The Dent-Liner
Volume 6 Issue 4
Fall 2002
A BULLETIN DEALING WITH ISSUES FOR DENTAL HEALTH PROFESSIONALS
Cosmetic
Results with Attachments
Cosmetic procedures are still at the top
of the list for dentists. So the results of the 6th annual Dental Industry
of Canada Survey (www.diac.ca) indicates. Dental lab products on the increase
are All-Ceramic Crowns and Ceramic Veneers. The next group with the exception
of mouth guards is implant supported crowns, bridges, partials and
full dentures. Cosmetics is also vital with these types of restorations.
Metal clasps, over sized attachments and loose fitting dentures will not
meet the demands of the increasingly sophisticated patient. Dental professionals
have the opportunity to provide a broad range of reliable cosmetic services
that include the Bredent attachments. Versatility and broad compatibility
reassures, that they can be used in cases supported by natural teeth, remaining
roots and implants. Anchorage abutments fit the most common implant platforms.
Prefabricated components simplify the working procedures and the retention
sleeves can be changed chair side. The attachments provide space for flexibility
of design and protection of the abutments. Implementation by the Techno-clinical
team provides the ultimate benefit to the patient. For complimentary
information on the attachments, call Dent-line of Canada at 1-800-250-5111
Implant
Over Dentures with the SG Attachment
 |
In order to accomplish acceptable results,
a close collaborative approach between the restorative team is important.
The team can use two common approaches, a direct implant support or a bar
supported over denture. During fabrication, clinical and technical complications
should be reviewed. Fixed removable restorations for implants require proper
aesthetics, phonetics, comfort, hygiene and favorable biomechanical stress
distribution to the implants. This also improves the rehabilitation of
resorbed |
Palatal view of the
VKS-SGAttachments placed
on the Implant Bar
|
ridges, since further tissue damage is neutralized by implant support.
In this case the treatment plan had these objectives, restore and facilitate
the incomplete over bite between the anterior area of the metal super structure.
Then complete the restoration |
with a maxillary implant supported milled over denture, that would
oppose a mandibular implant retained over denture secured by a ball
attachment. Due to lack of manual dexterity, the Bredent VKS-SG attachment
was selected for the maxilla, because it facilitated easy manipulation.
Base plates and bite rims were fabricated and the vertical dimension of
occlusion was determined. The upper and lower master models were mounted
and it was evident that the teeth would have to be set up to correct a
class III relationship. A maxillary chrome cobalt frame work would be required.
An initial set up of the teeth were completed and tried in to evaluate
centric relations, vertical dimension of occlusion, aesthetics and phonetics.
Since the patient has a class III relationship, the lingual angulations
of the lower implants helped in fabricating a class I horizontal relationship.
The facial view of the upper model and palatal index showed a limited amount
of available space in the anterior region. Buccal indexes also evaluate
the space available for the infrastructure and in the definitive set up
of the teeth. The occulsal view indicates that cross-arching with an anterior
bar over the ridge is not possible due to the lack of space indicated by
the palatal index. Aesthetics and phonetics would be compromised. It was
recommended that a cantilever in the maxilla not exceed 10 mm due to the
unfavorable type of bone for support. The upper model was mounted on a
milling machine and the infrastructure was waxed up directly to the implant
analogues. A bredent preformed plastic bar and modeling resin was utilized
to fabricate the substructure. Holes were drilled in the predetermined
locations and the ball attachments were positioned with a parallel mandrel.
A 10 mm bilateral cantilever was used to get additional support from the
implants. The waxed patterns were invested and cast using a semi-precious
high palladium alloy (250HV) Afterward in the lab the cast bars were secured
to the master model and then milled using a 1.5 mm, 0 degree milling bur
at 15,000 rpm to correct the divergent angle. After polishing, the yellow
SG retention sleeves are placed on the metal ball attachments and the model
is blocked out for duplication for a casting . A 24 gauge leaf wax with
retention beads was placed on the refractory model. Afterward it was silicoated
and opaqued. Next the upper denture was invested, processed, recovered
and polished to completion. The lower over denture is completed with Bredent
universal implant abutments. Both restorations satisfied the treatment
plan objectives. In conclusion there are numerous benefits in using this
kind of anchorage system. The retention sleeves experience intra oral wear
and can be replaced at chair side. Ball stud placement whether labial or
lingual of the implant bar will only be affected by the aesthetic requirements.
In any event, team effort and a co-operative spirit can over come many
restorative complications. Source; Peter T. Pontsa RDT
Complete
Denture Set Up Using the 10 / 20 Rule.
