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
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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
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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
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