Transition Toward Digital Dentures: Clinical Workflows – Immediate Dentures

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Rewritten Transcript

Okay, another workflow is immediate dentures. If I had to pinpoint one workflow that exemplifies the value of transitioning to digital dentures, it would be for immediate dentures, as this service to the patient is tremendously enhanced by the technology.

You can take traditional impressions and bite registrations, preferably with the bite captured at your desired vertical dimension for the final prosthesis – no change from current techniques. These can then be scanned to obtain a virtual mounting.

The true advantage emerges with virtual extraction planning. You can approximate the extractions digitally using extraction tools, then proceed to design the denture teeth, ghosting in the patient’s existing teeth at any point as a reference guide. It’s crucial to carefully evaluate the existing teeth – midline, incisal lengths, etc. – and make notes so the lab knows where to start positioning the new teeth in relation to the preoperative condition.

This existing dentition reference, something we simply don’t have in the traditional workflow, provides an immense opportunity. You can design the ideal denture setup, then ghost in the planned extraction sites, potentially going back to adjust the virtual ridge reduction to properly accommodate the new tooth positions without compromise. No more disappointed wishes that you’d reduced an area more – you can visualize and plan everything in advance, a tremendous service to the patient.

Positioning the new teeth in a familiar location relative to the existing dentition eases the transition and provides a comforting sense of familiarity for the patient, despite being an immediate denture. Combine this with the uniform thickness only possible with milled bases, and you’ve truly optimized the procedure using this technology.

As an alternative to conventional impressions, you could perform an intraoral scan of the existing dentition, especially well-suited for those adept at digital workflows. Capture the data chairside, then proceed with virtual extraction planning – the process remains the same regardless of the data acquisition method.

Before extracting teeth, carefully inspect the existing condition, using the provided chart as a guide for what to evaluate and communicate to the lab. Note midlines, incisal edge positions, occlusal plane inclination, anterior tooth arrangements – anything that will aid the lab in understanding your objectives for the new prosthesis relative to the preoperative state.

A couple quick tips: For impressions, I prefer a polyvinyl putty like Virtual XD Putty if teeth stability permits. The added body captures excellent peripheral borders while still picking up tooth positions adequately for scanning. You can trim away excess and add a wash if desired.

For loose teeth, use a two-phase impression like acadeXD alginate – inject the light body first, then load the tray with the heavy body and press into place, capturing everything in one smooth impression.

Developing intraoral scanning skills is advisable going forward. And if you routinely perform alveolectomies, having a 3D printed clear surgical guide can be a very practical adjunct.

Overall, this workflow demonstrates how digital denture technology can profoundly improve interim prosthesis fabrication compared to traditional techniques, truly elevating the level of service provided to our patients.

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Tags: Workflows

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