Dental Asia March/April 2022

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BEHIND THE SCENES Combining digital and conventional denture workflows: An immediate denture case report By Wendy Auclair Clark, DDS, MS; Ibrahim Duqum DDS, MS; with Chris Love, laboratory technician, CDT; at Absolute Dental Lab, Durham NC Emerging technologies and developing workflows have completely changed the way many clinicians and dental laboratory technicians approach complete dentures in the last decade. It is important to remember, however, that fundamental prosthodontic concepts have not changed. One of the most exciting things about digital dentures is the flexibility of the workflows; once you grasp both the conventional and digital complete denture concepts, your toolbox becomes vast. This immediate denture case exemplifies the integration of conventional and digital complete denture concepts. A 75-year-old patient presented with a maxillary partial denture. It had been repaired many times, and his chief concern was replacement due to a fractured tooth of the maxillary left canine (Fig. 1a-c). After clinical evaluation, it was determined that the remaining maxillary teeth were not sufficient to predictably support a removable partial denture long term. After discussion, the treatment plan was formed: immediate complete maxillary denture and mandibular immediate acrylic partial denture. Both will be replaced with definitive prostheses after healing. The patient had a deep, V-shaped palate – a possible challenge to process and maintain even thickness and patient comfort. A digital denture was selected for the final product to increase the predictability of the fit of the base. While we often begin our removable cases with an intraoral scan, capturing the anatomy in the mandibular space, with its long span distal extensions, tends to present a clinical challenge. As such, we began this case with conventional impressions and utilised a record base and contoured occlusal rim to establish ideal tooth position, soft tissue support, the vertical dimension of occlusion and centric relation (Fig. 2). The case was then digitised by our laboratory partner, Chris Love, CDT. Using the wax rim in the occlusion scan allows the transfer of clinical data for tooth position. A proposed tooth arrangement was completed using 3Shape Dental System with Full Denture Design Module. Digital communication allowed the clinician to view the setup before the monolithic try-in was printed on the Carbon printer with Lucitone Digital Try-In 3D Trial Placement Resin, shade A2. A window was open with an e-cutter in the areas where teeth remained (Fig. 4a). This allowed the patient and clinician to approve aesthetics, speech, occlusion, and border extension before finalising (Fig. 4b). Fig. 1a Fig. 1b Fig. 1c Fig. 1d Fig. 1a: Pre-treatment presentation panoramic radiograph Fig. 1b: High smile with existing prostheses Fig. 1c: Image without prostheses Fig. 2: A conventional record base and the occlusal wax rim was utilised to record vertical dimension of occlusion, centric relation, incisal edge and midline position. 56 DENTAL ASIA MARCH / APRIL 2022
BEHIND THE SCENES prosthesis to allow for prosthetically guided treatment. Of all the digital denture workflows we have integrated into our practice, the immediate denture workflow is one of our favourites. The fit, aesthetics, and patient acceptance of immediate dentures are unpredictable at Fig. 4a the time of extraction and placement. The preservation and overlay of pre-extraction records and the enhanced communication between the clinician and dental laboratory technician have drastically improved our experience and allowed us to provide higher quality, more patient-centred care. DA Fig. 3 Fig. 4b ABOUT THE AUTHORS Dr Wendy AuClair Clark is full-time prosthodontic faculty at the University of North Carolina Chapel Hill. She earned her doctoral degree from the Marquette University in Milwaukee, Wisconsin, and a Master’s degree and certificate in prosthodontics from the University of Alabama at Birmingham. She Fig. 6a Fig. 5 Fig. 6b is currently pursuing certification from the American Board of Prosthodontics. Dr Clark practised prosthodontics for seven years with Team Atlanta (Goldstein, Garber & Salama). She lectures nationally on a variety of topics, has co-authored several articles in numerous peer-reviewed journals, and was named a Leader in Continuing Education by Dentistry Today in 2017. Fig. 3: Proposed design, overlaid with existing dentition Fig. 4a: Monolithic printed try-in, with windows open to allow clinical try-in Fig. 4b: Clinical monolithic try-in Fig. 5: Immediate denture design – note extension of deep, V-shaped palate Fig. 6a, b: Immediate prostheses, one-week post-insertion Requested changes were communicated with digital photographs to the technician and incorporated in the final design (Fig. 5). The denture base was printed on the Carbon printer with Lucitone Digital Print 3D Denture Base with fused IPN 3D Digital Denture Teeth. The immediate prostheses were inserted at the time of extractions, with no necessary reline (Fig. 6). Since the patient is pleased with the aesthetics and function, a reline impression will be made inside the denture six to nine months post-extraction to fabricate a conventional denture. Moreover, the patient is now considering a maxillary implant overdenture; the current denture design can be used for implant planning, guided surgery and fabrication of a new definitive Dr Ibrahim Duqum is a clinical associate professor at the University of North Carolina’s Adams School of Dentistry. He is a Fellow of the International College of Dentists and a member of numerous dental organisations. A recipient of the 2014 Richard Hunt Memorial Award for Teaching Excellence and the 2015 UNC-Chapel Hill nominee for the OKU Charles Craig National Award for the best innovative dental educator, Duqum serves as an editorial board member and reviewer for multiple dental journals. DENTAL ASIA MARCH / APRIL 2022 57
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