Spectrum Denturism

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June 2012 • Vol. 6, No. 3

In This Issue Implant supported bar work Genios: Spanning the range from combination restorations to implant restorations Occlusion and Attachments: The Underlying Scheme for Successful Overdentures The Latch Bar System - Part 1 Product Review Continuing Education Tests

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S P E C T R U M Publisher: Ettore Palmeri, MBA, AGDM, B.Ed., BA Palmeri Publishing Inc. Toronto, Canada ettore@palmeripublishing.com

Associate Publisher: Peter Pontsa, RDT

Editor: Carlo Zanon, DD, LD, FCAD – zczczc@cogeco.ca

Associate Editor: Mike Vakalis, CDT, DD

Office Administrators: Sanaz Moori Bakhtiari, B.SC – sanaz@palmeripublishing.com Tina Ellis – accounting@palmeripublishing.com Bahar Palmeri, B.SC – bahar@palmeripublishing.com Adriana Palmeri – adriana@palmeripublishing.com

Sales/Marketing: Mark Behar Bannelier – mark@palmeripublishing.com Gino Palmeri – gino@palmeripublishing.com

Editorial Director: Frank Palmeri, H.BA, M.Ed – frank@palmeripublishing.com

Production Manager: Samira Sedigh, Design Dip. – production@palmeripublishing.com

Design & Layout: Tim Faller – tim@palmeripublishing.com Sophie Faller Lindsay Hermsen, B.Des.Hons. – lindsay@palmeripublishing.com

Internet Marketing Director: Ambianz Inc., Rashid Qadri

Event Coordinator:

In this issue

Vol. 6 No. 3 – June 2012

Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Carlo Zanon, DD, LD, FCAD

Implant supported bar work Hans-Peter Vögtle, MDT

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Genios: Spanning the range from combination restorations to implant restorations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Hans-Peter Vögtle, MDT

Occlusion and Attachments: The Underlying Scheme for Successful Overdentures . . . . . . . . . . . . . . . . . . . . 24 Dennis Urban, CDT

The Latch Bar System - Part 1 DT Axel Mühlhäuser

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Continuing Education Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Advisors Connect the Dots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Dale Tucci

People and Products

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Advisory Board

Roya Safari, B.SC – events@palmeripublishing.com

Canadian Office: 35-145 Royal Crest Court, Markham, ON L3R 9Z4 Tel: 905-489-1970, Fax: 905-489-1971 Email: ettore@palmeripublishing.com

Website: www.palmeripublishing.com

Carlo Zanon, Editor-in-Chief

Allen Aptekar, DMD, BSc

Harold Bergman, DDS, Dipl OS&A, MScD(Path), MRCD(C)

Austin Carbone, LD, DD, BSc, BEd

Vallan Charron, LD

Paul Levasseur, LD, DD

Daniel Léveillé, DD

Frank McMinniman, CDT, DD

Peter Pontsa, RDT

Shawn M. Murray, CDT, LD

Marc Northover, DBSc (Hons), DD, Dip CDT RCS (Eng)

Peter Rotsaert, DD, CDT

Joe Smith, President, Central Dental Ltd.

Mike Vakalis, CDT, DD

SPECTRUM DENTURISM is published four times a year and distributed to Denturists across North America. The journal is committed to presenting cutting edge education in order to optimize patient care.

Articles published express the viewpoints of the author(s) and do not necessarily reflect the views and opinions of the Editor and Advisory Board.

All rights reserved. The contents of this publication may not be reproduced either in part or in full without written consent of the copyright owner.

Publication Dates February, March, May, July, September, November Printed in Canada Canadian Publications Mail Product Sale Agreement 40020046

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Editorial Carlo Zanon DD, LD, FCAD

Raising the bar n a world that is connected with instant notifications and news via the internet and media, it would be ideal to set up a network that would connect, unify and set international standards for Denturists.

I

Denturism is still in its infancy in comparison to many longer standing professions. Medicine and Dentistry have had a substantially longer time to evolve and implement national standards and respective business plans to advance their goals and profession. We are still in the evolutionary stages of developing programs and standards for education and quality in comparison.

Our efforts should be constructive in determining a worldwide structure that unifies education, examination standards and continuous learning in order to strengthen what we have achieved. In order to stay strong and gain in strength, we need individuals to step forward to lead and set higher standards.

Our profession is still not recognized in most states in the United States and most countries in Europe. It would seem elementary for a profession that is recognized and has been accepted and established in many parts of the world to have the ability to practice anywhere worldwide. Individuals have sacrificed incredible amounts of time and effort and some have been jailed, in order to achieve what we have accomplished this far!

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Spectrum Denturism – Vol. 6 No. 3 – June 2012

Our efforts should be constructive in determining a worldwide structure that unifies education, examination standards and continuous learning in order to strengthen what we have achieved. In order to stay strong and gain in strength, we need individuals to step forward to lead and set higher standards. We must remain independent and unified.

This can be achieved by working together and aiding in the educational process worldwide. Europe presently has open boarders for professionals, Professionals licensed to practice in the own countries have the ability to practice in all other countries if the country is a member of the European Economic Community (EEC). In Canada we still are working towards a national accreditation that will allow freedom of movement to practice. Standardized education is the key as well as a worldwide examination standard.

Although this is an ideal thought, it is a difficult task.

Governments are presently moving towards open borders.

Let us be leaders in this movement and prepare adequately for what hopefully will be implemented and let’s take control as a group in order to benefit and lead with this change. It is time to raise the bar once again and set standards that will be admired by others. n

o hear t t n a w We u! from yo ca cogeco. @ c z c z c z

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Implant supported bar work Status and planning • • • • • •

Four Straumann-implants regular neck, 4.8 mm diameter Bar work with four milled crowns and bars Three dolder bars Matrix distal on 35 and 34 Multicon attachment Secondary parts individually produced from precious metal

In the above-mentioned planning stage, set-up and wax-up are created, copied and converted to plaster (Figs. 1 to 4). Now I am able to visualize what the reconstruction might look like.

Impression After the teeth exposure, the denturist sends us a preimpression (Figs. 5 and 6). Once the model is produced, an individual impression tray for an open implant impression

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Hans-Peter Vögtle, MDT

(Figs. 7 to 10) in the mandibula is created. It is important that the impression posts do not interfere with the functional impression to avoid a fitting inaccuracy later on. In the case of multiple implants it is advisable to interlock the impression posts in the patient’s mouth before the impression taking; it ensures a considerably higher degree of stability.

