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.