What are the Records for Full Denture Workflow?

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Transcript

This short presentation will cover the records that doctors can use to begin ordering a digital denture from our laboratory. With digital dentures if you can scan it, we can probably make it. So let’s begin with the three different entry points. For years, we have fabricated digital dentures for immediate dentures. That was our entry into the digital denture arena. And this would be a very conventional process that we’ll go through, much like taking regular impressions of patients. So we’ll go through that in a little bit of detail. The second is to scan for custom trays. This is a way around scanning all of the muscle attachments and all of the landmarks that would arise from a dynamic impression used to stretch tissue. Rather than try to attempt to capture phenom and muscle attachments, we will scan for a custom tray. And the third is scanning a bite block, a traditional general dentistry bite block, but digitizing it in the office.

So let’s start with number one, scanning for immediate dentures, doctors would simply scan the entire land area. This is key. Often we get the image on the right, the palate is left out. Key land areas, landmarks are left off. We guess it’s kind of obvious, but we really need to have the full palate all the way back to the vibrating line. Now, if you have a patient who is a gagger or you just can’t seem to capture the pallet, then there is plan B, and that would be to take alginates, pour them up in stone and scan the stone models. It’s not as direct, but it’s better than shipping the models to the laboratory. So two good options. One thing to remember with scanning dentures is to scan, again, as mentioned before, all land areas. That means we want the full roll, the vestibule, we want all the areas, even edentulous areas just scanned. Just imagine you’ve made a custom tray and scan away.

Now, in our experience with immediates, the bite is critical just like it would be with regular immediates, but often a real challenge to capture when the patient has no posterior occlusion and the anterior contacts are a hit and slide. So this would be an area of caution and would not predict to have a perfect bite for the immediate in this situation. But on the right hand side, you can see this is going to be a bit of a guesswork of whether that scan captured the bite or not. So there would need to be a lot of confidence that the bite was captured. Now you can in some instances on the top right scan as much of the upper and the lower and then scan the bite areas. We may be able to manually put the upper and lower together. It’s not guaranteed, but we can make a very good effort to do so. Otherwise you would want to go back to traditional techniques of capture in the bite.

Method number two, scanning tissues for custom trays. So this is a wonderful entry point where in the past we’ve always said, you know, really don’t want to start a digital denture or any denture from an iOS scanner. But if all we’re going to do is fabricate a custom tray or even a bite block, which is even better, we’ll offer both options. Again, capture all the land areas, don’t leave anything out. And then we will just simply make custom trays for this that either you can print in your office or we print here at the laboratory and send. Now with this, there is an option that leads right into the third option that we’re going to talk about today. But one option here is that rather than just make a custom tray, we can make a base plate with a bite rim and that base plate, and we’re just going to go right into number three.

That base plate would be printed. We would use the normal averages for a bite block. And then when you receive this, this would be a wash impression situation every time bowler, border molded wash impression, just following regular techniques. And then you go right into the bite block adjustment and bite registration and markings. So that’s a really nice option going from from number two, right into a full bite block. Which brings us to number three bite block. So let’s say you completed the step two, we send you a bite block at this point, follow traditional methods, high smile line, midline cuspid lines. Use an actual knife to cut these in grooves so that they can be clearly seen on when they’re scanned. So we can see ’em in the software as opposed to using a marker. So it would be customary to use them to carve grooves and then mold the wax as normal for lip support. Carve the wax if possible for plaintiff of occlusion and spend some time on this part of the process so that we can go right to a final denture. Most of our bite blocks these days, I mean 95 plus percent of bite blocks that are scanned go right to final dentures. We skip the setup. Another wonderful thing about digital.

So during this process, the bite block, once this stage is completed in the mouth, the bite block is taken to the iOS scanner and you would scan the bite block. Now if it’s a single arch, you would scan the bite block, you would seat it back in the mouth and scan the opposing and bite, right? That seems pretty straightforward. This presentation is going to show scanning a double arch, and there are some key steps into scanning a bite block. So let’s go through them. The bite block will have a wash impression, border molded. It’s important to carve away any excess material that’s covering the wax. If it’s coming down and covering a lot of this wax, we want it removed. Is it vital? Well, if it’s covering the smile lines or if it’s covering any of the vertical markings for the teeth, yes, definitely remove it.

Trimming it is good. Any flashback in the any flash that’s back here, you could trim it away because that way it’s not moving when you’re trying to scan it. And the process here, and we have videos of this on our website live showing the exact process of scanning. But we have found that scanning the intaglio is always the first part of scanning a denture. Scan the full pallet area. And then once that is scanned, you move to the borders. And when you’re scanning a border, you scan the border, but also scan the intaglio at the same time, keep it in the field of view. And that will allow the scanner to understand that this part of the border is next to this part of intaglio. Otherwise it can get lost. So scan all the way around, scan the full border, and then you’ll start to roll towards the facial.

And again, you’ll scan the border and the wax at the same time to capture the full roundness of the wax and scan all the way around. And then you’ll roll over to the occlusion. Now, some scanners at this point will run out of memory, and you do not need to scan the tongue part of the palate. It’s not needed. We captured the intaglio. We will just make a simple calculation to figure out the depth, the thickness of this material. So scan the full occlusion and then you can be done. Just be sure that you’ve scanned the posterior distal area of the denture. All right, that’s the maxilla on the mandible. It’s the same process. Scan the intaglio, roll around to the borders, roll around to the facial and then to the occlusion. And then in this demonstration, we scanned everything. We have the latest Trios here at the laboratory, but if your scanner will not do it, then the part to skip is the lingual or the palatal.

Then of course, this is all outside the mouth. And I put here inside or outside. If you’ve captured a bite registration, then simply scan outside the mouth, hold it in your fingers and scan. If you did not capture the bite, you can reinsert it in the mouth, hold the patient firm and scan the bite. The key with a bite block scan is that you scan a lot of material. So you want to scan all the way around both arches because these can be a little tricky to register the upper and lower into the bite. You can see on this case the lower registered pretty well, and the upper did not register. We can manually do this, so we won’t have to worry about that. There are lines, there’s lots of landmarks for us to manually put the two together and then to orient this correctly.

But that only really works if you’ve scanned a nice area, the full area of the bite of the two coming together. And then from this, we will perform a setup design, the design, the dentures, and almost all doctors have us fabricate the dentures for them, the actual printing and luting and polishing and all the finishing. But if you are interested in printing in office, communicate with us. We’re happy to send you the STL files for you to print and finish quite a bit of work, take some skill, but certainly can be done. So those are the three entry points into making digital dentures through our laboratory. Thank you very much. And please contact us anytime for questions. And of course visit us on our website for several videos on digital dentures and the many processes that we have. Thank you.

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Independence, OH 44131 United States
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