Kenneth Kent
| Kenneth Kent |
Kent, Kenneth, Sevvanthiraja, Sivothayan, Hariton-Gross, Karina, Conejo, Julian, Blatz, Markus B.
University of Pennsylvania School of Dental Medicine,
Department of Preventive and Restorative Sciences
A simplified combined analog and digital workflow to successfully rehabilitate a totally edentulous patient with complete removable dental prostheses in fewer patient visits is described.
MethodsA 63-years old female presented with ill-fitting maxillary and mandibular complete dentures. Evaluation of existing prosthesis revealed inadequate border extensions, especially on the retromolar pads and maxillary tuberosity areas compromising retention of the dentures. After comprehensive examination including pre-operative digital photographs, new maxillary and mandibular complete dentures were planned. The existing prostheses were scanned, and duplicates were 3D printed. The existing dentures were relined with for tissue conditioning during the treatment process. The printed replicas of the existing dentures were border molded and PVS final impression relines were made and used to capture the centric relation jaw record at a slightly increased occlusal vertical dimension. IPN 3D PORTAIT INSPIRED teeth for digital dentures were selected. The analog impression and centric relation records were scanned using an inEos X5 lab scanner. New prostheses based on the anatomical landmarks, tooth mold and the articulation parameters were designed using inLab SW 20.0 complete denture software. A minimal increase in the vertical dimension was made on the virtual articulator to provide restorative space for coverage of the retromolar pads and tuberosities. Final adjustments to the software proposed design were performed manually using inlab 20 software tools. Pre-operative digital photographs were superimposed on the design to stimulate the virtual face during designing. Completed trial dentures were 3D printed with resin material. The trial dentures were evaluated intra-orally and confirmed for occlusion, esthetics, phonetics, function, stability, border extensions and patient satisfaction. Final denture bases were milled in Lucitone 199 denture base disks using our inLab X5 milling machine and denture teeth were bonded with the manufacturer recommended resin. The final prostheses were polished and delivered requiring minimal chair side adjustments.
ResultsThe patient was extremely happy with simplified digital workflow and her new dentures, stating: “I feel great. I feel free. I feel I like don’t have to worry anymore that my teeth are going to fall down or slip and slide up and down when I talk and eat. I feel like they are my own teeth!”
ConclusionTechnological developments in technologies have allowed digitalization of design and manufacture of removable dentures. A hybrid analog and computer-aided design and manufacture (CAD-CAM) workflow allowed fabrication of accurate and affordable complete dentures in fewer visits, with minimal adjustments and less processing errors or inaccuracies. Future development of more accurate intra oral soft tissue scanners and devices to digitally record maxillo-mandibular relationship and transfer them to the designing software will lead to fully digitized workflows for fabrication of complete removable dental prosthesis.