The 10 / 20 rule for complete dentures begins at the incisal line. The
upper central incisors are placed starting 10 mm from the center of the
incisal papilla and 20 mm down from the vestibular height. Use judgment
for placement of the maxillary central incisors, then place the rest of
the teeth by following the contour of the ridge. Place the anterior mandibular
teeth to verify the phonetics. The incisal guidance is done first. Lingualized
occlusion is required and also recommended by implant manufacturers for
implant supported dentures. For non supported dentures lingualized denture
teeth allow the lingual cusp to run over the shallow fossa of the opposing
teeth or dentition. Using gnathological posteriors such as 20 or 30 degree
teeth increases the potential for lateral excursion to cause dislodgement.
The 10 / 20 rule can also be used in the fabrication of diagnostic dentures,
by setting up the teeth and adjusting for proper phonetics and centric
relations. After the denture is processed the patient should wear the denture
or dentures for six weeks. During this period the clinician will readjust
the tissue bearing area using temporary impression material. When the patient
is satisfied with the fit and function, the denture should be reprocessed.
For completing the final denture the diagnostic denture is mounted on a
reline jig with the teeth firmly planted in plaster to leave a matrix.
The denture is removed and the 14 teeth should be carefully separated in
one section from the diagnostic denture. Then the teeth are placed
back in position on the reline jig. Wax the denture to the new natural
matrix created over the last six weeks and process the new denture. It
is a wise practioner who at the time of the try-in asks the patient to
bring to the office a member of the family or a close personal friend to
observe the tooth arrangement and give advice. The technique and process
has been used quite successfully in many practices across the United States.
Source;
Dr. Turbyfill American Prosthodontic Society, Feb. 26th, 1996.
Tooth
Arrangement for Complete Dentures
When fabricating
immediate dentures it is understood they are not too forthcoming, so copying
tooth form can usually be hampered. Photographs or snap shots will be valuable
as to size of teeth in relation to the face and will define tooth arrangement.
In selecting teeth try not to use the teeth as thy come from the card.
Always use “staggered “shades. Select cuspids several shades darker than
the incisors also make sure the cuspids have labio lingual bulk for a prominent
look. Use central incisors with slightly different shading as you are trying
to make these teeth look like natural teeth. In the middle aged, natural
teeth show a marked variation in color from tooth to tooth. All that is
needed is six to eight moulds of teeth and that should cover practically
all the needs of a complete denture service. We should not make the process
too complicated since nature puts ovoid teeth in square faces and tapered
teeth in ovoid faces and so can you. The factor of family has been a great
help in working out aesthetic problems. A daughter, son, sister or other
relative who bears some resemblance to the patient is used as a model.
If you don’t have old photos or a family member try the following formula.
1 Select teeth of adequate size. 2. Have the centrals dominant and have
laterals of different moulds. 3. Use the incisive papilla as a guide and
set the centrals “forward” of the papilla. 4.Follow the arch form as a
guide in setting the remaining teeth. Finally the return of self- confidence,
the pride in appearance of the patient are welcomed when the restorations
are enthusiastically accepted. Source; Dr. G. Smutko, American Prosthodontic
Society, Feb. 26th 1996
Dent-Line Announces
Newest Milling Courses:
The hands on Milling Course will introduce basic milling techniques
in combination with the Vario Soft III Attachment from Bredent. It will
take place Nov, 9th and 10th at Lab Dentaire I’Outaouais, 1620 Chemin Pink
Rd., Aylmer, Québec. Close to Hull and the Ottawa region. The fee
is $ 450.00 CAD and 24 CDTO continuing education will credits apply.
The next Milling Course will be in Toronto in February 2003. Participants
can pre register for this course now.
June 8th & 9th, 2002 Milling Course:
Dent-Line
of Canada Inc. is pleased to present the participants who attended the
Bredent Milling and Attachment hands on course June 8 and 9th, 2002 at
George Brown College. Peter T. Pontsa RDT introduced them to basic milling
and attachment techniques as well as the theory behind the procedures.
Trade
News; Dental History on the Development of Novocain
Cocaine was widely used as a local anesthetic after Carl Koller demonstrated
its effectiveness in 1884. The addictive properties of cocaine were recognized
and doctors decided to synthesis it for practical use. The first successful
substitute was stovaine discovered in 1904 by Earnst Fourneau. Soon it
was followed in 1905, by procaine, discovered by Alfred Einhorn who gave
his substance the trade name of Novocain from the Latin novus. Introduced
by Heinrich Braun in 1905 novocain soon showed its positive effects without
the drugs drawbacks. Guido Fisher popularized Novocain in the U.S. Injected
by needle Novocain immediately became popular as a local anesthetic for
both medical and dental purposes. Other similar synthetic substitutes for
cocaine produced after novocain include tropocaine, aucaine, monocaine
and lignocain. Source; World of Scientific Discovery. Gale (1994)
The Dent-liner; Vol. 6, No. 4
Publisher: Peter T. Pontsa RDT
Editor: A. Van Breemen BA
E-Mail: info@dent-line.com
Subscription Rates:
Canada
1year $5.00
USA
1 year $7.00
International 1 year $15.00
