October 2017
Volume 8, Issue 10

Sharing Opinions to Provide Optimal Choices

With the introduction of digital dentures, what considerations are required by the team to confidently prescribe and deliver removable prosthetic treatment options?

Steven L. Klein, DDS

In the realm of all dentures, including those that are implant supported and/or digitally produced, retention should be the number one concern. All the other aspects like esthetics, cleanability, durability, etc, are secondary and mean little if the dentures don’t stay where they are supposed to. To best address this concern, I prefer to plan treatment with a technician using study models and occlusal indices, as well as considering different types of prostheses. Dennis is very approachable, so I enjoy working with him and feel able to “pick his brain.” This is a necessary exercise with any lead technician handling your case, so that you can both come to an agreement on where occlusal rests, recontouring, and other improvements may be needed. Using study models to facilitate this conversation is my own preference, but using photographs or other 2D images is also acceptable.

One of the most important parts of an effective collaboration is actually not a clinical or technical consideration; it has to do with the technician or laboratory you’re working with. I appreciate a laboratory that fosters a close working relationship with one technician taking lead on my case, and I prefer communicating directly—even through something like Skype or Facetime—with that technician. Just sending over a prescription to a laboratory, where any number of anonymous technicians may touch the case, doesn’t give me confidence in the results.

Our collaboration has benefitted my practice immensely, since it was Dennis who originally told me of the developments in digital dentistry. In fact, I attended a lecture he hosted about implant-retained prostheses, and I am now doing them in practice. I feel like I can offer my patients even more options now, since implants are not always feasible. This new approach for digital dentures has given me new faith in partials. They are much more affordable and accessible now that they are part of a digital workflow. I have the utmost confidence in working with Dennis since I know he educates himself, as I do, for the best of our patients. And it feels wonderful to see them happy with the results.

Dennis Urban, CDT

In removable denture technology, there are more patient options than ever before. The dentist and the experienced removable dental technician must provide a treatment option which will fulfill the patient’s needs. Whether it is for an implant overdenture case, a hybrid all-on-4 or all-on-6 case, a partial denture, a full denture, or even a digital denture, we must follow the correct protocol in case planning with the ultimate goal of patient satisfaction in mind.

The effective collaboration on a removable treatment plan includes the dentist and the technician first looking at the overall health and quality of life of the patient. Then we look at the problems that the patient may have incurred in the past with a removable prosthesis, such as poor fit creating sore spots, inferior esthetics with poor quality denture teeth, or a dysfunctional occlusal scheme affecting the way the patient chews and eats, as well as function and phonetics.

A successful removables case outcome all starts with an accurate impression from the dentist. This is essential so that we technicians have all the anatomical landmarks in the mouth to follow for good fit, form, and function. If I don’t get want I need from the dentist in the beginning, then I ask him or her to start over and provide me with the correct information. Usually the dentists I collaborate with, such as Steven Klein, know they will have a successful case if the correct communication and information is there from the start.

With so many removable options available today, the collaboration of the entire dental team is essential. Whenever there’s a case with implants involved, we even get the oral surgeon and periodontist on board to eliminate any miscommunication. For me, communication has been invaluable, from proper case planning at the onset of the case to putting the finishing touches on the completed denture. Consistent contact among team members also promotes mutual respect and success on the first try. Because of the decisive successes of our removable cases, constant collaboration has changed my perspective on removable restorations for the better.

Ceramage: Zirconium silicate indirect restorative
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