Clinical Report
A forty-five years of age female patient presented to the clinic with the chief complaint “I need new dentures”. The patient claimed to have been wearing the existing complete dentures for the last 15 years. (Figures 1, 2 and 3) After a detailed evaluation, the findings were extreme alveolar ridge resorption in the maxilla and mandibular arches and diagnosed as a Class III of complete edentulism according to the American College of Prosthodontists classification. The alveolar mucosa appears healthy with adequate keratinized gingiva covering the crest of both ridges, although it seems thinner relative to the mandibular arch. (Figures 4, 5, and 6) The patient reported the extraction of all her teeth due to different reasons, such as caries and periodontal diseases at a young adult age. Due to the known pattern of maxillary and mandibular ridges resorption and loss of vertical dimension of occlusion resulted from denture teeth wear, the denture occlusion became a class III.
Treatment options were conveyed to the patient; however, treatment should start with a new set of complete dentures and then mandibular to have a fixed mandibular implant-supported prosthesis. The patient accepted and requested first to have the new set of complete dentures. She was also offered the option to have milled complete dentures, but due to the extreme alveolar ridge resorption it was suggested to have final impressions, master cast fabrication and jaw relation records using conventional techniques. The patient accepted the proposal and requested to start the treatment. Final impressions with polyvinyl siloxane material (Aquasil Ultra Smart Wetting, Dentsply Sirona, York, Pennsylvania, USA) were made using her current prosthesis as the impression trays, and it was performed following the functional technique. Impressions were poured out and master casts were fabricated with type IV stone (ResinRock, WhipMix, Louisville, Kentucky, USA). Conventional jaw relation records using record bases (Triad VLC Denture Base Material, Dentsply Sirona, York, Pennsylvania, USA) with pink wax rim (Hygienic U-Shaped Occlusal Rim Wax, Coltene Whaledent, Inc, Cuyahoga Falls, Ohio, USA) and vinyl polysiloxane bite registration (Regisil Rigid, Dentsply Sirona, York, Pennsylvania, USA) were fabricated following traditional record measurements of closest speaking space, lip support and smile line in order to obtain the vertical and vinyl polysiloxane bite registration (Regisil Rigid, Dentsply Sirona, York, Pennsylvania, USA). (Figure 7) A laboratory order form was downloaded from the company’s website and it was filled out. The clinician and patient selected the tooth shape, tooth shade, denture base shade, and anatomic features to be included in the denture base. Mounted casts, jaw relations records, and complete laboratory prescription forms were shipped to the company (AvaDent Digital Dental Solutions, Scottsdale, Arizona USA). A few days later the company provided a password to the clinician in order to log in to company’s website and the tooth arrangement and all other features requested were digitally designed, the clinician was available to digitally modify the tooth arrangement for every specific tooth if it was desired, and it also provided the option to alter the anatomic features requested in the prostheses. (Figures 8 and 9) The company mailed the prostheses the following week, and the patient was scheduled for delivery appointment. (Figures 10 and 11) The milled complete denture prostheses were tried in, and they provided acceptable retention and stability. Pressure-indicating paste (White Pressure Indicator Paste, Pip Mizzy, Cherry Hill, New Jersey, USA) was used in order to evaluate the fit and pressure areas in the intaglio surfaces of the prostheses and no adjustments were needed. Border extensions were also assessed using disclosing wax (Kerr Corporation, Brea, California, USA). A conventional clinical remount was made in order to evaluate occlusion. No occlusal adjustments were required. Phonetics and esthetics were evaluated and the patient and clinician felt very satisfied. (Figures 12, 13 and 14) The applications within the manufacturing software allow full control over the selection of denture teeth position, shape, cuspal inclination and occlusal relationship upon centric and eccentric movements. Since the patient presented with atrophic mandibular ridge, semi-anatomic acrylic resin teeth of 15 degrees were chosen for posterior teeth, which were set over the crest of the ridge in bilateral balanced occlusal scheme to allow maximum denture stabilization upon horizontal jaw movements. The patient was seen in a follow-up appointment on the next day and no complaint regarding the prostheses was noted. The patient was satisfied with the prostheses’ retention, stability and esthetics. The clinician evaluated the denture foundation areas and no sore spots were present; pressure-indicating paste was used again in order to assess the fit and pressure areas in the intaglio surfaces of the prostheses and no denture adjustment was required. One- and two-weeks follow-up appointments showed complete patient satisfaction with no need for denture adjustment following thorough intra-oral evaluation.