Pittsburgh Dentures Ask us about our New Vinyl and injected NO monomer Denture, No more gum irritation, No Allergy, No more Methylmethacrylate. Warranty and Satisfaction guaranteed.

Your Denture is your frontier image, It express your personality. That is why we customize it to suite your
personality and your social activities.There are no two Dentures look a like.

Dentures are generally classified as partial, full or implant supported. Partial dentures are designed to replace a small section of teeth, and help prevent existing healthy natural teeth from shifting position. Full dentures generally replace an entire set of teeth such as upper and lower dentures. Implant supported dentures have dental implants that support and stabilize the overlying partial or full denture. Often these types of implant supported dentures are preferred because it gives the patient the retention they are wanting when eating.


Many candidates for conventional dentures (also called “immediate” dentures) are able to wear the appliances immediately following the removal of affected natural teeth. Partial dentures, also sometimes called “over dentures,” are designed to fit over a small section of implants or natural teeth. Partial dentures are characteristic by their pinkish gum-like plastic bases, on to which replacement teeth are attached. Small clasps are used to attach the denture to existing teeth. Some clasps, which can be more expensive, are made of natural-looking material that is hard-to-detect and in some cases, a crown will be installed on an existing healthy tooth to facilitate a better hold for the clasp. Often when dental implants are used to support the partial denture, the metal clasps are not necessary.

There are many benefits, which the dentist elaborate on, when dental implants are utilized to support overlying full or partial dentures. They allow for a more natural feel and maximum retention when used. Often when patients go from having a traditional denture or partial to an implant supported overdenture, the first thing out of their mouths is, “Why did I not do this sooner!”

Permanent Dentures

Dentures that slip, slide and pop out can be a thing of the past with permanent type dentures. Permanent dentures are right on the cutting edge of denture technology. Old style dentures used to rely solely on suction and/or clips to help keep them in place, but that was an imperfect system. Learning to chew with new dentures can be a little intimidating at first, but try it while your teeth are floating around in your mouth and the degree of difficulty shoots right up the scale. Permanent dentures are a terrific alternative. Let's get an overview of the process and types of permanent dentures available.

To begin, the dentist will help you select the type of denture you need based upon your individual situation. One tooth (Flipper), several teeth (partial Denture ), or a full set of teeth (dentures) may be in order. Then the custom fitting process begins. Fitting your dentures is a multi-stage process that will require several visits. At the first visit, the dentist will do a thorough examination of your mouth and make sure that your gum tissue and ridges are in the proper shape to support the dentures.  the dentist will then take an impression of your upper and lower jaws. This impression will be used to make a wax bite regestration , that Dentures teeth can be set to get a working model for the final denture to be constructed from. Once the final denture is made and given your approval you are ready for permanent process.

Permanent dentures can be mounted in different ways. A partial denture ridge can be permanently mounted by bonding it to the abutment teeth which have been built up with crowns for added stability. This can be quite adequate to hold a partial denture in place, but there is another method that is even more secure because it doesn't depend on the natural teeth not decaying. This style is called the implant method.

Implant dentures are suitable no matter how many teeth you need, the mounting method varies only slightly. The basic process involves surgically implanting titanium rods directly into the bone tissue of your gums. The rods will be positioned according to the shape and location of your new denture, either pointing up or down from the appropriate jaw, or facing outward for frontal bridges. When your gums have completely healed, the new dentures can be permanently cemented to the exposed posts.
The result is dentures that look wonderful and feel so natural that no one will suspect you're wearing them. Consult your denturist to see if permanent dentures are the right choice for you.

Cosmetic Dentures

Cosmetic dentures are a world away from old fashioned false teeth. When most people think of dentures, they think of their grandparent's teeth floating in a jar because they were too uncomfortable to be worn full time. Not so for today's dentures. Advancements in denture technology have brought us beautiful, durable dentures that look and feel great!

Cosmetic dentures can really give a boost to your facial appearance. By increasing the distance between your upper and lower jaw, facial muscles are given a "lift" which can minimize wrinkles around the mouth area.

And that's not all. Computer imaging technology gives you the chance to go "shopping" for your new dentures. It's like trying on fabulous clothes at the mall before you buy. Start by looking at an array of pink denture bases in shades and styles that can be combined to perfectly match your natural gums. Then move on to the real fun, picking out teeth. Now is your chance to change your style if you like. Want teeth that are a little whiter, a little larger or longer? You can have them in your new denture! You can even pick the shape or style that you've always wanted. You have the power to design custom dentures with your dream smile. But don't forget, if you were happy with your old smile, cosmetic dentures can be made to match that too.

Cosmetic dentures also provide optimum comfort. George Washington could only wish he'd had it so good. Cosmetic dentures make use of all the latest manufacturing techniques. Previously, denture bases were manufactured with a heat curing process that would slightly distort the base from the original bite molds they were meant to duplicate. Injection molded acrylic bases eliminate this shrinkage and warping. The result? Denture bases that perfectly match your gums for the best possible fit, which means the best possible comfort for you.

