Transition Toward Digital Dentures: Clinical Workflows – Direct to Try-In

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Rewritten Transcript

The last workflow we’ll cover is what I refer to as a direct-to-try workflow. Reflecting on the other three workflows – wax rim bite, impressions in existing dentures, and immediate dentures – each provided the design technician with reference information, whether a wax rim, existing dentures, or pre-extracted teeth. The direct-to-try workflow is where the patient doesn’t have a denture, so we’re starting from scratch, which is less desirable as it’s harder without a starting reference compared to the other workflows, particularly the impressions in existing denture technique.

We begin by taking conventional impressions. The only addition is a centric tray, a scaffolding device that helps us capture a relationship between the upper and lower jaws via a glorified “mush bite”. The UTS CAD, while not a facebow, attaches to the centric tray and provides patient data – specifically the bi-pupillary plane angle. This extra information becomes important when starting without any other references.

After scanning, we have a virtual mounting, leveraging details like the UTS CAD bi-pupillary and camper’s plane angles to guide initial occlusal plane positioning for the tooth setup, since we lack wax rims, denture teeth, or other typical starting references in this workflow. There’s no real need to fabricate separate occlusal rims, as we transition directly to designing a monolithic resin try-in with the planned tooth positions.

You’ll see in this try-in image, the pink areas represent the denture base material, distinguishing it from the tooth portion. It’s a monolithic print/mill, skipping the traditional wax rim stage entirely for this workflow unless specific occlusal rims are needed for gothic arch tracing – an academic exercise, but not particularly practical clinically speaking.

For impressions, you can take preliminary alginate or putty impressions initially, then refine them into final impressions using a wash technique if desired. Or you can simply proceed directly to intraoral scanning as your definitive impression approach – the choice is up to the clinician’s preferred techniques.

The centric tray is essentially a scaffolding with integrated tongue guards to facilitate the bite registration process. My preferred material is a regular-set polyvinyl putty impression material, as it provides a bit more working time compared to the fast-set putties.

We’ll load the tray with the putty material, insert it, have the patient close into the pre-assessed vertical dimension, and guide them through physiologic movements to record a “mush bite” relationship between the arches. I’ll refrain from getting into the fine details here, but we do have an instruction for use document that provides comprehensive guidance on this centric tray bite registration process.

The UTS CAD, though resembling a facebow, is designed solely to capture the bi-pupillary plane and camper’s plane angles. With it attached to the centric tray intraorally, we adjust and record the numerical value that aligns the UTS CAD arch parallel to the patient’s pupillary line for the bi-pupillary plane. We then re-adjust and record the corresponding camper’s plane angle measurement. These two numerical values, not the UTS CAD itself, get communicated to the lab to help establish the occlusal plane orientation from which they’ll develop the tooth setup for this direct-to-try workflow.

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Tags: Workflows

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