We use the individual impression supplied by the denturist to create the master model. This is done with or without the gingiva mask.

Bite-taking Back in the laboratory the next step is bite-taking (Fig. 11), which is produced with bite registration aids or impression posts so that a stable fit in the mouth is guaranteed. The denturist marks the midline and cuspidline (Fig. 12). With this information, the work is transferred to the semiadjustable articulator.

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Set-up Now we start with the actual work by choosing the proper teeth and doing a set-up of the teeth on the adjustable bite plate, which is then placed in the patient’s mouth and corrected if needed. This step is absolutely necessary to ensure proper planning and to reach the desired goal (Figs. 13 to 15).

Fig.1

Fig.3

Figure 5 — Mandibula with implants

Fig.2

Figure 6 — Impression posts on the mandibula model

Fig.4 Figures 1 to 4 — Planning model, set-up and wax-up

Figure 7 — Wax-out with wax Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Fig.8

Fig.10

Fig.9 Figures 8 to 10 — Individual impression tray from different angles

Figure 12 — Bite situation with maxilla

Figure 11 — Bite-taking

Figure 13 — Teeth set-up

Fig.14

Fig.15 Figures 14 and 15 — Mandibula set-up

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Figure 16 — Lay-out of the mandibula with silicone wall

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If the patient and denturist are pleased with the set-up and all functions work properly, a 1/1 silicone precast is prepared in the laboratory. It is used for design, bar positioning, attachment and spacing purposes (Fig. 16).

Primary construction We are ready to choose the implant elements: synOctasecondary parts 1.5 and the matching attachable gold cap for better fitting results (Figs. 17 to 20). For nonconical implant systems, we usually suggest a sealant like

Gebsil for our clients. We begin with the modellation of the bar and the milled posts.

We then place the attachments (Figs. 21 and 22) and invest the cast piece. These pieces are created in wax in twoparts or multi-parts. After the casting, the work is fitted, secured with a laser and soldered (Figs. 23 and 24).

Secondary construction Once the bar fits tension-free the structure is milled, polished (Figs. 25 to 29) and the secondary construction is modeled.

Fig.18

Fig.17 Figures 17 and 18 — Secondary parts milled in wax

Fig.19

Fig.20 Figures 19 and 20 — Adding of the attachment

Fig.21

Fig.22 Figures 21 and 22 — Attachment of the bars

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Fig.23

Fig.24 Figures 23 and 24 — Casted gold bar

Fig.26

Fig.25

Figures 25 and 26 — Lasered bar

Fig.27

Fig.28 Figures 27 and 28 — Finishing of the bar

Figure 29 — Finished bar with rider

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Figure 30 — Manufacture of the secondary part

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Figure 31 — Space verification with precast

Fig.32

The prefabricated bar matrices dolder macro are integrated tension-free and polymerized into the acrylic later on. It is important that the bar riders can be activated and deactivated freely and are not covered with acrylic. We polymerize instead of soldering; this way we eliminate the tempering of the riders.

The modellation should offer sufficient retention for the teeth and the acrylic and yet be delicate enough. We model metal occlusal surfaces over the attachment boxes due to space and stability requirements (Figs. 30 to 33).

After casting the secondary parts, (please note: a good cast result is very important) we finish the secondary structure and prepare it for the set-up (Figs. 34 and 35). The transfer is easy

Fig.33 Figures 32 and 33 — Modellation

Fig.34

Fig.35 Figures 34 and 35 — Cast result

Fig.36

Fig.37 Figures 36 and 37 — Set-up Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Figure 38 — Preparation for the finishing

Fig.40

Figure 39 — Precast with acrylic teeth

Fig.41 Figures 40 and 41 — Work unprocessed

Fig.42

Fig.43

because we work with a precast and the metal occlusal surfaces integrate well into the prosthesis. We insert a thin gold strip to our work on the lingual side, which adds a delicate touch (Fig. 36). Once more function and aesthetic are verified in the articulator (Fig. 37), followed with a complete wax-up, embedding and boiling process.

Finishing Fig.44

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Finally the work is prepared for the finishing process. The frameworks are opaquered and the structure is waxed-out in

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Fig.45

Fig.46

Figures 42 to 49— The finished work from different angles

Fig.47

Fig.48

all undercut areas (Figs. 38 and 39). It is important that a thin wax layer is applied in the small opening between the prefabricated matrix and cast piece. It ensures an easy activation and deactivation of the bar in the future. With the acrylic finishing the final stage of our work is reached. For the finishing we use the cuvette technique by Candulor. We opt for a cast acrylic by Merz Dental (Figs. 40 and 41). It flows well and has minimal shrinkage. After the acrylic work is done we attach a composite veneer on tooth 34 and 45 followed by polishing and functional tests.

The very last step is the polishing of the precious metal parts and the implant pieces, which is a timeconsuming process that has to be done very meticulously (Figs. 42 to 49).

Conclusion This type of removable prosthesis is a solid and above all durable solution and is manageable for an elderly person as well. It can be activated easily and the specific adjustment of friction, which is matched to the patient individually, is easily obtained.

With regard to price, it is a reasonable and contemporary solution compared to a fixed restoration consisting of six to eight implants. The aesthetic’s compromise compared to a fixed option is definitely acceptable mainly because we are dealing with a technique that has proven itself for years. n Acknowledgement

Fig.49

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Special thanks to MDT Volker Weber who inspired me as a highly competent course instructor and as a person.

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Genios: Spanning the range from combination restorations to implant restorations

Hans-Peter Vögtle, MDT

One tooth line instead of three: Same performance, lower inventory cost

Discussions about healthcare have a way of focusing almost exclusively on rising costs and associated problems.

Yet, experiences have shown that restorations fabricated by pros in dental laboratories at a fair price generally continue to be in great demand. Most patients will opt for restorations in the upper-medium price range when presented with different options. Treatments commonly opted for as a result include combination restorations or telescoping bridges that include the use of denture teeth. The quality and economic aspects of a restoration will therefore greatly depend on the selection of an appropriate tooth line. This article discusses aspects to be considered in the selection process and reflects the experience by the author’s medium-sized laboratory with a staff of 12.