The best possible fit means the most stability. Cosmetic dentures can also utilize implant technology. Titanium rods can be surgically implanted into the boney ridge of the jaw, and the new denture can be mounted directly on each post. The process is good for one tooth, a partial denture bridge, or a complete set of dentures. No more embarrassing slipping around when you eat or speak. Cosmetic dentures can feel so secure and comfortable you'll forget they aren't your natural teeth!

With new cosmetic dentures, the battle between looking good and feeling good is over, and you have been declared the winner!

Implant Supported Dentures

Are implant supported dentures more beneficial than standard dentures? That's a question many denture wearers have been asking themselves. Your answers to the following simple questions may help you decide.

•    Do your dentures slip when you speak?
•    Does food get under your dentures when you eat?
•    Do your old dentures seem to be loosing their grip?
•    Are you just plain tired of dealing with sore gums?

If you found yourself answering yes more than once, you owe it to yourself to find out a little more about implant supported dentures.

What exactly do we mean when we say "denture implants"? The term implant refers directly to a surgical procedure that is performed under anesthetic. One or more small titanium rods are literally screwed into the bone of the dental ridge under your gums, and the tops of the rods are left exposed above the gum line. The implants are then given time to heal, usually at least two months. If all looks good, then you are ready for mounting.

The number of implants depends on exactly what type of denture you are mounting to them. A full denture plate can be mounted with just a few strategically placed rods, and much the same for a partial. Single teeth can also be cemented to individual posts.

Dentures that have been permanently implanted have a few advantages. Number one is stability. Since implanted dentures are anchored to the jaw with titanium screws, you never have to worry about them moving around. No more shifting while you speak or chew. Dentures rubbing your gums and leaving tender spots are a thing of the past. Implant supported dentures stay put.

A common problem most standard denture wearers will eventually face is bone resorption. Once natural teeth have been removed there is no longer any pressure stimulation to the boney ridge beneath the gums. Bone production now slows to a halt and the bone begins to deteriorate, resulting in a shrunken appearance. It is this shrinkage that causes once perfectly fitted dentures to begin slipping. Even with adjustments or total replacement dentures, bone resorption will continue throughout the denture wearers life time, eventually making it impossible to wear conventional dentures.

This is where implant supported dentures shine their brightest (no pun intended). The pressure stimulation provided by the implanted titanium rods means little to none of the bone shrinkage that usually spoils the fit of standard dentures within a couple of years. Titanium is actually the best material for implants as it has been found more compatible with the bone tissue, which actually attaches to the rods as it grows. The result? Stabile dentures and no more sore spots!

If any of this sounds to you like an improvement over standard dentures, then implant supported dentures may be the right choice for you. Be sure to consult with your denture professional.

Soft Dentures

Get ready for the most comfortable dentures you are ever going to wear, the soft denture. Soft dentures are on their way to becoming the gold standard in denture technology. Completely flexible, yet with a grip so firm you can bite an apple, soft dentures finally offer what denture wearers have always dreamed of; a denture that doesn't hurt or slip.
Soft dentures are completely made of a flexible resin, differing slightly from their close cousin, the flexible denture which consists of a flexible resin overlay on an acrylic denture base.

Let's take a look at why soft dentures fit so snugly. Our jaw ridges tend to be wider near where the teeth meet the gums and tend to curve slightly inward just above and below our natural teeth. This curve inward is referred to as the undercut. When being inserted, a soft denture has the ability to give a little as it passes over the widest point of the gum, but then flexes back inward to conform to the undercut. That's how such a soft denture can provide a great grip without any clips. And perhaps the best part, curving into the undercut keeps food from getting up under the denture. You can go out to dinner and not worry about having to remove your dentures and rinse them in a public restroom.

Soft dentures may wear out a little sooner than flexible resin over acrylic denture types, but they are still far more durable than standard acrylic denture bases. And while soft dentures are still capable of being relined, you may not need any adjustments at all. The small amount of give in the resin material allows a soft denture to rest against your gums more completely, eliminating those agonizing sore spots caused by pressure points on acrylic dentures.
It may interest you to know that the flexible resin used in soft dentures is hypo-allergenic. That's good news for those who are allergic to acrylic and thought they could never wear a denture.

In addition to comfort and fit, soft dentures also look really great. The base has a soft pink transparent tone that allows some of your natural gum color to show through, and no unsightly clips to give away the fact that you're wearing a denture.

So, if you'd almost given up hope of ever finding a truly comfortable denture that is so secure you could grind nuts with it, the soft denture may be just the ticket.

Flexible Dentures

Wait no longer, flexible dentures are here! Whether it's your first time choosing a denture, or if you are just plain tired of your old painful dentures rubbing against your gums, flexible dentures simply have one of the highest comfort levels of any dentures available. How long has it been since you've sat down at the ball game with a bag of nuts? Probably too long if you're wearing conventional dentures.

What's the secret? It's the flexible resin coating on the outer layer of the denture base. This flexibility allows the denture to lock in around the undercut of the jaw bone for superior stability. Flexible dentures are so light and thin you'll hardly feel like you're wearing them.

