Dentaltown April 2022 - 48

For this patient, a milled prosthetic
option that did not require manually bonding
the milled denture teeth to the base was
chosen. The unique geometry of the bicolor
milling disc allows for a single milling
process (PrograMill PM7, Ivoclar) to produce
a definitive monolithic denture (Fig. 16).
The economic advantages include having
to use only one disc, uninterrupted milling
procedure, less milling time overall and
fewer chairside adjustments. In addition, the
strength of the denture is enhanced because
the homogeneous chemical fusion of the teeth
and base materials are uniquely processed
without a bonding interface; therefore, the
dentures are physically monolithic, producing
dimensionally accurate final dentures with
high-quality aesthetics that require only
minimal clean-up and finishing.
Definitive denture placement
While the dentures were being milled,
the patient's four remaining tooth roots
were extracted. Once the milling process
was completed, the final dentures were
manually polished (Fig. 17) and inserted
into the patient's mouth (Figs. 18 and 19).
The placement and postplacement
adjustments of CAD/CAM-created complete
dentures are similar to the placement of
conventional dentures; however, the degree
of adjustment required to insert digitally
processed dentures and the follow-up postinsertion
appointments are significantly
minimized, compared with traditional
clinical workflow and manufacturing.6
Traditional
procedures and materials (Fit Checker,
GC America) or pressure-indicating paste
(PIP, Keystone Industries) are suggested to
identify and adjust the fit of the intaglio
surfaces of the dentures to the intraoral
mucosa. For this case, occlusal contacts were
verified and adjustments made intraorally.
If considered needed, a clinical remount
procedure can be performed depending on
the degree of occlusal adjustment required.
Conclusion
Although this unique case required
in-practice completion of the digitally
manufactured case, all of the steps leading
48 APRIL 2022 // dentaltown.com
up to the milling process and final delivery
are conventional protocols that dentists
would normally complete for denture
processing.
Digital dentures offer clinicians many
advantages over conventionally fabricated
dentures.7,8
Among them:
* The ability to efficiently and
effectively treat patients who have
difficulty commuting to the practice
for multiple appointments.
* The ability to record clinical
information (impressions,
interocclusal records, and tooth
selection) in a single, one- to
two-hour appointment, depending on
the clinician's experience.
* The ability to place and seat the
dentures in the second appointment.
* The ability to reduce clinical chair
time, which is more cost effective and
decreases practice overhead.
* The ability to archive digitally
obtained 3D images and recordtaking
data in the event the patient
should need a replacement denture.
* And the prepolymerized acrylic
resin used for the fabrication of the
denture base provides a superior
fit and strength compared with
conventionally processed bases. n
References
1. Porter, J., Ntouva, A., Read, A., Murdoch, M., Ola, D., and
Tsakos, G. " The Impact of Oral Health on the Quality of Life
of Nursing Home Residents. " Health Qual Life Outcomes.
2015;13:102.
2. Medina, Lauren, Sabo, Shannon, and Vespa, Jonathan.
" Living Longer: Historical and Projected Life Expectancy in
the United States, 1960 to 2060 Population Estimates and
Projections. " U.S. Census Bureau, US Department of Commerce.
https://www.census.gov/library/publications/2020/
demo/p25-1145.html, accessed Feb. 7, 2022.
3. CDC. Public Health and Aging: Retention of Natural Teeth
Among Older Adults-United States, 2002. https://www.
cdc.gov/mmwr/preview/mmwrhtml/mm5250a3.htm, accessed
Feb. 7, 2022
4.
Badewy, Rana, Singh,Kharkirat, Quinone, Carlos, and
Singhal, Sonica. " Impact of Poor Oral Health on Community-Dwelling
Seniors: A Scoping Review. " Health Service
Insights, Vol. 14: 1-19. Accessed Feb. 7, 2022.
5.
CDC. COVID-19 Risks and Vaccine Information for Older
Adults. www.cdc.gov. Accessed Feb. 7, 2022.
6. Smith, P.B., Perry, J., and Elza, W. " Economic and Clinical
Impact of Digitally Produced Dentures. " J Prosthodont
2021;30(S2):108-112.
7. Janeva, N.M., Kovacevska, G., Elencevski, S., Panchevska,
S., Mijoska, A., and Lazarevska, B. " Advantages of CAD/
CAM Versus Conventional Complete Dentures-A Review. "
Open Access Maced J Med Sci. 2018 Aug 4;6(8):1498-1502.
8.
Baba, N.Z., Goodacre, B.J., Goodacre, C.J., Müller, F., and
Wagner, S. " CAD/CAM Complete Denture Systems and
Physical Properties: A Review of the Literature. " J Prosthodont
2021;30(S2):113--124.
Fig. 16
Fig. 17
Fig. 18
Fig. 19
https://www.census.gov/library/publications/2020/ https://www http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5250a3.htm http://www.cdc.gov http://www.dentaltown.com
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