T

he Vögtle dental laboratory has traditionally focused on combination restorations. Recently, this existing focus has been expanded to cover more and more implant restorations. Needless to say, our top priority is to offer consistently high quality in terms of function, occlusal design and aesthetics. However, the upper-medium price range of dental restorations requires an aggressive approach to cost calculation. A novel and very economical strategy employed at our laboratory concerns our use of denture teeth to finish combination restorations, telescoping bridges and barsupported suprastructures.

The Objective: One tooth line for all indications A few years ago we were still using three different tooth lines side by side. But given the time-consuming and costly inventory requirements, we decided to streamline our

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workflow by standardizing on a single tooth line. A welldeviser product was therefore needed that could be both universally applied and conveniently processed. In other words, compatibility was required both with all indications and with the personal preferences of all staff members.

This search criteria eventually led us to the Genios system (Dentsply, Canada).

A number of cases will be presented below to illustrate some of the important aspects of this decision in greater detail.

Comparative aesthetics A natural aesthetic appearance is a vital goal when restoring teeth in the anterior segment. We evaluated the aesthetic outcomes of the Genios system in comparison with other tooth lines. It turned out that interdental closures just did not get any nicer than with the Genios A (anterior) tooth line.

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Fig.1

Fig.2

Fig.4 Fig.3

Fig.5

Fig.6

Figures 1 to 5 — Situation on the cast: Nice relation between the Genios A anteriors with the mandibular ceramic bridge.

Fig.8 Fig.7

Figures 6 to 8 — Intraoral try-in: Thanks to their favourable surface structure, the Genios A Fig.8 anteriors self-adjust to the mandibular restorations, which still require treatment.

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Combination restorations: Preserving a traditional strength

Fig.9

Fig.10

Fig.11 Figures 9 to 11 — Combination restoration, standard telescopic design: The Genios tooth blends in very naturally into the overall situation with regards to both shape and size.

The lively arrangement of the layering, especially in the incisal areas, were convincing. If trimming adjustments were necessary at all, they could usually be kept to a minimum, promoting fast and economical workflows.

The competing product required placing the papillae at a higher level, such that a larger percentage of the tooth surface was covered with denture resin. The human eye will immediately notice the artificial nature of such teeth. Not so with Genios.

If desired, Genios teeth can be perfectly customized by minimal abrasive adjustments, or by the addition of resin material. For example, translucent incisal edges could be implemented in this fashion (Figures 14 to 16). Mamelons can be designed without a problem. Genios teeth also differ from competing products by retaining their surface texture even after polishing.

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We have been able to capitalize on all these Genios advantages for combination works too. Restorations of this type have been a traditional focus of our laboratory. Perfect compatibility with this application was therefore a major requirement in selecting this new tooth line.

Figures 9 and 10 illustrate a telescopic restoration. Perfect harmony of the gypsum teeth, telescope and denture teeth is evident from the sizes without any cut backs. Functionally excellent occlusal relations are almost invariably obtained in all clinical situations. Due to the translucency offered by Genios teeth, more refined shades can normally be obtained using standard layering techniques for composite resins (Figure 11) – all conductive to a swift, and hence economical, workflow.

Implant restorations: Broadening the laboratory focus Implant-supported restorations have become another focus of our laboratory. One important requirement was therefore that our denture teeth should be universally suited for implantsupported restorations. The Genios system is perfectly serviceable in this respect, for example by ensuring that the resultant papillae have nice outlines that can be visualized on the model ahead of time (Figures 1 to 5). Teeth 11 and 12 were optimized in size and position by axial and longitudinal adjustment to balance out an asymmetrical lip line. We did not have to wait for customization with veneering resin but were able to appreciate the overall harmony in appearance as early as during the wax try-in (Figures 6 to 8). Note the correct occlusal relationships with the mandibular dentition, which had been restored with a ceramic bridge.

The lower anterior segment had yet to be restored at the time.

Nevertheless, the patient expressed a desire for younger, brighter teeth. This goal could be readily achieved, given the late juvenile morphology of the Genios teeth. Unpleasant contrasts with the non-restored mandibular dentition were safely avoided by the natural surface texture of the denture teeth.

Implant restorations: Accelerating the workflow With appropriate denture teeth, more straightforward routes can be selected on the roadmap to success. Time can be saved by circumventing any lengthy wax-up and modelling procedures with verification in the articulator. The case presented here required the design of a four-unit partial denture supported by two implants (sites 11 and 21). Our initial thought was to combine a substructure with a mesostructure and a tertiary

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Fig.12

Fig.14

Fig.13

Fig.15

Figures 12 to 13 — No complex wax-up required: The set-up is directly used as the base for the first firing of a mandibular implant-supported restoration.

structure. However, on performing a simple set-up with the help of an occlusion rim, it became evident that casting a fully anatomical one-piece framework was a much better solution.

The screw abutments were placed far lingually and were eventually bonded without tension in the patient’s mouth.

A laborious wax-up was not needed in this case, thanks to the anatomical form and size of the Genios A tooth used. Instead, the set-up could be tried in directly (Figures 12 and 13).

Experience has shown that this approach will yield good results even in the hands of less experienced technicians.

Complete dentures: Convincing quality and cost-effectiveness Complete dentures – which unfortunately are not always given as much attention as other dental restorations – can also be fabricated to the standards expected in the upper-medium price range by using Genios teeth within economically reasonable limits. After all, the occlusal surface design of Genios P (posterior) teeth features an intercuspation pattern that is inherently correct for all practical purposes. A fully balanced occlusion with group function could be obtained without major effort (Figures 17 to 20).

Overall evaluation and conclusions Committing to the Genios tooth line has allowed us to reduce our denture teeth inventory by more than half, minimizing

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Fig.16 Figures 14 to 16 — Natural papillary design and beautiful interdental closures: Comparison of Genios A (teeth 21 to 23) with a competitor product (teeth 11 to 13).

inventory cost. Nevertheless, we still have a complete range of teeth for universal indications available. Even those staff technicians who initially preferred working with other teeth have quickly become familiar with the new system. In fact, they ended up reconsidering their previous option, realizing that this streamlining of laboratory routines has simplified things rather than narrowed down options.

The convenient processing of Genios teeth has certainly contributed greatly to this positive feeling. Also, we have noticed that long-term bond with the denture resin is guaranteed even without the use of any specific retention aids or primers. Genios teeth are not prone to fracture, and their overall design ensures that natural colour effects will be present at all times, even in the sporadic cases where major subtractive adjustments are required.

