the occlusion scan allows the transfer of clinical data for tooth position. A proposed tooth arrangement was completed using 3Shape Dental System with Full Denture Design Module.
Digital communication allowed the clinician to view the setup before the monolithic try-in was printed on the Carbon printer with Lucitone Digital Try-In 3D Trial Placement Resin, shade A2. A window was open with an e-cutter in the areas where teeth remained (Fig. 4a). This allowed the patient and clinician to approve aesthetics, speech, occlusion, and border extension before finalising (Fig. 4b).
Requested changes were communicated with digital photographs to the technician and incorporated in the final design. (Fig. 5) The denture base was printed on the Carbon printer with Lucitone Digital Print 3D Denture Base with fused IPN 3D Digital Denture Teeth. The immediate prostheses were inserted at the time of extractions, with no necessary reline. (Fig. 6) Since the patient is pleased with the aesthetics and function, a reline impression will be made inside the denture six to nine months post-extraction to fabricate a conventional denture. Moreover, the patient is now considering a maxillary implant overdenture; the current denture design can be used for implant planning, guided surgery and fabrication of a new definitive prosthesis to allow for prosthetically guided treatment.
Of all the digital denture workflows we have integrated into our practice, the immediate denture workflow is one of our favourites. The fit, aesthetics, and patient acceptance of immediate dentures are unpredictable at the time of extraction and placement. The preservation and overlay of pre-extraction records and the enhanced communication between the clinician and dental laboratory technician have drastically improved our experience and allowed us to provide higher quality, more patient-centred care.
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