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How to Fine-Tune Form and Function During Complete Denture Fabrication

How to Fine-Tune Form and Function During Complete Denture Fabrication
Siamak Abai, DDS, MMedSc

article by Siamak Abai, DDS, MMedSc

chairside@glidewelldental.com

Complete dentures provide a viable solution for edentulous patients, even though today’s practitioners have access to many implant-supported treatment options. To serve the population who cannot receive implant-supported prostheses due to financial or anatomical restraints, it is helpful for clinicians to maintain their ability to deliver complete dentures. A predictable outcome can be achieved when the clinician has a full understanding of the desired result, accurately captures the stabilizing areas, and successfully communicates the anatomical information — such as tooth characteristics, vertical dimension and interocclusal space — to the dental laboratory.

In the case that follows I will outline my straightforward clinical protocol for replacing an ill-fitting existing denture in a fully edentulous patient. The patient in this case is Daniel, a CAD/CAM mill technician who has worked in the Fixed department at Glidewell Laboratories for 10 years. Daniel operates the milling machines that are used in the production of many of the restorative materials delivered to dentists around the world, including BruxZir® Solid Zirconia and Obsidian® lithium silicate ceramic (Glidewell Laboratories; Newport Beach, Calif.).

Complete dentures provide a viable solution for edentulous patients.

Appointment 1: Preliminary Impressions

Custom trays ... better capture the denture-bearing surfaces and tissues.

Appointment 2: Border Molding and Final Impressions

Appointment 3: Establishing Vertical Dimension, Tooth Position, Tooth Location and Jaw Relation

The bite rims serve as a record to communicate to the laboratory the esthetic and functional aspects of the complete dentures.

Appointment 4: Anterior Teeth Wax Setup Try-In

Figure 14: The preliminary setup try-in features the six anterior teeth on both the maxillary and mandibular arches. The try-ins are seated, and I evaluate the vertical and horizontal positioning, occlusal relationship, masticatory and speech function, and esthetics. Any changes are communicated to the lab. If a reset is not necessary and the tooth positioning for the anterior try-in is acceptable, the lab will then set the remainder of the teeth and fabricate a complete setup try-in.

Conventional complete dentures continue to serve as a viable option to rehabilitate patients and restore everyday oral functions and esthetics.

Appointment 5: Complete Setup Try-In

Figures 15a, 15b: The laboratory then delivers the secondary setup try-in that features all anterior and posterior denture teeth. At this appointment, all of the parameters communicated to the laboratory are reevaluated. Further, I confirm and adjust the positioning of the teeth as needed. It is paramount that the patient is satisfied with the prostheses overall at this stage. Once all aspects of the setup try-in have been adjusted or confirmed and the patient is comfortable with the device, it can then be returned to the laboratory for festooning and processing of the final complete dentures.

Appointment 6: Final Delivery

Figures 16a, 16b: The complete final dentures arrive from the laboratory. Daniel is brought back in, and the appliances are seated and evaluated. Because great care was taken during the setup appointments, adjustments during the final appointment are minimal. The intaglio surface of the dentures can be checked with pressure-indicating paste and adjusted if necessary. Occlusion is also checked and adjusted at the delivery appointment. Post-delivery follow-up appointments are scheduled to evaluate ongoing patient comfort and the continued fit, function and esthetics of the complete dentures.

Figures 17a, 17b: The complete final denture as seen from the extraoral view. The nature of the conventional process requires numerous appointments with multiple try-ins being part and parcel to the protocol; however, the results can be outstanding and patient-pleasing.

Conclusion

Conventional complete dentures continue to serve as a viable option to rehabilitate patients and restore everyday oral functions and esthetics. What we often fail to recognize, however, is the value of complete dentures for diagnostic purposes when planning cases for patients receiving implant-supported prosthetic solutions. A well-made set of complete dentures for the edentulous patient can act as a prototype for the implant-supported prosthesis prior to implant placement, providing information such as tooth position, tooth shape, vertical dimension, interocclusal space, esthetics and phonetics. The ability to deliver conventional complete dentures should still be regarded as a necessary skill set for practitioners as it serves edentulous patients across the economic spectrum.

Chairside Magazine: Volume 12, Issue 1

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