The Genios posterior moulds with a reduced basal segment allow even faster and more efficient workflows in situations characterized by limited space. Beyond improving the cost-effectiveness of our workflows, the tooth line is continuously being improved further, yielding products that really make our daily laboratory work more efficient.

Personally, I like these Genios teeth better than any of the other tooth lines we have used. Their occlusal surface design has

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Fig.17

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Fig.18

Fig.19

Fig.20 Figures 17 to 20 — Even complete dentures can be fabricated in a highly economical manner thanks to the anatomic shape of the Genios teeth.

suited me very well. Their translucency including the mamelon structure and multiple layering correspond with the desire of many patients for having relatively brighter teeth with significantly enhanced aesthetics. Genios teeth can, if desired, be perfectly veneered and offer a final appearance similar to ceramic teeth. n

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Occlusion and Attachments: The Underlying Scheme for Successful Overdentures Dennis Urban, CDT n the ever-changing world of dental technology, the one segment that seems to be a mainstay in growth consistency is removables. Whether it is full dentures, partials, implant overdentures, or attachment overdentures, the potential for continued laboratory business growth in these areas is substantial. While growth opportunity is a major factor, the success factor for removable cases included in the areas mentioned includes many variables.

We are faced today with the demand of creating a denture that by far surpasses the esthetics and function of dentures that were made twenty years ago. Denture wearers want to look as if aesthetic natural dentition is taking up the oral cavity as opposed to the old mediocre look of denture teeth and acrylic or as I have heard it called “The Pink Smoothie”.

The good news is now the patient can get what he or she wants when it comes to function and high-end aesthetics.

Successful high-end cosmetic dentures all start with good communication with the denturist and the patient and then it is combined with knowledge, technical expertise, and quality materials. But all of the above mentioned cannot be

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Figure 1 — Equator attachments for implants

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Figure 2 — Equator attachments for castable sphere

Spectrum Denturism – Vol. 6 No. 3 – June 2012

achieved without the appropriate occlusal scheme and the right attachment system.

Also, the following points listed are a must for a successful case: • Case planning • Accurate impressions • Correctly contoured bite rims and accurate bite registrations • A semi-adjustable or fully-adjustable articulator to mimic jaw function • Precise denture processing Let’s start with case planning. Keep in mind that the most important objective here is patient satisfaction.

Without patient satisfaction the denturist loses business and the patient suffers with an inadequate restoration.

That is why it is so impor tant to have quality communication between the denturist, the patient, and the laboratory technician. When it comes to case planning for

Figure 3 — Low profile Equator vs. Locator

Figure 4 — Equator profile

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Figure 5 — After implants have been placed

Figure 6 — Equator caps placed on implants

Figure 7 — Prepared denture for processing attachments

Figure 8 — Finished denture with equator attachments

implant cases, the ideal situation is to have the Oral Surgeon and if possible the Periodontist involved in the communication loop.

Unfortunately, many dental schools still do not train in depth about implant-supported overdentures. Numerous denturists still rely on condensed courses presented by implant

companies. This is why knowledge, material science, and the expertise of the denturist are so important.

A few of the factors for prescribing an implant overdenture for a patient are inadequate bone support, loss of alveolar ridge, and instability with fit and function on a tissue supported denture base. After a radiograph is done and the evaluation of

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Figure 9 — Castable spheres with housings for soldering or curing in acrylic

bone quantity is determined, then the treatment for the patient is ready to begin. Let’s utilize an attachment system that will allow us size options, retention choice, and quality. An excellent attachment of choice is Rhein 83. Rhein 83 offers a complete system of prefabricated components for planning and fabricating a successful and personalized case. The new OT Equator offers a low profile and is compatible with all implant brands. In addition, the Equator offers optional castable components for the indirect system. (Figs. 1-8) The low profile feature enables the technician to utilize more space for an enhanced esthetic denture set-up. The additional space also provides more room for denture acrylic, which will in turn strengthen the denture.

When planning a case for a simple overdenture with single spheres, the OT cap is the perfect choice and they are available in 2.5 mm and 1.8mm (Normal and Micro). The caps also come in a variety of retentive values (Figs. 9, 10).

In an overdenture, the use of a sphere with a leveled head in conjunction with an elastic cap results in case stability with a minimum amount of trauma. Keep in mind that an overdenture made entirely from resin will be exposed to possible fracture. I recommend using a castable reinforcement bar called the OT Box. Any type of alloy can be used for the casting (Figs. 11-14).

Let’s assume that you are ready to go to the denture tooth set

up stage and all the prerequisites for a successful case have been met up until this point. You have received an accurate bite registration and are ready to proceed with the next step. The articulation system that I find the most user friendly and the most accurate is the ARTEX System by Jensen. A separate mounting articulator can be used to keep dust and debris from getting into places on the main Artex units used throughout the lab. The mounting units are calibrated and models can be accurately transferred to the working articulator.

The semi-adjustable Artex CR has an adjustable condylar inclination of -20˚and +60˚, a radius of 19mm, and adjustable Bennett angle from 0 - 30˚ including side shift functions and protrusion functions. It is designed to mimic realistic jaw movement and that is precisely what you want when creating full mouth reconstruction and overdentures.

After the case is mounted and you have determined the mould of the anteriors, the most important part of the denture set up is going to come into play and that is the occlusal scheme. The scheme that works the best with implant

Figure 11 — OT Box placed on relieved model

Figure 12 — Sprued OT Box

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Figure 10 — Various retentive values

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Figure 13 — Finished OT Box casting

Figure 14 — Finished OT Box processed into denture

overdentures is lingualized occlusion. What is lingualized occlusion? It is when the lingual cusps of the upper posterior teeth come in contact with the central fossa of the lower posteriors. Why is lingualized occlusion so important? Because the objective is to get the patient in the most ideal occlusal function while relieving the off axis stress on the alveolar and on an implant or attachment. The minimizing of lateral forces on implants and attachments lead to a denture with functional stability. All occlusal forces are directed to the crest of the ridge.

Years ago a higher degree of tooth was used on the upper posteriors such as 20˚, while a lesser degree tooth was used on the lower such as 10˚ or 0˚. The object was to still have the lingual cusp of the upper occlude with the central fossa of the lower. Today tooth companies sell specially designed lingualized teeth. Some are effective and some are not.

