focus Edition 2 - February 2015
with Carl Fenwick www.dental-education.co.uk // www.ivoclarvivadent.co.uk
iDenture; a revolutionary concept in complete denture prosthetics Since the introduction of the Biofunctional Prosthetic System (BPS), Ivoclar Vivadent has led the way in the field of complete dentures. The BPS system has developed somewhat over the years but always stayed true to it’s core principles, accurate impressions, correct bite registration, highest quality materials, superb fitting and both functional and aesthetic prosthesis. I think it’s widely accepted amongst many dental professionals that the provision of successful prosthetics for the completely edentulous patient can be a challenge for the most gifted clinician, and has caused many sleepless nights.
bow and help us improve our complete denture provision?” This was the challenge we were faced with.
Presenting complaint
In 2013, whilst attending the Ivoclar Vivadent International Expert Symposium, Vienna, I attended Dr Jiro Abe’s lecture on what sounded like the holy grail of removable prosthetics…suction on complete lower dentures!
Our latest development in the BPS system or iDenture as it will be known in the UK and Ireland is the addition of some new techniques to improve both function and aesthetics even further. This was brought about to, in part address the question; “What about patients who are unsuitable for implants, if they cannot afford them or simply do not like the idea of them? Is
Among many other qualifications, Dr Abe is a Professor and specialist in Tokyo, an international Opinion Leader for Ivoclar Vivadent and president of the Japanese Denture Association. After this lecture I signed up and attended Dr Abe’s two hands on course in Sengawa, Tokyo to find out more. I am so pleased I did as it has changed the way I work forever.
there anything that can give the clinician another string to their Carl completing his suction denture training with Dr Abe in Japan.
“What about patients who are unsuitable for implants, if they cannot afford them or simply do not like the idea of them? Is there anything that can give the clinician another string to their bow and help us improve our complete denture provision?”
Fig 1
Patients existing dentures
Fig 3
Accudent maxilliary impression
Fig 2
Fig 4
Using Dr Abe’s suction technique we would achieve suction on this ridge
Mandibular impression using Frame cut back tray
Fig 5
Dr Abe FCB tray
Fig 8
Tooth set up according to BPS principles
Fig 3
Fig 6
Centric tray impression
Fig 7
Custom trays incorporating Gnathometer M
A prospective patient presented himself to the clinic expressing a desire for a more natural looking set of dentures with which he hoped would lead to improved chewing ability and increased stability, additionally he expressed concerns about age related wear as well as trapped food. On examination the patient had satisfactory maxilla ridge however the mandibular ridge showed evidence of considerate resorption anteriorly (fig 2). The patients existing dentures (fig 1) were adequate in both fit and appearance but a definite improvement could be achieved using the new iDenture system. Good saliva production was also observed and the patient was an experienced denture wearer of some 40+yrs.
Treatment provision After consultation the treatment plan was to provide the patient with a new F/F iDenture incorporating Dr Abe’s suction technique. Starting with both Accudent and FCB impressions, jaw registration using the Gnathometer-M and try in with Phonares II teeth. This will then be processed in the Ivobase injection moulding system using Ivobase High Impact Resin, once processed lifelike characterisation will be completed with SR Nexco gingivae composite. Emphasis would be on providing premium aesthetics and function as well as incorporating Dr Abe suction impression technique.
The process Primary impressions using Accugel (fig 3) in the Accudent upper tray were taken and the lower impression (fig 4) was taken using Vival alginate in the bespoke FCB tray (fig 5) as designed by Dr Abe. An accurate Centric tray was used with Virtual putty to record a preliminary jaw relationship and OVD (fig 6), these were cast and mounted on a Stratos 200 Articulator in order that the Gnathometer M custom trays could be designed (fig 7). Using these trays our secondary impressions were taken using Virtual PVS impression material, the border impression was taken using heavy body regular set on the upper and lower with monophase reg set around the retremolar pads. Dr Abe’s 5 movements were then carried out, the second part of the impressions used Virtual light body reg set. The combination of these two materials and the 5 Dr Abe movements give a fully functional, accurate and easy impression. Suction was checked on both impressions and was present. If this is not achieved the impression must be retaken as this is a direct 1-1 of your fitting surface, using the Ivobase means that my denture bases are as true to the impression as is possible so no suction now means no suction at the fit appointment.
Fig 9
A detailed natural gingival wax up was created
Fig 10
Finished wax tray in with aesthetic and functional contouring
With the secondary impressions taken, the OVD was determined by the use of phonetics getting the patient to count from 55-60 and 50-40, if sufficient FWS (around 3mm) is observed without any contact then the FWS is deemed ideal. A mould of tooth which was similar in size to the existing denture was preferred by the patient albeit in a lighter shade. Back to the laboratory for the teeth to be set up according to the BPS principles (fig 8) using set up templates to achieve perfect Wilson, Spe and Monson curves. Once the teeth were set up a natural wax up was achieved to assess tooth length and tissue support
Fig 11
Dentures processed in high impact using Ivobase injection moulding
(fig 9/10), the try in was a success needing nothing altered, speech and stability proved to be superb and the decision was made to continue to finish in the Ivobase injection system (fig 11)
Fitting Upon fitting, the suction of both upper and lower was checked, as well as the occlusion was to ensure smooth and balanced excursions were present with no displacement due to occlusal interferences, none were observed.