Flexible dentures are cosmetically pleasing too. The denture base has a transparent pink shading which allows your natural gum color to show through for an absolutely great blend. And you can still choose the style and shade of teeth you'd like to go with them.

And the benefits don't stop there. The flexible resin material is non-porous, so it won't support the growth of bacteria. That means no more denture breath! But even though it's non-porous, the denture will still retain a slight amount of moisture to keep it comfortable against your gums.

Now let's talk about durability. Flexible denture bases are basically unbreakable, unlike standard acrylic bases that can crack if you drop them in the sink during cleaning. No such worries with flexible resin dentures. And even though flexible resin denture bases are more expensive than their close cousins, the soft denture, they make up for it by lasting far longer.

Want more good news? Let's talk fitting. Standard acrylic denture bases require multiple stages to fit and manufacture. Once the wax bite try-in is refined for a perfect fit, it's sent back to the lab where the traditional heat curing of the acrylic base often shrinks the final product, leading to the need for further adjustment to the denture base. With flexible resin dentures, the try-in used during the trial fitting can actually be used in the final denture, shortening the entire process, so you get your dentures faster.

Flexible dentures may just be the denture the world has been waiting for, so what are you waiting for? The sooner you have your new dentures, the sooner you have the freedom to eat what you really want. Go ahead... bite into that juicy red apple. With flexible dentures, you can!

DENTURE DESIGNED FOR DEMANDING PATIENTS

Patients are demanding when it comes to dentures. They want stable dentures that look and feel natural.
Using the most advanced denture techniques, our laboratory combines aesthetics, phonetics and functional characteristics with great success.
The Tri-Denture Technique offers an effective system for fabricating highly accurate, stable and aesthetic dentures in just three appointments. The system is simple yet precise and results in improved fit and stability for the patient and an average of 50% reduction in office visit for the patient. The technique offers superior aesthetics, taking into consideration the patient's age, gender and personality traits.
The Myo-flex denture system insures stability and comfort for lower dentures. A positional memory hinge and expected flange are incorporated into the denture base, maintaining the stability of the denture.
Our proprietary e-dent denture technique bridges the gap between conventional dentures and implants. The totally bone-supported e-dent does not extend into soft tissue areas or interfere with any muscle activity.
There are several new injection processing system that result in highly price, better fitting dentures. They can be used with conventional dentures as well as the above mentioned system.


DENTURES
 - Complete denture also called full denture, or removable prosthesis or appliance for edentulous patient, also called false teeth or artificial teeth, chopper (you name it).
 - The Maxilarry denture is known as, upper denture or top denture; it replaces the missing teeth in the upper palate of the mouth.
 - Mandibolar denture known as lower denture or bottom denture. It replace the teeth or the lower jaw.
 - Wisdom teeth are not present in denture.

Dentures can help patient through:

 - Mastocation as chewing ability is improved by replacing edentulous areas with denture teeth.
 - Aethetics because the presence of teeth provide a natural facial appearance, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that occurs after losing teeth.
 - the improvement of pronunciation of those words containing sibilants or fricatives by replacing missing teeth, especially the anteriors enabling patients to speak better.
 - improving Self-Esteem

DENTURE PROBLEMS

Problems with dentures include the fact that patients are not used to having something in their  mouth that is not food. The  brain senses this appliance as "food" and sends messages to the salivary glands to produce more saliva and to secret it at a higher rate. This will only happen in the first 12 or 24 hours, after which the salivary glands return to their normal output. New dentures can also be the cause of sore spots as they compress the soft tissues mucosa (denture bearing soft tissue). A few denture adjustments for the days following insertion of the dentures can take care of this issue. Gagging is another problem encounted by a minority of patients. At times, this may be due to a denture is too loose, too thick or extended too far posteriorly onto the soft palate. At times, gagging may also be attributed to psychological denial of the denture. (Psychological gagging is the most difficult to treat since it is out of dentist's control. In such cases, an implant supported palateless denture may have to be constructed). Sometimes there could be a gingivitis under the full dentures, which is caused by accumulation of dental plague.
One of the most common problem for new full upper denture wearers is the loss of taste.
Another problem with dentures is keeping them in place. There are three ruled governing the existence of removable oral appliances:  support, stability and retention.

PROTHODONIC PRINCIPLES OF DENTURES

Support is the principle that describes how well the underlying mucosa (oral tissues, including gums and the vestibules) keeps the denture from moving vertically towards the arch in question, and thus being excessively depressed and moving deeper into the arch. For the mandibular arch, this function is provided by the gingiva (gums) and the buccal shelf (region extending laterally (beside) from the posterior (back) ridges), whereas in the maxillary arch, the palate joins in to help support the denture. The larger the denture flanges (part of the denture that extends into the vestibule), the better the support and stability. Long flanges beyond the functional depth of the sulcus are a common error in denture construction, often (but not always) leading to movement in function.