Lingoform teeth by Vita satisfy both esthetics and function when utilizing lingualized occlusion. They are extremely easy

to set and come in 3D shades (Figs. 15, 16, 17). Also keep in mind that the patient is spending a large amount of money on an overdenture case. We want to use a tooth that will wear like natural dentition and the wear factor on Vita teeth is phenomenal. They wear almost like natural dentition.

If all the steps required for a successful overdenture case have been followed correctly and the denturist and patient are satisfied with the overdenture try-in, then we are ready to process and finish the case. Be sure to use a high impact acrylic with an accurate processing method such as the injection method of packing. To complete this high-end aesthetic overdenture, a denture base stain may be added for natural effects.

Obviously, there are some other factors that come into play for a successful overdenture case. We have covered some of the most important ones. Keep in mind; the patient is the one we have to please. Utilizing the best materials available, applying our expertise, and proper communication will inevitably yield to a successful case. n

Fig.16

Fig.15

Fig.17

Figures 15, 16 and 17 — When setting Lingoform, make sure that the lower teeth are set first and that you maintain a Curve of Spee, but not a Curve of Wilson

About the author

Dennis Urban, CDT has worked in the dental technology field for 35 years. He owned and operated a full service lab on Long Island, New York for many years. He has lectured worldwide since 1985 and his technical articles have been published in many dental publications in the U.S. and Canada. Dennis Urban has been Vice President of both the Long Island Dental Laboratory Association and the Dental Laboratory Association of the State of New York. He was a Cal Lab board member and a delegate for the NADL. He was the recipient of the 2007 NADL Excellence in Education award. Dennis has been a Technical and Sales Director for various dental manufacturers and is now the Technical Consultant and Removable Manager for Drake Precision Dental Laboratory in Charlotte, NC.

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The Latch Bar System – Part 1 DT Axel Mühlhäuser

The use of latch bars in restorations has declined steadily in the past years. The cost factor plays an important role, no doubt. In addition, the latch bar approach requires a bar or telescope design, which by itself provides enough stability for the prosthesis and considering the price of alloy these days, creates substantial costs for the patient. Two additional individual turn-type, pivoting or push latches are too costly for this kind of project. In the following article Axel Mühlhäuser will demonstrate when it is advisable to integrate a latch bar system and how, with a ready-made latch bar, the costs are manageable without compromising function.

Patient: 65 years with an old, insufficient telescope restoration in the maxilla and a clasp prosthesis in the mandibula (Figure 1). The remaining teeth were severely damaged and were not worth preserving (Figure 2). Full dentures seemed to be the only option in this case. Since the patient did not like the idea

of a covered palatal region we agreed on a restoration with implants. We informed the patient that a fixed restoration was not possible in this particular case, which she accepted but she strongly insisted on a restoration that would not purely rely on friction bonding, fearing instability and possible loosening of the restoration. Therefore our only choice was the latch bar technique. In order to keep the costs down yet create a design with high-gold content, we inserted

Figure 1 — The initial situation

Figure 2 — The remaining teeth are not worth preserving

Anamnesis and design

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Figure 7 — The impression posts have been placed

Figure 3 — The model is waxedout for the individual impression tray

Figure 4 — Wax wires mark the openings

Figure 5 — The impression tray made of C-Plast in the maxilla for the open impression

Figure 6 — In the mandibula the base of the tray handle has been widely recessed

Fig.8

Fig.9 Figures 8 and 9 — Open impression in the maxilla and mandibula

bar stubs instead of creating a full bar structure. The use of ready-made latch bars enabled us to stay even more within the estimated budget. We opted for the Si-tec latch system with a continuous inner and external stop activation mechanism plus an exchangeable retention element. In terms of the aesthetic aspect the patient had specific requests: A light and pleasant colour, more visible anterior teeth, stronger lip support and an even idealized set-up.

impression tray using C-Plast material for the maxilla and the mandibula (Figure 6). Since it might be necessary to either enlarge or reposition the openings later on, the tray handle should not be too close to the openings or, as seen in the mandibula, needs to be recessed accordingly at the base.

Once the impression posts are inserted (Figure 7) and fit, positioning and opening size have all been verified by the denturist, we take the open impression.

Model and bite

Model fabrication

We are and have always been supporters of the open impression technique. Based on the anatomic impression with healing caps, we extend a thick wax wire over the planned impression tray base axial to the healing cap plateau. On the model we wax-out the area around the implants for the impression posts (Figures 3 and 4) we then create the

The impression does not show signs of imperfections or distortions in the maxilla (Figure 8) or the mandibula (Figure 9), the impression posts are firmly fixed. Before we insert the laboratory analogs, the implant position needs to be meticulously checked for possible imperfections or impurities.

During the placement of the laboratory analogs it is important Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Fig.11

Fig.10

Figures 10 and 11 — The model analogs are in place

Fig.12

Fig.13 Figures 12 and 13 — Master casts with gingival mask

Fig.14

Fig.15 Figures 14 and 15 — For a more stable fixation temporary abutments are incorporated

that the locating screw is tightened only by hand to prevent over-tightening (Figures 10 and 11). Once the gingival mask material has been placed and hardened, the mesial and distal seals are cut in a right angle to ensure a better fit on the model. We then proceed with the fabrication of the model with split cast.

The atrophy between 11/14 and 21/24 is quite noticeable on the completed master model of the maxilla (Figure 12). We do not detect any problem areas in the mandibula at first glance (Figure 13). For more stability in the mouth we integrate a temporary abutment into the C-Plast bite base (Figures 14 and 15). The remaining implant areas need to be generously waxed-out analogous to the healing caps. Idealized wax walls that predetermine the tooth arch as well as the bite height complete the bite plates (Figure 16).

Bite-taking For the bite-taking, reference lines like smile line and midline are very helpful and essential for the further workflow.

To facilitate the denturist’s work with the facebow we load a bite fork with Platinum 85 material and take an impression of the maxilla. Once it has hardened we cut back the impression.

The denturist has the option to reline this base if necessary. With the transfer stand we adjust the relation of the maxilla to the cranium (Figure 18). Afterwards with the help of the bite plate the counterbite is articulated (Figure 19).