Finished iDenture and patient’s new smile
Conclusion Finally the BTC point was checked by applying Virtual light body around the Retromolar pad area and asking the patient to carry out two movements, swallow and tongue pressure. The patient was delighted with all aspects of the prosthetics, he commented on the strong suction of the lower in particular giving him extreme confidence and the aesthetics now felt like real teeth which gave him the ability to smile confidently knowing people were looking at his smile and without the fear of people looking at his ‘dentures’. Our new iDenture is the next evolution of the BPS system and was designed in-house with the intention of bringing together premium products and enhancing the BPS by incorporating our latest developments in removable prosthetics. Namely the Dr Abe technique to achieve mandibular suction, the new Phonares II teeth for outstanding aesthetics and function, the Ivobase for unparalleled accuracy and convenience in processing and SR Nexco to create lifelike aesthetics. We have already run our first course on all stages of the process, receiving the highest feedback possible from CDT’s, Dentists and Dental Technicians all commenting on how it will change their approach after attending. There are a wide range of courses available on the www.dental-education.co.uk website for this new process which include, live patient courses as well as specific courses for dentist and technicians. For more information please call our ICDE team on 0116 284 7326.
An IvoBase Training An IvoBase Training Day SR Nexco) Day with SR (with Nexco
with Carl Fenwi
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with Carl Fenwick This is a hands-on course in which you will be taken through all the stages involved in processing a complete denture in
Ivobase injection moulding.
Objectives:
You will flask, inject and de-flask one denture which you can take home to polish and use as a demonstration piece for your laboratory or practice. While we process the dentures you will then have a chance to get hands • Understand the investing VENUE on with course our gumincharacterisation composite system SR Nexco. Thestages uses will be explained This is a hands-on which you will be taken through all the involved in and process. ICDE UK, you will denture be showninhow to apply this to acrylic to dramatically the pink aesthetics processing athen complete Ivobase injection moulding. You willimprove flask, inject and deCompass Building, of you prosthetic work. flask one denture which you can take home to polish and use as a demonstration piece for • Learn how to appropriately Feldspar Close, Enderby, your laboratory or practice. place the aeration channels. Objectives: Leicester, LE19 4SD While we process the dentures you will then have a chance to get hands on with our gum DATE: 12th Mar • Understand the investing process • Clarify the 2015 correct usage of characterisation composite system SR Nexco. The uses will be a flask and- 5.00pm using the locking TIME: 9.30am • then Learn how to appropriately place the aeration channels explained and you will be shown how to apply this to clasps. Y acrylic to dramatically improve the pink aesthetics of you ONL • Clarify the correct usage of a flask and using the DATE: 11th June 2015 prosthetic work. locking clasps • Understand how to use the
DATE:
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Understand how to use the specific tools in 12th conjunction with the IvoBase System March 2015 // 11th June 2015
10th Sept 2015 // 10th Dec 2015 •
Define the differences between the materials used
•
Inject a polymerise your own flasks
VENUE: Ivoclar Vivadent, Compass Building • Understand how to create detailed Feldspar Close, Leicester, LE19 4SD
+vat 5 9 £2 RS 7 HOFIUABLE VERI D CP
characterised gingiva
TIME: 9.30am - 5.00pm
specific tools in conjunction IvoBase DATE: with 10ththe Sept 2015 System.
TIME: 9.30am - 5.00pm •
Define the differences between the materials used th
DATE: 10 Dec 2015 TIME: 9.30am - 5.00pm
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With over 26 years experience in Dental Technology and having initially started out as a Karen: 0116of 284 7326 Dental Technician, Carl brings toCall the company a wealth valuable experience. In 2009, HERE TO he began an advanced 2-year CDT training course programme with KSS Deanery (Health Visit: www.dental-education.co.uk Education Kent, Surrey, Sussex).
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Qualifying in 2011, he soon opened his own CDT Denture Centre, Consett Denture Centre, which he still manages today. Carl also progressed into becoming a member of the teaching team at KSS Deanery and continues to be involved in the training of new Clinical Dental Technicians. Carl Fenwick, Consett Denture Centre, 42 Medomsley Road, Consett, County Durham, DH8 5HA e. carl.fenwick@ivoclarvivadent.com
Products mentioned
Phonares II
IvoBase High Impact
Ivobase Injector
SR Nexco Pastes
For more information on products used on this course please speak to your local Product Specialist.