Written by Andrew Sedler
What does it mean when the term "digital denture" is used? There is not just one single answer to that question. The reality is that workflow for a “digital denture” is dependent on what records you gather at the first appointment. While the term that we are discussing here is “digital denture,” virtually all of the workflows commonly being presented today begin with a fundamentally conventional impression and bite relationship process.
Examples of denture impression systems:
Mar. 8-9, 2019
Jun. 20-21, 2019
Jul. 5-6, 2019
Baltimore, MD
Columbus, OH
Honolulu, HI
- Fundamentals of Digital Impressions
- Mastery of single unit impressions, complex cases, and staging of full arch cases
- Managing errors introduced in imaging
- How and what to delegate to team members
- Digital restorations
- Mastery of CAD-Ray software for the dentist
- Design single units, copy cases, and custom abutments from scan bodies
- Introduction and mastery of Integration of Cone Beam data and STL data
- Understanding the limitation of Cone Beam and STL Integration
- Integration and limitation of multiple Cone Beam data sets
- Proper digitization of denture duplicates for stent fabrication
- Multiple ways to design a surgical stent and how to choose appropriate design type
- Proper case presentation techniques for patients
- Hands on Exercises
- Single implant placement designs
- Understand how to bill for your Cone Beam scans and surgical stents
- Learn how you can bill for numerous surgical procedures
- Treatment planning for large cases
- Appropriate case set ups and their ramifications during surgery
- The multiple uses for chairside denture application
- Chairside denture duplications and scan appliance fabrication
- Impression techniques for multiple fixtures and multi-abutments
- Restorative designs of abutments on CAD software
- Immediate extractions and how to keep track of the vertical dimension
- The multiple restorative options available to you
- Accurate transfers of fixtures to models
- Digital Impressions for edentulous cases
- Edentulous case design with digital dentures
- Measure vertical and take pictures of vertical measurement with a caliper.
- Mark tip of nose and chin, and measure vertical dimension at physiologic rest position.
Handmade Software, Inc. Image Alchemy v1.13
2. Measure the lip closure line
- The lip closure line is one of the most important pieces of information, in particular for the length of the anterior teeth. The Papillameter is the ideal instrument for measuring the length of the upper lip and the lip closure line. The Papillameter is made of a sterilizable and disinfectable resin.
- Duplicating the denture is a first appointment way to capture, occlusion, bite record, VDO, Midline, and also used as a custom tray-capture final impression.
- Duplicate denture(s) in a denture duplicating flask. (Lang dental)
- Lubricate denture with vasoline or similar.
- Using alginate, fill one side of the flask and submerge occlusal side of denture into the impression material up to the peripheral roll.
- After impression sets up, lubricate intaglio of denture and impression material.
- Fill the empty side of the flask, close, and fasten set screw.
- After the impression is set, open flask and carefully remove denture.
- Fill both sides of the impression with a cold cure acrylic, and place in pressure pot with warm water at 30 psi. for about 10 minutes.
- Remove duplicate denture, inspect, and compare to make sure it is an accurate duplicate.
1. Using duplicate denture as a custom tray, paint inside with tray adhesive.
Make a border impression with putty. Cover the peripheral roll and extend into the vestibule.
2. Make sure that borders are extended into the vestibule, but do not impinge on muscle attachment landmarks. Have the patient go through motions and sucking actions to capture muscle attachment positions.
- Extend impression to the retro-molar pads on the mandibular, and post-dam area, and Hamular Notch on maxillary.
- After putty impression, take a medium body and wash impression and repeat motions and sucking action.
3. Before the final wash impression, remove any areas where the tray kisses through the body impression. (Relieve 1-2 mm )
- Check vertical with relined final impression duplicate denture(s).
- With relined duplicate denture inserted, evaluate the facial dimensions and appearance.
- Measure the same 2 dots on the nose and chin again to assist in evaluating vertical.
If vertical is satisfactory proceed as follows:
- Take a face bow record using Kois Facial Analyzer. Be sure to record facial midline with the vertical rod positioned. We highly recommend using the Kois Facial Analyzer to record the horizontal smile line and facial midline of the old denture(s).
- Take a bite with PVS bite registration material.
- Mark facial midline on denture
If you need to increase vertical:
- Add slices of pink base-plate wax to occlusal until vertical is satisfactory.
- Follow steps above with pink wax in place as bite record.
- Close-up or smile
- Full face smile
- Repose of lip at rest
Communicate to dental lab all changes from current denture, especially incisal edge positions in the smile. Include both incisal edge position vertically to the lip and anterior-posterior shift changes.
Procedures
Send to the lab to fabricate teeth set-up try-in.
The lab can now articulate a duplicate denture/custom tray and proceed to set-up.
Today we have options both digital and conventional to fabricate a set-up for try-in from the records described above.
Conventional Workflow in Lab
Baseplate, wax and set denture teeth up in wax for try-in.
Digital Workflow in Lab
We can scan the impression, and the articulated duplicate denture, and poured models, and design the set-up via CAD systems like 3Shape, Blue Sky Plan, Exocad. When working in the digital environment we are then able to mill or print a one-piece monolithic set-up try-in.
Monolithic Teeth Try-in
One very distinct benefit of milling the set-up try-in is that the fit will be virtually 100% the same as the final fit, and will be vastly superior to the fit of baseplates, or dentures processed by other methods. (More to come about milled denture in the near future.)
2nd Appointment
Try-in Teeth Set-up and Evaluate. Notate any changes and communicate directions for the lab to finish or provide a 2nd set-up try-in.
3rd Appointment