Set-up Figure 16 — Idealized wax walls facilitate bite registration

Figure 17 — The mandatory marking of the reference lines

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Since we want to gain important information during the first aesthetic try-in regarding aesthetics and phonetics yet be able to easily verify the occlusion, we do the set-up just up to tooth number four (Figure 20). The teeth need to be adjusted far towards the labial side. According to the requirements a light, neat colour is selected and misalignment of the teeth is kept to a minimum (Figure 21). Contrary to the initial situation the anterior teeth have to be longer and more

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dominant. To check the bite we use an acrylic wall for the posterior region of the maxilla (Figure 22) and in the mandibula simply a wax wall with bite impressions. The try-in reveals insignificant bite adjustments and from an aesthetic point of view the teeth number three need to be reduced slightly and both teeth number two need to be shortened distally to achieve a more pleasant smile line. Since we do not want to go beyond the scope of this work description, we are summing further processes up as follows: completing of the posterior set-up, modeling and a final try-in.

Individual abutments

matrix made of Platinum material (by Zhermack, Marl) from the palatal/lingual and buccal/labial side and simultaneously a two-part matrix for the actual fabrication. The cast-on abutments are inserted and the direction of insertion is adjusted. In order to eliminate unnecessary milling and avoid wasting high-gold material we premill with a H364RGE cutter (by Gebr. Brasseler. Lemgo) (Figure 23). Analogous to the working matrices made of Platinum material the plastic tubes are shortened to the desired length in the mandibula (Figure 24) and the maxilla (Figure 25). We solve any space issue with the creation of chamfers and complete the primary form with milling wax followed by the premilling of the common direction of insertion.

If no additional adjustments are needed during the set-up we start the fabrication of the individual abutments. As a preliminary step we need to ensure that we have all the required information for the different applications. For the fabrication of the abutments we start by creating a working

We then use the paralleling mandrel from the latch bar kit (Sitec, Gevelsberg) to fix the bar stub with Pattern material to the

Figure 18 — The relation of the maxilla to the cranium is adjusted in the articulator

Figure 19 — The mandibula has been adjusted

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Bar stubs

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Figure 20 — First cosmetic set-up with wax walls in the posterior region of the mandibula

Fig.27

Figure 21 — As desired: neat without major misalignments

Figure 22 — Fixed with screws and acrylic walls in the maxilla

Figure 23 — Premilling with the H364RGE cutter

Figure 24 — A matrix made of Platinum putty material creates needed space lingually…

Figure 25 — …and buccally

Figure 26 — Fixation of the bar stub with a paralleling mandrel

Fig.28 Figures 27 and 28 — Verification of the latch bar position with the Platinum-matrix Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Figure 29 — The correct positioning does not always coincide with the jaw ridge center of the mandibula…

Fig.31

Figure 30 — …or of the maxilla

Fig.32 Figures 31 and 32 — The bar stubs are completed with wax from the basal side

Figure 33 — Sprued in the “open casting ring”

appropriate spot (Figure 26). Since this is an important step we will describe it in more details subsequently.

The latch top has to integrate harmoniously into the prosthesis after completion and it should neither be in the area of the prosthesis teeth nor too close to the rim of the prosthesis.

The base angle may deviate slightly from the jaw line (up to a maximum of 15˚), which means it should be lowered minimally towards the distal direction to facilitate the opening from the mesial side for the patient and to allow smooth gliding of the tongue. We are also aiming for a positioning in the interdental spaces where possible. With the help of the working matrices with integrated abutments, the final position is determined with

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reference to the expansion of the prosthesis and the alignment of the teeth in the maxilla (Figure 27) and the mandibula (Figure 28). Markings on the model facilitate the correct positioning additionally (Figure 29).

Should insufficient space be an issue, the bar stubs are reducible or may be aligned (Figure 30). From the buccal view it is evident that the bar stubs do not necessarily need to be positioned in the center of the jaw ridge. In fact a repositioning towards the oral direction or, in this case towards the buccal direction, is possible at any time (Figure 31). The bar stub is also extendable basally with wax, should additional support be desired or needed (Figure 32). Note: Of course the bar stub is extendable so it can also be used as a bar. In the final step the edges are thoroughly checked under the stereo microscope for possible imperfections. There should be no signs of overcontouring towards the implant or gaps. Finally the components are thoroughly cleaned to remove excess wax and greasy residue and then sprued (Figure 33). The screw channel should always be placed almost vertically in the muffle to avoid bubble formation and subsequently casting beads. The actual holding time in the furnace has to be extended by at least 15 to 30 minutes, depending on the number of individual abutments, and the final temperature needs to be raised by 50 to 70 degrees to ensure a successful initial casting. The divesting is done with

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Figure 34 — A perfect cast with Biolight

Figure 35 — Finishing with polishing aid and blue silicone polisher

polishing beads and minimal pressure to prevent damage to the implant. This attention to detail and meticulous approach promises a perfect cast (Figure 34) using the high-gold alloy Biolight (by Argen, Düsseldorf). The rich yellow golden colour and surface quality speak for themselves.

Casting and working-up

Figure 36 — The basal regions are finished and polished

Figure 37— Rough premilling with a H364RXE cutter

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After cutting off we eliminate possible imperfections or casting beads and work on the edges. In order to prevent damage to the implant we always use a polishing aid. The blue polishing wheel enables us to quickly and efficiently create a low gloss shine in the subgingival or basal areas (Figure 35). The high gloss polishing is done with brushes, polishing paste and for the finish with a buffing wheel – again only with a polishing aid. The mirror image displays an all over neat result (Figure 36) and future milling work will be almost eliminated. The rough milling is performed with the H364RXE cutter (Figure 37) and it is important that the gingival mask is not touched during the process. The spacing between implant regio 24 and 25 is a reason for concern. We use cutters from the H364RGE series at approximately 12,000 rpm for the precision milling (Figure 38) and at approximately 2,000 rpm for smoothing until we achieve

Figure 38 — Precision-milling with a H364RGE cutter

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Figure 39 — A perfect finish on the bar stubs due to the wax-up from the basal side

Figure 40 — From the lingual view the shifting of the bar stubs towards the buccal direction is clearly visible

Figure 41— Limited space in the region of abutments 36 and 46 from the lingual side

Figure 42 — Insufficient spacing between abutment and bar stub

Figure 43 — Also in the maxilla the bar stubs shift towards the buccal direction

Figure 44 — The shoulder is shaped according to the soft tissue line

a satin finish. Finally the occlusal parts need to be worked-up and polished, during which time a constant verification of the spacing with the matrices is essential. The aim is to have enough space for the actual telescopic coping as well as the non-ferrous secondary structure. After a thorough cleaning and steaming-off, the abutments are placed on the model.

