Digital Denture for a life-changing smile - Part 2
Part 2: Andrea and the treatment process
“When Eric Kukucka, DD, approached me about doing treatment for this particular young patient I was intrigued by the new process about which he had told me. Although the surgery was routine, the prosthesis produced with the Digital Denture system was anything but routine”, says the attending oral surgeon Dr Mark Shuren. Part 1 described Andrea’s distressing initial pre-operative state, Part 2 explains the treatment process.
DD Eric Kukucka, Canada | Facebook | Instagram
Andrea’s few remaining teeth could not be saved (Part 1) and had to be extracted. Because of her dental history Andrea was terrified of undergoing major dental treatment. Digital Denture enabled us to offer her a “comfortable” treatment approach and an interim denture. She did not have to be without teeth during any part of the treatment. With the help of Digital Denture we produced an interim denture which was ready for the patient at the tooth extraction appointment.
“Kukucka, DD, and his team explained every step of the process in great detail. I felt comfortable with what was going to happen. They made sure that if we had any questions they would answer them. Even though I was scared and full of anxiety, I knew that I was in the very good hands.”
The few remaining teeth were severely damaged and could not be saved. Because of her dental history, Andrea was terrified of undergoing major treatment.
Models were cast on the basis of anatomic impressions.
The study models were digitized with a laboratory scanner (3Shape) and the data record was transferred to the Digital Denture software program. Before the interim denture could be designed, the remaining teeth had to be removed from the virtual model. For this purpose, the software program features a virtual extraction tool. Based on the maxillomandibular relationship record, the vertical dimension between the upper and the lower jaw was opened by 5.5 mm.
Digital Denture comprises a complete manufacturing process for the efficient production of removable dentures. This innovative process integrates digital manufacturing techniques in the dental lab with established dental treatment modalities. Exclusive design software combined with coordinated materials and specialized manufacturing strategies and the cutting-edge PrograMill milling equipment provide predictable and consistent results.
Conventional anatomical impression taking
Digitalized study models in the Digital Denture software
Removal of the teeth with a special virtual tool
Digital model measurement in accordance with the conventional process
The tooth moulds were selected with the help of the Digital Denture Full Arch tooth library.
We selected the teeth from the Phonares II B71-L50-N3 range. The software automatically generated a suggestion for setting up the selected teeth. If necessary this set-up can be customized. Next, we evaluated the basic parameters and adjusted any details. We finalized the denture base and characterized the gingival contours. Digital Denture is easy to use due to its convenient virtual tools.
Designing the dentures with the Digital Denture CAD software. The process is fully automatic. However, individual adjustments can be made at every stage.
Selection of the tooth moulds from the Digital Denture Full Arch tooth library
The program automatically sets up the teeth according to the model analysis. Adjustments can be made if necessary.
Customized positioning of the dental arch within the SR Vivodent CAD Multi disc.
The CAD file was saved and the software generated two CAM output files:
- a CAM output file for milling the dental arch
- a CAM output file for milling the denture base
The dental arch was milled from a polychromatic DCL (Double-Cross Linked) resin disc. The tooth-coloured SR Vivodent CAD Multi discs feature multiple shade layers. They are characterized by the Pearl Structure Effect which ensures a balanced progression of the shade. This effect imparts the monolithic teeth with a very natural-looking appearance. A gingiva-coloured PMMA disc was used to mill the denture base. The Digital Denture process incorporates a number of different PMMA discs (IvoBase CAD); in the present case we used IvoBase CAD Pink V.
The dental arch and denture base were milled in oversized form (PrograMill PM7).
While the occlusal surfaces of the dental arch were produced in oversized form, the basal surfaces were exactly milled to fit the denture base. In the next step, the tooth arch and the denture base were bonded together. A two-component bonding agent was used (IvoBase CAD Bond) for this purpose. The tooth arch and the denture base were finalized in the subsequent precision milling and finishing process.
The SR Vivodent CAD Multi disc was used to mill the dental arch
Loading SR Vivodent CAD in PrograMill PM7
The IvoBase CAD PMMA disc (shade Pink V) for milling the denture base
File splitting for the CAM data set (tooth arch and denture base) and transfer to the milling machine
Milling of the tooth arch and the denture base in the PrograMill PM7
The discs immediately following coarse milling in the oversize process
The second milling cycle takes place after the permanent bonding of the two segments with IvoBase CAD Bond.
The maxillary denture immediately after precision milling in the PrograMill PM7
After the CAD/CAM milling process, the interim Digital Denture required only minimal manual finishing.
The manual finishing work was reduced to a minimum.
The morphology of the vestibular areas of the denture base was created with the help of the software and then machined in a 1:1 ratio. The soft transition from the tooth to the gums was created with a fine fissure bur. The teeth were separated with an elastic glass-fibre reinforced separating disc (Dynex, Renfert). The dentures were pre-polished with a dental handpiece and then polished to a final high gloss in a polishing unit, using pumice and polishing paste and a cotton buffing wheel. The digitally manufactured interim dentures were ready in the surgery at the tooth extraction appointment. The patient was fitted with the dentures immediately following the intervention.
Separation of the teeth with a separating disc
The digitally manufactured interim dentures look very natural.
The interim dentures were ready for the patient at the tooth extraction appointment.
Andrea’s story continues (tooth extraction and the new smile). Find out more in Part 3.