Stability is the principle that describes how well the denture base is prevented from moving in the horizontal plane, and thus from sliding side to side or front and back. The more the denture base (pink material) runs and smooth and continuous contact with the edentulous ridge (the hill upon which the teeth used to reside, but now consists of only residual alveolar bone with overlying mucosa), the better the stability. Of course, the higher and broader the ridge, the better the stability will be, but this is usually just a result of patient anatomy, barring surgical intervention (bone grafts, etc.)  

Retention is the principle that describes how well the denture is prevented from moving vertically from the opposite direction of insertion. The better the topographical mimicry of the intaglio (interior )
 surface of the denture base ti the surface of the underlying mucosa, the better the retention will be (in removable partial dentures, the clasps are a major provider of retention), as surface tension, suction and friction will aid in keeping the denture base from breaking initiate contact with mucosal surface. It is important to note that the most critical element in the retentive design of  a full maxillary denture is a complete and total border seal (complete peripheral seal) in order to achieve "suction". The posterior palatal seal design is accomplished by covering the entire hard palate and extending not beyond the soft palate and ending 1 - 2 mm from the vibrating line.

Implant technology can vastly improve the oatient's denture- wearing experience by increasing stability and saving his or her bone from wearing away. Implants can also help with the retention factor. Instead of merely placing the implants to serve as blocking mechanism against the denture pushing on the alveolar bone, small retentive appliances can be attached to the implants that can then snap into a modified denture base to allow for tremendously increased retention. Options available include a metal Hader bar or precision balls attachments, among other things.

COMPLICATIOS AND RECOMENDATIONS

The fabrication of a set of complete dentures is a challenge for any Dentist/Denturist, including those who are experienced. There are many axioms in the production of dentures that must be understood; ignorance of one axiom can lead to failure of the denture case. In the vast majority of cases, complete denture should be comfortable soon after insertion, although almost always at least two adjustment visits will be necessary to remove sore spots. One of the most critical aspects of dentures is the impression of the denture must be perfectly made and used with perfect technique to make a model of the patient's edentulous (toothless) gums. The dentist must use a process called border molding to ensure that the denture flanges are properly extended. An array of problems may occur if the final impression of the denture is not made properly. It takes considerable patience and experience for a dentist who know hoe to make a denture, and for this reason it may be in the patient's best interest to seek a specialist, either a prosthodontist or perhaps even a denturist, to make the denture. A general dentist may do a good job, but only he or she is meticulous and usually he or she mast be experienced.

The maxillary denture (the top denture) is usually relatively  straightforward to manufacturer so that is stable without slippage. It fit by suction.

Some patients who believe they have "bad teeth" may think it is in their best interests to have all their teeth extracted and full dentures placed. However , statistics show that the majority of patients who actually receive this treatment wind up regretting they did so. This is because full dentures have only 10% of the chewing power of natural teeth, and it is difficult to get them fitted satisfactorily, particularly in the mandibular arch. Even if a patient retains one tooth, that will contribute to the denture'stability. However, retention of just one or two teeth in the upper jaw does not contribute much to the overall stability of a denture, since a full upper denture tends to be very stable, in contrast to a full lower denture. It is thus advised that patients keep their natural teeth as long as possible.



 

The need to replace lost teeth has haunted humans since the beginning of time. False teeth have been made out of human and other animal teeth since around 700 BCE and this technique was still popular up until the mid 19th Century. The first modern looking dentures were made in Japan in the 16th Century of wood and they continued to be made until the beginning of the 20th Century. No, George Washington did not have a set of wooden dentures. Instead, in the 17-18th Centuries dentures were made of gold, lead, ivory, human and other animal teeth. The 19th Century saw the invention of hard rubber dentures and the 20th Century plastic dentures were invented. Now, in the 21st Century we have a revolutionary new way to make dentures called digital dentures!

Conventional Denture:

Twentieth Century plastic dentures are still made to this day all over the world. They are made by first making a very accurate impression of the mouth and then constructing a base plate and occlusion rims. These are essentially wax rims that are molded by the dentist to show how wide the mouth is, where the lips go, how high the smile line is, where the midline of the teeth are located and how wide the smile is by showing where the canines are located in the smile line. The upper and lower record bases and occlusion rims are then “glued” together to simulate the bite and sent to the local dental lab to be processed. The lab man then sets the actual denture teeth that will be in the finished dentures in the wax on the occlusion rims so they can be tried into the mouth to see how they look. Once the aesthetics have been worked out with the wax try-in, the dentures are processed by boiling out the wax and replacing the wax with denture plastic.

Below are the well known problems with the way we make dentures using wax bites and wax rims to set up denture teeth.