In the mandibula from the buccal side at implant regio 43 the neat finish is noticeable, which we created by doing a waxup basally on the bar stub (Figure 39). From the lingual side the shift of the bar stubs towards the buccal direction is apparent (Figure 40). From the occlusal, lingual side the insufficient spacing at implant regio 36 and especially at regio 46 is evident (Figure 41). In the maxilla from the buccal side the limited space between implant regio 24 and the bar stub is clearly noticeable (Figure 42). From the palatal side the shift of

the bar stubs towards the buccal direction is again quite visible (Figure 43). From the occlusal side the beautiful shoulder form of the telescope crowns is apparent (Figure 44).

Telescopic coping and latch bar system The latch bar set includes two kinds of spacers for various techniques and fabrication methods: Spacer D (short) for the doubling method, spacer F (long) for the lifting technique.

Detailed and user-friendly instructions are included in the set.

In this particular case we use the lifting technique analogous to the telescope method. For this, spacer F is fully inserted into the corresponding hole of the bar stub and fixed with a Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Figure 45 — The spacer is attached with Pattern resin

Figure 47 — Reduced to the minimum thickness

Fig.48

Figure 46 — The remaining surface areas are covered

small amount of thick Pattern material (Figure 45). To begin with, the screw channels need to be closed completely with wax followed by the piece by piece completion with Pattern material and over extending a little around the spacer (Figure 46). Once the material has hardened, we proceed with the reducing to the minimal thickness and removing the spacer with a rotary motion (Figure 47). Minor Pattern imperfections between spacer and bar stub can be removed at this point.

After the placing of the abutments and the Pattern caps onto the master model we attach a seal in the mandibula (Figure 48) and in the maxilla (Figure 49). It supplies not only

Fig.49 Figures 48 and 49 — Circular seals are attached

Figure 50 — Perfect Biolight outer surfaces

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Figure 51 — Perfect on the inside as well

Figure 52 — The remaining sprued abutments

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Figure 53 — A clean cast with an impeccable surface

Figure 54 — The fitting is no problem even without any rework

Figure 55 — Inner surface of the latch system with bar stub

Figure 56— After finishing and polishing of the basal parts the transitions are barely visible

Figure 57 — The circular seals are shortened in a right angle…

extra stability but also a neatly defined transition from acrylic to gold. The open ring cast displays a perfect result already after divesting due to the Biolight alloy (Figure 50). The elements are also without any defects, casting beads or casting lugs (Figure 51). Elaborate and time-consuming fitting work later on will not be necessary with such a casting result.

Simultaneously the remaining telescopic crowns are fabricated and sprued (Figure 52). Here too we achieved a perfect casting result of impeccable quality and appearance (Figure 53).

With this kind of approach practically all major fitting work is eliminated, the marginal seal is perfect without elaborate rework (Figure 54) and the same applies to the inner

Figure 58 — …contact surfaces have to be avoided

surface of the latch bar system (Figure 55). During the fitting with latch bars it is important to avoid friction yet a slight suction fit is acceptable. Now the basal parts are ready to be worked-up and polished. These areas should always be slightly hollowed out to prevent pressure points in the mouth. The end result with inserted abutments after polishing speaks for itself, even in the bar stub area no significant gap shows (Figure 56). Finally the circumferential telescopic seals are reduced to the required width making sure that they have a right-angled finish. We clean the inner copings and the abutments and position them in the mandibula (Figure 57) and the maxilla (Figure 58). n Spectrum Denturism – Vol. 6 No. 3 – June 2012

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S P E C T R U M

Continuing Education Test for Spectrum Denturism Vol.6 No.3

Each clinical article in Spectrum Denturism is part of a continuing education series.

The answers to the questions can be found within the body of the article.

Circle the correct answers to the questions below. Then simply complete the form and submit it to Palmeri Publishing Inc. You will receive your corrected test which you can save for your Continuing Education Records.

Questions for:

Questions for:

Implant supported bar work — Part I Hans-Peter Vögtle, MDT

Genios: Spanning the range from combination restorations to implant restorations Hans-Peter Vögtle

1. During the finishing stage...

A: the frameworks are opaquered.

B: the structure is waxed out in all undercut areas.

C: a thin wax layer is applied between the prefabricated matrix and cast piece.

D: all of the above 2. To finish why does the author opt for a cast acrylic by Merz Dental?

A: it is of high quality yet economical B: it is extremely durable.

C: it flows well and has minimal shrinkage.

D: though it does not flow well it has minimal shrinkage.

3. When is a 1/1 silicone precast prepared?

A: After the patient and denturist are pleased with the set-up.

B: After all functions work properly.

C: A and B D: none of the above 4. The 1/1 silicone precast is used by the denturist...

A: for design.

B: for bar positioning.

C: for attachment and spacing purposes.

D: All of the above 5. Why are bite registration aids or impression posts used?

A: To guarantee a stable fit in the mouth.

B: To assist with the modellation of the bar.

C: To facilitate the activation and deactivation of the bar.

D: none of the above.

1. In a standard telescopic design, the Genios tooth blends in very naturally into the overall situation with regards to...

A: shape B: texture and shape C: size and texture D: shape and size 2. Genios teeth can be perfectly customized...

A: by minimal abrasive adjustments B: by the addition of resin material C: A and B D: none of the above 3. Genios teeth differ from competing products because...

A: they can only be used in particular restorations B: they retain their surface texture even after polishing C: they cannot be perfectly veneered D: of their poor compatibility with other applications 4. Which of these statements is true?

A: Genios teeth are not prone to fracture B: Genios teeth look artificial in nature C: need wax-ups D: can be very costly 5. In this particular lab it is felt that...

A: Genios has minimized inventory cost B: Genios has simplified things for staff technicians C: Genios teeth are better than any of the other tooth lines they have used D: all of the above

Once you have completed the questionnaire, fill out the information below. You can photocopy this form. Then simply complete the form and submit to Spectrum Denturism by mail to 35-145 Royal Crest Court, Markham, ON L3R 9Z4 or by fax to 905-489-1971. It’s that easy!

