Fixed Full Denture

[sushantpatel_doc]

Here is an alternative to patients requiring complete dentures who complain of unstability of the dentures..have a look at the attachment below..

        

[gaurang_thanvi2003]

How you mantain Occlusion in these types of denture and can we use magnet in them for more retention….
Gaurang Thanvi
Jodhpur Dental College
Jodhpur National University

        

[tirath]

how many magnets should be attached?

        

[gaurang_thanvi2003]

Its depends on the type,mode and strength of the retention we need ….

        

[sushantpatel_doc]

I guess the procedure for maintaining occlusion in such dentures has to be similar to an overdenture..please correct me if i am wrong..

        

[sushantpatel_doc]

Wanted to know what is the duration for the entire treatment..

        

[Anonymous]

sushantpatel_doc wrote:

Wanted to know what is the duration for the entire treatment..

Takes a fairly long time. To begin with slavaging the teeth takes some time. thereafter making the prostheses takes some time as at times there is no expertise in the lab technicians to fabricate these.

Patients do get irritated if the prostheses fabrications takes a long time.

Regards,

Veerendra Darakh

        

[gaurang_thanvi2003]

Sir what you say about uses of magnet in these type of magnets????

        

[Anonymous]

To begin with magnets are not easily available in India. Furthermore there should be sufficient vertical diemension to accomodate magnets which at times may not be there. As mentione before the whole exercise may take some time and therefore proper patient counselling is a must.

Regards,

Veerendra Darakh

        

[drmithila]

 Fixed prosthodontic procedures comprise a major part of the services provided by general dentists in the United States. It has been estimated by the National Association of Dental Laboratories that there were about 36 million units, most of which were single crowns, placed in the United States during 2010 (Bennett Napier, co-executive director, personal communication, January 2011). Assuming that there were about 140,000 practicing general dentists in the United States and roughly 3,500 prosthodontists, it appears that each general dentist placed more than 20 units of crowns or multiunit fixed prostheses per month in 2010. There is significant revenue produced by fixed prosthodontic procedures, but practitioners and dental assistants must be highly organized and efficient to make this dental laboratory dependent side of dentistry profitable. All dentists using conventional procedures and/or in-office CAD/CAM milling devices have to be organized and time efficient to ensure an adequate return on their major investment for any technologies purchased. 

In this article, we will discuss the current methods to accomplish fixed prosthodontic procedures and look at the products used in conventional techniques as well as in the constantly evolving and improving digital methods to produce restorations. We will emphasize the most commonly accomplished procedure, the single crown. The purpose of the article is to motivate practitioners to evaluate their personal fixed prosthodontic procedures, thus allowing them to make logical decisions about any potential desirable changes toward digital concepts in their clinical fixed prosthodontic technique

        

[drmithila]

 CONVENTIONAL TECHNIQUES

Experienced dentists are very familiar with conventional fixed prosthodontic procedures. However, some practitioners could increase their efficiency and clinical predictability by using products different from those that they have currently in use. We will make suggestions based on CLINICIANS REPORT (CR) (formerly named CRA) and other international research as well as our own personal experience relative to the most efficient, popular, and effective clinical procedures.

For more than 50 years, PFM restorations have dominated procedures involving single crowns. That day is rapidly passing. According to data from Glidewell Laboratories, one of the largest dental laboratories in the United States, during 2010 about one half of the indirect restorations were all-ceramic, and other half were the other types of crowns, including PFM (Jim Shuck, sales executive at Glidewell Laboratories, personal communication, January 2011). It has been our observation from speaking with thousands of dentists that this is the case regardless of what dental laboratory they are using. Milling of monolithic restorations in dental laboratories is beginning to dominate crown fabrication in many labs because of the ease of fabrication when using the milling procedure and the lower amount of labor required to hand-invest wax patterns, cast metals, and layer porcelain. From our observations and reports from laboratories full-zirconia crowns are among the fastest growing crown types in the history of dentistry. BruxZir from Glidewell Laboratories, was the first brand to begin this movement and there are now many more brands being marketed. PFM restorations, and now all-ceramic restorations, are the most commonly placed indirect restorations in the United States. In spite of the frustration expressed by many experienced dentists, full-gold alloy restorations are significantly reduced in use, and infrequently offered as a treatment option to patients.

The typical US dentist is using conventional fixed prosthodontic techniques and materials, although this long-proven, successful orientation is changing rapidly. We suggest in this article many successful devices, materials, and techniques that have been identified from research by CR, reports from hundreds of CR product evaluators, and from our own personal experience.

The following are categories of activity in the fixed prosthodontic procedure, with accompanying successful products that are well known to allow optimum speed and efficiency.

        

[drsushant]

 Tooth Preparations

A very small percentage of the restorations placed in 2010, about 2%, were inlays and onlays (Limoli and Associates, personal communication, January 2011). Both authors are known to encourage use of these conservative restorations (when indicated), particularly when the facial and lingual portions of teeth are intact and the intracoronal portion of the teeth is either destroyed by dental caries or has a previously placed defective restoration. Most of these types of restorations are placed by those practitioners using CEREC from Sirona Dental Systems (Patterson Dental) and E4D from D4D (Henry Schein) in-office milling devices to be discussed later in this article. However, we encourage more dentists who do not useCAD/CAM devices to provide onlays, because of their simplicity and conservative nature. 
In spite of our desire for more onlays and the resultant less tooth reduction, the easiest indirect tooth restoration is reported by experienced practitioners to be the full-crown. However, these restorations are the most aggressive. The full-crown preparation concept is changing, as full-zirconia restorations are becoming more popular. Full-zirconia restorations do not require deep preparations as with PFM or the popular all-ceramic options. Because many dentists purposely or inadvertently prepare teeth to a minimal degree, the acceptability of these minimally prepared teeth may be one of the reasons for the growing popularity of the full-zirconia restoration.