  • Wax is not very hard and it shrinks, creeps and expands a great deal according to the temperature and position the dentures are stored at between appointments. Error!
  • The denture teeth set in wax may have looked great inside the mouth, but when the lab courier picks them up and transports them around town in a hot/cold car before bringing them to the lab, the teeth may shift in the wax. By the time they are ready for the dental lab technician to process the dentures, the teeth are no longer in the right position. Error!
  • Not all dental laboratories have a certified dental lab technician setting up their teeth in ideal occlusion. Instead, someone taught the tech how to set teeth. They may not have a formal lab education themselves. Unfortunately, this may mean that the denture teeth may have excessive grinding on the biting surfaces of the patient’s expensive denture teeth to force them to fit inside the bite. A good dental lab tech knows to do most of the grinding on the neck of the tooth that will be processed into the wax instead of grinding away the anatomy of the biting surfaces. Error! Good dental lab technicians are hard to find and that is why dentists are constantly on the look-out for the best ones in their area.
  • During the final processing of the dentures, plastic is packed around the denture teeth and cured under heat and pressure. During this process the curing plastic shrinks and distorts. Error!

Four to seven dental appointments later the dentures are back at the dental office and ready for delivery. If all the above errors were not kept to a minimum, the dentures will needed more adjustments and may feel loose frustrating not only the dentist, but the patient as well.

Before now, making dentures were just as much an art as a science. Many dentists didn’t like to make them because of all the built in errors and the final product was to unpredictable. With these errors it was hard to satisfy many of the more demanding denture patients and many dentists shied away from making them because of those reasons. “Denture Mills” have sprung up all over the place to fill in the private practice void and in many instances can make you a set of dentures in a single day at a low bargain price. Unfortunately, bait and switch tactics and using inferior quality materials are rampant in the usual Denture Mill. This fast pace industry has given dentistry a bad name over the last decade.

Digital dentures has removed most of the guess work and replaced it with a solid well thought out technique to deliver a great set of teeth to even the most demanding patient.

Digital Dentures:

With Avadent digital dentures there is no wax and none of the usual errors of conventional dentures (Unless you choose to do an Advanced Try-in appointment with a much more stable plastic/wax). All of the information is collected on the first appointment and two weeks later the dentures are delivered. When the dentures are delivered, all the supplies that you used to make the dentures are restocked (additional $99)! Amazing!
The process is as follows:

  • In the Avadent starter kit is a set of 1 large, 2 medium and 1 small thermoplastic trays to be used as custom trays. If the patient has an existing set of dentures you can either make a putty mold inside the existing dentures to form the thermoplastic trays over or you can shape the trays in the mouth directly. The trays are placed into a water bath (bath cup and digital thermometer provided) 70℃ or 160℉ for 60 seconds. The starter kit comes with a specially formulated scannable border molding and wash polyvinyl siloxane (PVS) to make a very accurate final impression. Place a border molding bead of heavy base PVS around and on top of the outside rim of the custom tray and one small spot into the palate. Then place it into the mouth and shape the lips and frenum. Then follow with a light based PVS washing shaping the lips and frenum again. These impressions are never poured up in stone, but instead are scanned and digitized at the lab. I just wish they made the border molding heavy base PVS a different color than the thermoplastic trays. It is very hard to know if it is tray or border molding showing through the thin based wash PVS. You will sometime (almost always) have to trim the thermoplastic trays, especially the lower. I found it just as easy to form the trays in the mouth as I did on the putty PVS models. Mark the vibrating line with a Thompson stick and re-insert the upper final impression to transfer the position of the post-dam. Then use a marker to place where you want the end of the denture to be.
  • Place a marker spot on the patients upper lip or nose and lower chin and measure the vertical dimension of occlusion (VDO) the final dentures will need. Use your usual technique to determine this space. The starter kit includes a caliper.
  • Additionally, in the starter kit are 1 large, 2 medium and 1 small upper and lower proprietary base plates called the Anatomical Measuring Devices (AMD) that make record taking a snap. Using the supplied plastic calipers measure the distance between the 2 tuberosities and the 2 retromolar pads. Choose the appropriate base plates (default to the next smaller size so the coronoid process will not interfere with the lateral excursions during the gothic arch tracing) and in the upper place adhesive into tray and place PVS bite registration material inside the tray and make an impression of the upper arch inside the base plate (trim off the excess). Screw out the gothic arch pin as far as possible before you insert the upper part of the AMD so you will know if you will need to add the extender to the pin (the new style upper AMD has a plastic pin and screws and maybe more difficult to manipulate). You can always grind the base plate if it is a little too big, but remember to default to the next smaller tray. It is not necessary to make perfect impression inside the AMD’s, just cover enough of it to make a record of most of the ridge so it will be stable and hold into place. (Later at the lab the ridge in the final impression will be matched up with the ridge inside the base plate AMD to digitally mount the case. The materials are the same consistency so be sure to use the same pressure when making both the final impression and the base plate stabilization). Easy!
  • On the front of the upper base plate is an adjustable lip bumper. Use the provided screw driver to move the bumper out to support the lip like you would if you were to shape the old style occlusion rim wax. This is much better than the wax occlusion rim because you can move the lip out and in with ease, instead of removing and replacing wax (the newer AMD has a clear plastic bumper that is a little harder to manipulate, but you can see the gothic pin through). Easy!
  • There are two different types of lower base plates, but I will only discuss the one I like to use at this time. It is the flat plate for the “Gothic Arch” tracing. Place adhesive, then inject PVS bite registration material into the lower base plate and fit it to the lower arch just like you did with the upper. Most dentists never have done a gothic arch tracing to manufacture a denture. Taking the tracing often extends the number of appointment it takes to make a denture and complicates the process with extra parts and pieces. Usually only prosthodontists or specially trained general dentists go to the trouble to do this tracing. The gothic arch tracing it considered the most accurate way to find the proper jaw position to set the teeth at (centric relation). The Avadent digital denture technique allows a quick, accurate and simple way to do this tracing. OPTION: You can spray Green Occlude occlusal spray on the lower base plate to accentuate the gothic arch tracing. With the newer ADM trays green spray is needed because the pin is plastic and will not mark the lower tray. Easy!

