Kreyer on Removables: Seeing is believing

Excellence in service is a unique ability to anticipate the needs of your customer. As dental technicians, we offer a technical prosthodontic service for consulting, designing and manufacturing complete denture prosthetics according to a clinician’s dental laboratory work authorization or prescription. It is through excellent communication and collaboration that we are able to understand all the technical variables involved in ­removable prosthodontic treatment.

With the current economic conditions, we will experience more immediate complete dentures involving provisional prosthetics that are transitioned over a period of time to definitive conventional or implant-retained/-supported dentures. In this article, I present a case showing before-and-after photos of maxillary and mandibular complete denture prosthetics from provisional to definitive.

The emphasis of this case presentation is excellence in communication to exceed a patient’s expectations and desires. I would like to thank Dr. Kerry Whitten and the American Academy of Cosmetic Dentistry for assistance with clinical photos and the case.

Expectations and desires

To exceed expectations, the clinician and technician must understand what each other’s needs are during treatment. If the goal is to provide optimal prosthetic treatment and care, there must be clinical and technical collaboration.

The best way for a dental technician to understand these expectations is to see the current prosthetic situation through digital photos. The digital camera should be an everyday tool in the dental office. All dental laboratory prescriptions should be accompanied by a series of photos. Preliminary impressions should be sent with photos of patient full face, profile and intraoral (Figs. A and B). The ability to provide before-and-after photos adds value to the prosthetic service provided.

In this case presented, a technician can visualize the intraoral environment before and after extractions, understanding inter-arch relationships of provisional complete dentures (Figs. C, D and E).

Communication

Collaborating as a multidisciplinary team to design and provide interdisciplinary treatment and care for complete or partially edentulous patients requires excellence in communication.

Instruments that measure vertical or horizontal dimensions and planes aid communication and provide us with the exact information we need to design complete denture prosthetics. Instrumentation can be used to create correctly contoured occlusal rims and thus establish a preliminary baseline for the smile design.

To measure existing provisional denture and communicate vertical and horizontal planes, a denture or Alma gauge works very well. At chairside, the clinician measures the provisional and communicates this to the dental laboratory technician (Fig. F).

Another instrument that is excellent for communicating facial measurements is the Papillameter (Figs. G and H). In this case, it is only possible to use this tool after extractions, surgical healing and residual ridge resorption has taken place, which is usually 4-6 weeks after surgery. Used to measure length of a maxillary lip, the Papillameter shows length of the lip at rest, tooth display at rest, smile line and high lip line. The superior portion of a Papillameter is cut with a V-groove providing room for the labial frenum when placed in the anterior vestibule. At zero on the millimeter ruled portion, there is a horizontal extension on the back that is placed on the incisive papilla, where zero is set on the ruled face. These measurements are used when designing the occlusal rims and anterior tooth arrangement.

Other tools of communication for the dental laboratory include a Facial meter, which measures the width of a patient’s nose for anterior mold selection (Fig. I) and a Centric Tray that records a preliminary OVD and CR for construction of occlusal records or placement of a central bearing device for an intraoral tracing (Fig. J).

An essential photo is the selected shade tab in relation to the patient’s lip (Fig. K). This not only verifies shade tab used but also helps the prosthetic dental technician visualize the shade in relation to a patient’s complexion. Cases such as this with a bleach shade for a younger patient are better communicated with digital photos.

Fig. L shows a profile of the definitive complete dentures, which adds value to treatment when compared to Figs. B and C and explains the patient’s desire for bleached prosthetic teeth.

Summary

A comprehensive complete denture treatment involves clinical and technical collaboration and communication to provide optimal patient care. The ability to analyze and recognize individual variables involved in prosthetic treatment enables the technician to exceed expectations.

Attaching digital photo files to a dental laboratory prescription enables the dental technician to visualize expectations and desires for complete denture prosthetics and understand the functional and esthetic value. 

Contact Robert Kreyer CDT, at PersonalizedDenture.com or on Facebook.