Diamond Rotary Instruments 
These instruments significantly vary in price from just more than one dollar (for the so-called single use diamonds) to 10 times that cost (for diamonds intended to be used many times). Our research has shown that some low-cost brands of diamond instruments prepare teeth very similarly to higher cost instruments. Two well-proven, low-cost diamond brands are NeoDiamond (Microcopy) and Diamond Burs (Spring Health). Nevertheless, some dentists prefer to use the more expensive multiple-use diamonds that are also effective and may provide more options. Example companies include: Axis Dental, Brasseler USA, KOMET USA, Premier Dental Products, SS White Burs, and others. CR works with all of these companies and has found many different diamonds to be successful.

        

[drmithila]

 In the past, patients suffering from tooth loss faced many challenges on their road to recovery. Aside from physical limitations like premature aging and loss of chewing efficiency, emotional effects of tooth loss included bereavement, lowered self-confidence, altered self-image, dislike of appearance, and a feeling of taboo when discussing their problem with others.1 Along with these common behaviors, patients also found themselves attempting to keep their problem a secret, and often had difficulty socializing and forming close relationships.¹ 

The loss of hard and soft tissues is associated with a loss of orofacial support.² Because of this, facial aesthetics, phonetics, and collapse of vertical dimensions coincided with the appearance of premature aging caused by the lack of lip support and a decrease in facial height.² Changes in orofacial structure led to impaired oral function, pain, insufficient retention due to bone loss in the residual ridge, and instability of conventional dentures, along with nutritional and psychological changes, which caused many issues for patients.² 

The conventional treatment for this condition, removable prostheses, exacerbated many of these emotional and physical effects since dentures have been uncomfortable.^3,4 Because traditional dentures seldom provide the desired stability, patients found themselves struggling to keep them in place with their tongue, cheek, and lip muscles.^3,4

The average bite-force for dentate patients, 150 to 250 psi, and for those who clenched or were bruxers, 1,000 psi, was reduced to 50 psi when the patient became edentulous.^3,4 After 15 or more years wearing dentures, many patients’ bite-force and chewing efficiencies were reduced even further to 5.6 psi, making simple functional tasks like eating very difficult.^3,4

Implant-supported overdentures, the new standard of care for edentulous patients, offer many benefits over fixed options.² To achieve the best results, clinicians realized that it was necessary to place endosseous osseointegrated implants under removable prostheses to preserve bone and to provide prosthetic retention, stability, and a degree of occlusal support.² It was also discovered that quality of life, self-confidence, nutritional state, and facial aesthetics improve with implant-supported or implant-retained prostheses.^3,4 Patients seeking to correct chronic pain in load-bearing areas will find that implant-retained overdentures, aside from improving aesthetics, offer more comfort and psychological benefits.² Overall, this type of prostheses allows patients to function normally in society and enables them to eat what they want, instead of only what they can.² 

However, despite enhancements in denture fit and comfort, there still has been a need for denture teeth capable of withstanding implant forces and that also resemble natural looking dentition.^3,4 Because implant-retained and supported dentures are very stable intraorally, they require materials that are much stronger and, more importantly, demonstrate a higher resistance to wear.⁵Aesthetics and better bite characteristics also have become more desirable traits by patients.⁵

Newly available denture base materials and denture tooth technology provide a more comfortable fit with improved biocompatibility.⁵With advancements in CAD/CAM technologies, denture teeth can now be designed for advanced occlusal schemes and demonstrate decreased incidences of breakage because of their density.⁵ Displaying less change, especially in the fifth dimension, these advanced materials represent the future of implant supported and retained prostheses.

        

[drmithila]

 New Generation of Denture Teeth Introduced

Denture teeth fabricated from inorganic nanofillers that are integrated in a highly cross-linked, tough elastic matrix (Mondial [Heraeus Kulzer]) demonstrate lifelike opalescence, high abrasion resistance, biocompatibility, plaque resistance, and color stability. Also, because they are fabricated using CAD/CAM technology, harmonious tooth set-up and reproducible articulation are ensured. 

Based on the Magister/Orthognath molds, which have seen worldwide success during the last 40 years, aesthetics, function, and material quality have been improved significantly with the Mondial line of denture teeth. To improve aesthetics, the labial, buccal, and occlusal surfaces have been modified, along with restructuring of the layering to match the Vitapan Classical shade system (Vident). The layering technique and material improves opalescence, while integrated nanofillers improve optical characteristics like attainable depth and lifelike color.

To improve function, Mondial dentures have a precisely defined centric relationship that permits clear cut setup. Because they are designed using CAD/CAM technology, identical sets of teeth can be created with identical shape for all tooth sizes. With the high functional accuracy created through CAD/CAM utilization, there also are no frictional surfaces that resist function.

Improved material sciences, including nanopearls, allow Mondial dentures to demonstrate high abrasion resistance, without altering hardness or elasticity, which was a common problem with conventional polymethyl methacrylate (PMMA) materials. However, the polish obtained with Mondial prostheses is similar to that attainable with PMMA dentures. The advanced material science also allows these dentures to demonstrate improved bond strength between layers to improve retention rates.

Overall, the quality of the Mondial line of denture teeth provides natural light dynamics and a material that is highly resistant to discoloration for a more natural look. Because of the injection and compression INCOMP manufacturing process, bubble-and porosity-free prostheses also can be expected. 

This article describes a case in which a team approach was undertaken to meet the patient’s expectations. By first visualizing the case conceptually, then in wax and ultimately in the acrylic dentures, the team overall was able to deliver a highly aesthetic and functional implant-supported prostheses.

        

[drsushant]

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[Author]

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