  • In the middle of the upper base plate is an adjustable tracing pen that can be adjusted to open or close the VDO (the newer AMD the tracing pen is made of plastic). If the pin is not long enough to touch the lower plate, the kit has pin extenders that simply screw over the shorter built in one. Use the previously placed dots on the upper lip and chin to adjust the base plates to the proper VDO with the screw driver provided. Use the caliper reading from the VDO reading you obtained in the beginning of the appointment.
  • Now have the patient move their lower jaw through right/left and protrusive excursions to use the VDO pin to mark on the lower plate base plate a “Gothic Arch” tracing (will need green occlude spray on lower tray with the newer ADM plastic pins). Remove the lower base plate, take a round bur and drill a small dimple in the point intersection of the gothic tracing and replace back into the mouth. This tray was actually too big and almost traced right off the back of the plate!
  • Replace the lower AMD and allow the upper pin to slide into the bur hole on the lower. Make sure both trays are stable on the arches. Inject PVS bite registration material between the upper and lower base plates to completely secure the centric relation bite. Be sure not to cover the lip bumper. If bite material gets on the lip bumper, simple take out the entire apparatus and use a scalpel to remove the excess and replace it back into the mouth.
  • Provided in the starter kit is a combination fox plane/earless face bow (I call it the “Angulator”). Snap it completely through the lip bumper and into the base plate, firmly. Line the top of the angulator with the interpupillary line and record the angle on the prescription form. Numbers higher than 10 mean the teeth cant to the left and lower than 10 to the right. (I suggested to Avadent to only put the numbers on one side. I got confused when reading one side then the other because if you don’t really look at the scale on each side carefully, you could miss that the numbers ago up on one side and down on the other. What is 9 on one side may be mistaken as 11 on the other if you are not careful).
  • On the lip bumper is a surface that you can write on with a pencil (the newer lip bumper is clear plastic and you need to use a sharpie marker). Scribe the proper incisal edge, midline, high lip line and canine positions.
  • Provided in the starter kit are thin pieces of clear plastic film with different sized teeth printed on it. They come in small, medium and large. The large is 46mm between the the height of contours of the canines and the medium and small are 40mm. The only difference between the medium and small is the medium is 1mm longer incisally. Place flowable composite (not provided) on the back rougher side of the plastic strip and line it up with the midline and incisal edge you previously scribed on the lip bumper. This will give you a good idea how large you want to make the teeth in association with the high lip line. This will more accurately describes to the lab where you want the necks of the teeth to be and will let the patient see it as well. Write the neck number down on the lab script.
  • The dentist then selects the appropriate color, type and size of teeth to be placed into the denture. As of now a limited number of style and brands are offered, but more are on the way. (Although mentioned at my course this is not their official policy and not recommended at this time. This is because of the difficulty in tracking teeth, possible wrong size or color teeth, missing teeth in sets or possibly blemished teeth. Avadent wants to only use factory guaranteed pristine teeth for their digital denture product). IVOSTAR and BLUELINE from Ivoclar Vivadent and PORTRAIT IPN from Dentsply (premium). The premium teeth are an additional fee which is quite significant to the overall price of the processed dentures ($99 per arch, better ask!). The color of the acrylic base is also requested. This is not something I was use to specifying so I requested the shade guides from the manufactures and let the patient choose what they like: Pro Base Hot US-L (light), Lucitone 199 Original Shade (#688111), Lucitone 199 Light (#688211), Lucitone 199 Dark Pink (#688411), Diamond D Heat Cure Original, Diamond D Heat Cure LIght and Diamond D Heat Cure Dark Veined. Characterization is none, stippled, low, medium and high. You can even ask to copy the palatal rugae onto the palate of the denture if the patient wants to have a more natural feeling denture (Cool!). You can always polish it out later if it becomes bothersome.
  • You do not have to pick out the specific numbers of the denture teeth to match the dentures since all the information provided allows the lab tech to do that for you on the computer. Easy!
  • On the lab slip the dentist can check to have photos of the final set-up emailed to them if they want to approve the set-up before they are processed. The only problem with this is that the processing will not start until you approve the set-up. This may cause some logistical problems if you do not check your email regularly. If you want to do a wax try-in then you need to order that with your case (SEE Advanced Try-in protocol below).
  • Finally you will have to specify the occlusion. Currently, they only place the teeth into lingualized occlusion and flat plane posterior teeth.
  • Remove the whole apparatus, sterilize it with lab spray, put it into the provided plastic bag and wrap it all in bubble wrap. You should have 4 things to mail to the lab: upper impression, lower impression, the base plate apparatus and the Avadent lab slip. The starter kit includes shipping boxes and prepaid mailing slips. It doesn’t get any easier than that! The whole process will take about an hour with no side bookings and no hygiene. You can have your assistants make the PVS models of the dentures and be fitting the custom trays to speed things up.
The other lower base plate that comes with the kit I think is harder to use. It has a grooved slot that the upper pin snaps into. The dentist has to manipulate the jaw into centric manually after finding the proper VDO. I don’t trust this as much as using the gothic arch tracing. I figure since the other base plate actually makes a proper tracing on CR, then it should be used over the manual manipulation of the jaw. If you are a student of a particular way to find CR, then you may find this base plate more to your liking.

