With the advent of the esthetic revolution, there has been heightened demand for better esthetics and denture wearers are no exception. Often times we can achieve as good or better results with a full denture than partials or fixed bridgework using traditional denture treatment planning.
Premium dentures with Portrait IPN teeth and Lucitone 199® acrylic provide the best option for optimal strength and esthetics. The Portrait IPN teeth combine esthetics with function. Portrait IPN teeth have nice mamelon development (figure 1) and natural, lifelike contours available in 16 Vita Classic® shades and eight enhanced Bioform®-based shades (figure 2). Portrait IPN teeth wear similar to natural dentition by employing an Interpenetrating Polymer Network (IPN) of cross-linked polymers.
Lucitone 199 acrylic is the industry standard for acrylic denture bases. It has one of the highest measures for impact resistance, providing exceptional strength. Lucitone 199 has a balance of natural veining with translucence, mimicking natural tissue shading.
Typically, denture/partial cases require a few more appointments than crown and bridge. The steps include custom trays/bite blocks, final impression, wax try-in, and final insertion. Following these steps should result in optimal results in the least amount of chair time. It is probably best to discuss shade options at the earliest appointment to either match the shade of the remaining teeth or select one that will match the patient’s complexion.
Custom trays and bite blocks
The custom tray will allow a better-fitting tray in the patient’s mouth, which makes the impression-taking process easier and allows the practitioner to capture all the necessary anatomical features (figure 3). Two areas often missed with standard trays are the periphery and postdam areas, which are much easier to secure with a custom tray.
Bite blocks are an important part of a successful denture as they are the starting point in determining factors such as the midline, vertical dimension, and plane of occlusion (figure 4). Bite blocks can be easily modified chairside to determine these dimensions, and marked right on the bite blocks. It is at this stage that the doctor can choose the proper mould or give the laboratory the facial measurements - including the tooth width of the anteriors and description of facial contour - or have the laboratory technician assist in choosing the tooth mould.
The best results are achieved with a mucostatic impression material. Alginate is the ideal material because it is mucostatic and will not distort the tissue (figure 5). Though there are alginate impression materials that remain stable for up to 72 hours, it is recommended to pour them as quickly as possible to reduce the chance of distortion in the model.
At the wax try-in stage, we are able to confirm proper dimensions that were originally communicated on the bite block such as midline, vertical dimension, and plane of occlusion (figure 6). Additionally, we are able to confirm tooth shade, tooth arrangement, proper lip support, speech considerations, and esthetic appeal by the patient. This is the time to address concerns by the patient because it is easier to make changes to the wax-up - both chairside and in the laboratory - prior to processing.
The wax-up will be refined and then processed using the Lucitone 199 acrylic. The occlusion is paste-milled making minor adjustments for better occlusion. The denture base is then stippled, which refracts light in different directions and makes the base look more natural. It is polished to a high luster that resists staining and bacterial build-up (figure 7).
Usually only minor adjustments are necessary at chairside to relieve sore spots or slight occlusal discrepancies.
For a product demonstration on Trident’s Premium Portrait IPN Dentures, go to www. tridentlab.com.