I think they covered all the bases, don’t you? Can you think of anything that you do that they have not considered with this technique? If so, then add it to the comment section below.

At the Avadent Denture Lab

The Avadent digital dentures is owned by Global Dental Sciences and is located in Scottsdale, Arizona. This is the only problem I’ve seen with this system. The distance adds time onto the processing and locks out local dental labs from providing this serve. Avadent said they are addressing these concerns and will in the future be packaging it for local labs to use. I hope this technology will be provided on a local bases for a reasonable price in the near future.

  • When the lab receives the case, the whole upper/lower impressions/ADM apparatus is scanned into the computer. The posterior smile line is calculated as 2/3 the way up the retromolar pad (if space provided, of course). The teeth are set digitally and can be in lingualized occlusion or zero degree posteriors. First, the teeth are set over the mandibular ridge and then the maxillary teeth are set to match. The computer automatically adjusts the occlusion and can be customized from this point to reflect any characterizations needed. (SEE Advanced Try-In Protocol below).
  • At this point pictures of the set-up are e-mailed to the doctor for his/her final approval.
  • The pink base is then CAD/CAM milled by a computer milling machine out of a solid block of perfectly cured denture colored methylmethacrylate. This is note worthy in that milling this from a solid block of previously cured acrylic means that there will NO distortion when it is milled out. No shrinkage from curing, therefor a much tighter and noticeable final fitting denture.
  • The holes for the teeth are also CAD/CAM milled into the denture base. One of the few human tasks needed in the manufacturing of the digital denture is manually bonding the teeth to the denture base. The dental lab tech “bonds” each tooth into the proper milled socket in the newly constructed dentures. This bonding is supposed to be stronger than either the denture teeth or the denture base acrylic making it virtually impossible to have a tooth fall out over time.
  • Once the teeth are bonded into the dentures the dentures are scanned again to assure they have the same occlusion as what is on the computer. If different, the lab tech will adjust the occlusion accordingly before shipping them out for delivery.

Total control over the whole process is very alluring and has many advantages. The ability to make beautiful bubble-free final impressions, the ease of finding the proper denture dimensions, a simplified way to find centric relationship, computerized occlusal tooth set-ups, milling from a solid block of cured acrylic, the optional ATI and verifying the denture set-up against a know computer template is all a formula for outstanding successful complete denture cases.

Quick Check List:

  • Measure the upper and lower arch size
  • Select the appropriate trays (select next smallest tray)
  • Place trays in 160 F water bath for 60 seconds
  • Mold trays in mouth (or on putty PVS model)
  • Trim trays if necessary
  • Heavy PVS on borders with stops on palate and ridges
  • Wash with light base PVS
  • Mark vibrating line with Thompson stick and re-insert into mouth to transfer
  • Use maker to outline vibrating line on dry impression
  • Place VDO spots on upper and lower (nose/lip/chin area)
  • Measure with provided caliper
  • Use impressions to select the upper/lower AMD
  • Screw out the gothic pin all the way (to see if you need an extender with metal pin only)
  • PVS bite registration in upper AMD (trim back from adjustable lip bumper)
  • Adjust upper lip bumper to proper lip profile
  • PSV bite registration in lower AMD
  • Adjust the gothic arch pin to proper VDO
  • Left/right/protrusive gothic arch tracing
  • Dimple with bur at CR
  • Replace the two AMD into mouth and allow pin to slide into dimple
  • Register bite (without covering upper lip bumper with PVS bite registration material)
  • Place “Angulator” and measure the Fox plane angle/earless facebow
  • Pencil/sharpie in lip lines (incisal edge, midline, high lip line and canine positions)
  • Composite glue the plastic film teeth into position on the upper ADM’s lip bumper and record the height level you want the necks of the teeth to be in relationship to the high smile line.
  • Select teeth/gingiva/rugae
  • Specify occlusion and the need for the Advanced Try-In (described below) or not
  • Fill out lab slip, package and mail.

 

 

Advanced Try-In Protocol:

The Avadent digital denture Advanced Try-In (ATI) protocol is truly the “missing link” in the manufacturing of the next generation of complete upper and lower dentures. Dentists around the world have been doing dentures the same way for the past 100 years and have come accustom to “seeing what you get” BEFORE the dentures pass the point of no return by being processed into expensive pieces of plastic.
ATI is the exact denture that you would have received without this additional step, but instead with a custom milled baseplate and teeth set in a customizable plastic/wax gingiva pattern. Everything you are use to doing with a regular old fashion wax try-in can be done to this ATI including:
  • Resetting anterior/posterior teeth
  • Equilibration
  • Adjust buccal corridor
  • Record base adjustments (PIP adjustments of record base/flanges, or even a complete reline of the record base)
Once all of the appropriate adjustments have been completed and the patient is satisfied with the aesthetics, a bite registration of the upper and lowers should be taken. Send it back to the lab luted together in one piece.
Single arch with ATI cost $450
Two arches with ATI cost $900

Implant Retained Overdentures:

This process is exactly the same as with conventional dentures. The process works best with attachments that can be picked up such as locator attachments or “O” ring snaps. Simply make a final impression over the attachments and the lab will mill the spaces for you to pick up the attachments with cold cure at delivery.

Delivery:

When I blog about a product, my sword can swing both ways. I will let you have an honest accounting of what I experience so that you will be on the look-out for possible pitfalls. In the case of this digital denture case, the patient was extremely satisfied with the results,

This is my 2nd set of dentures and they are great. The look and fell are by far superior than the first. The technology that is used to fit them to my mouth was a lot easier to deal with and on my second and final visit everything went a lot smoother than I hoped for. Dr Kraver and his assistant where wonderful, caring and accommodating. Watching the birds in the aviary is a great distraction to what is being done not to mention T.V. I highly recommend Cape Dental Care for all your dental needs.

Les Singer

but I was not.

  • I checked on the lab slip to have pictures of the set-up emailed to me before manufacturing, but didn’t receive any (they are new at this, too. November 2011).
  • The set up had an anterior open bite.
  • The occlusion was high on the posterior most teeth.
  • The palatal tongue surface was pebbly (rugae that the patient oddly didn’t mind, interesting)
  • The cant was off (in all honesty I think I may have read the “Angulator” wrong and wrote down 11 when I meant 9, oops!)
This is probably not a good case to start off with because he has a prominent lower jaw (Angles Class 3 tendencies) and asymmetrical facial feature, especially the lips. With his old dentures he only showed his lower teeth and was in an anterior cross bite (below).
At the Avadent Program I attended they did say that there was a learning curve and were prepared to use your first case as if it were a wax try-in to help train you in this denture technique (as long as you return the original denture so the patient doesn’t get two dentures for the price of one or you sell them the other set for your own profit). I contacted Gene Peterson, Director of Clinical Excellence at Global Dental Sciences and he was most helpful. He said he had read my blog and liked it! He corrected a few things that I had placed in the blog (strike outs) and set up a computer link with me the very next day to sort out my concerns.
During the computer conference I was able to see the whole design process. WOW! Computers are crazy number crunchers! We fixed the cant, changed the smile line, smoothed out the palate and tightened up the anterior overbite. Below are the emailed photos of the new finished case. They processed the case in just a few days and we called in Les to see if he liked his new “new teeth”.
The patient didn’t even know I switched out the dentures! I called him in for a follow-up visit and took his first set out of his mouth and put in the second newer set. The chant was gone and the palate was smoother, but he didn’t seem to notice. Now the only problem the patient would have is getting the two set mismatched and using the wrong uppers with the wrong lowers! That is why we are keeping the first set for our own illustration of the technology.
That is why the addition of the ATI was so important to this whole process!

Denture Cost and Replenishment Kit:

They really have a great system for making dentures. When they say the Starter Kit includes everything you need to make a sets of complete upper and lower digital dentures, they mean it! When you get each C/C back this is what comes with it
 
 
NOTE: If you added up the price of impression materials, bite registration material (mixing tips) and custom trays it comes up to about $95 and that’s not including the propitiatory Anatomical Measuring Devices (AMD).

Avadent Warranty:

During the 1 year warranty term of your denture, we all repair, free-of-charge, any break,crack,or fracture, replace, free-of-charge, any tooth loss that results of a flaw in workmanship. However,we will not reconstruct, repair, or reline or replace the denture, free-of-charge, due to any of the following: loss, discoloration, excessive wear (for example, excessive grinding of teeth), neglect or abuse, improper care or handling, accidents, modifications, unauthorized repairs, or other causes which are not defects in material and workmanship. Any and all warranties will be void, if dental prosthesis is repaired with glue or any self-repair kit during the warranty period.
This is a good selling point for a duplicate denture because if they need to have their denture(s) repaired under warranty they will have to be mailed to Arizona!

Duplicated Dentures:

A new caveat involving complete dentures is the ability to make an exact copy as a spare back-up denture at half the cost. With little more than a phone call or lab slip the patient can now have an exact duplicate of their original denture in just 2 weeks. I can see it now, “Buy one and get the second one for half off the original price!” Got to love marketing.