Subscriber Name: ________________________________________ Phone: _________________________ Fax: _________________________ Address: ___________________________________________________________________________________________________________ Email: ___________________________________ CDT or RDT #: _______________________ Signature: _______________________________

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SDen_V6N3_JUN12_Spectrum 6/18/2012 11:25 AM Page 43

S P E C T R U M

Continuing Education Test for Spectrum Denturism Vol.6 No.3

Each clinical article in Spectrum Denturism is part of a continuing education series.

The answers to the questions can be found within the body of the article.

Circle the correct answers to the questions below. Then simply complete the form and submit it to Palmeri Publishing Inc. You will receive your corrected test which you can save for your Continuing Education Records.

Questions for:

Questions for:

Occlusion and Attachments The Underlying Scheme for Successful Overdentures Dennis Urban, CDT

The Latch Bar System — Part I DT Axel Mühlhäuser

1. The field of Dentistry that has seen consistent growth over the years is: A: Fixed B: Orthodontics C: Perio D: Removables E: None of the above 2. Factors used in deciding as to recommend an implant retained denture are: A: Inadequate bone support B: Loss of alveolar ridge C: Instability D: Poor Fit E: All of the above are true 3. Equator abutments are smaller then Locator abutments: A: True B: False 4. The author recommends an “OT BOX” which is: A: A method of placing the Equator abutments B: A method of balancing the pressure over an implant C: A technique used to add retention when cementing the Equator retentive caps to the denture D: A technique of pouring the final impression E: A castable reinforcement bar 5. 5. According to the author the posterior teeth that work best with implant overdentures are: A: Zero degree Rational posterior teeth B: Lingualized occlusion C: Twenty degree semi-anatomical teeth D: Thirty degree fully-anatomical teeth E: Does not matter providing that balancing and working contacts are incorporated into the set up

1. Latch bar designs have steadily declined over the past years due to: A: Clinicians not being trained in this technique B: Degree of difficulty in impression taking C: Lack of laboratories qualified to produce them D: Costs involved in producing them E: Poor patient acceptance of the appliance 2. Once the final impression is taken the laboratory analogs are: A: Placed in position and tightened by hand to ensure proper seating B: Placed in position and tightened using the appropriate screw driver to ensure proper seating C: Used only if necessary as the retentive clips can be cold cured in the denture at insertion D: Not needed in this technique E: Placed in position and tightened using a torque wrench to ensure proper seating 3. During the first aesthetic try in the: A: Anterior and posterior teeth are set and waxed up B: Teeth are only set to the fourth (4) tooth in each quadrant C: Posterior sections of the maxillary & mandibular bases are wax only D: Anterior teeth are not positioned E: None of the above are true 4. The bar studs are: A: Always positioned on the buccal side B: Always positioned on the lingual side C: Positioned on buccal or lingual side as position doesn’t matter D: Always positioned depending on the position of the anterior teeth E: Optional in this case design 5. The telescopic copings and latch bar system are constructed using: A: Titanium B: Chromium C: Titanium and gold D: Gold E: Palladium

Once you have completed the questionnaire, fill out the information below. You can photocopy this form. Then simply complete the form and submit to Spectrum Denturism by mail to 35-145 Royal Crest Court, Markham, ON L3R 9Z4 or by fax to 905-489-1971. It’s that easy!

Subscriber Name: ________________________________________ Phone: _________________________ Fax: _________________________ Address: ___________________________________________________________________________________________________________ Email: ___________________________________ CDT or RDT #: _______________________ Signature: _______________________________

Spectrum Denturism – Vol. 6 No. 3 – June 2012

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Advisors Connect the Dots Dale Tucci ore often than I can tell you, denturists share with me their frustration and confusion over guidance rendered by their trusted advisors. Of course each advisor, be it lawyers, accountants, wealth planners, bankers or consultants is acting in the best interest of their client, attempting to offer valuable input. The frustration and confusion comes when the denturist is left on their own struggling to translate the information and connect it to their business plan.

I’ve determined that there are two classifications of advisors; disconnected and like-minded each with their own set of characteristics and tendencies. Although they are experts in their own field, disconnected advisors automatically increase the denturist’s stress level. What ensues is an increase in time spent gathering and processing information in relationship to the business and unnecessary confusion for the denturist. If the denturist then attempts to link the advisors further costs are likely, as each advisor attempts to educate the other as the denturist seeks clarification. This scenario virtually guarantees that time, energy and finances will be stretched.

Like-minded advisors are quickly identified in the onset of the business relationship. They advise clients with a common approach, speaking the same language and clearly communicating, thus reducing confusion. Since they are familiar with acting in unison on behalf of the client, they consider their advice in the context of the entire group of services. Even better, advisors who have worked specifically with dental professionals bring their collective experience to improve client outcomes.

Denturists who are starting a practice, associating, solo or group practitioners, general or specialists or succession planning, will discover sooner or later, that the combined experience of their circle of advisors will have a profound effect on their business.

Our firm has worked in tandem with lawyers, wealth planners and accountants on behalf of dental professionals who are buying a practice, starting a practice, expanding and or transitioning their practices. In my experience clients truly benefit from advisors who work in concert. Some of the advantages are: reduced client stress and expenses due to smoother transactions executed by like-minded professionals who have experience transacting together.

Advisors who share common approaches to business and

M

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clients tend to “speak the same language”. As the nature of successful business transactions transpire through communication, the ability of an advisor y group to understand the other is a significant benefit.

Top athletes know that to ensure their success in the sports arena they need to rely on coaches. Not just any coach, but individuals who truly know their game, versus just know about it. The proof of this comes through the coach’s proven history of experience with the particular sport, shared relatable experiences of success and failure, a proven track record and a sincere desire to devote their skills, time and energy in order to see the athlete or team develop to full potential.

Coaches with limited exposure to the field can result in a great deal of wheel-spinning, frustration and set-back for the team.

They reveal their inadequacy by the “part-time” approach they apply to their work, a lack of specific experience and full understanding of the field, an inability to provide clear and prompt insight and direction, and a poor or vague track record.

It’s no different in the dental industry - experienced and proven coaching is valued as an integral part of a team and its success. The right skilled advisors will be able to offer a level of trusted expertise in their methods of analysis, problem solving, and forecasting. As in the athletic arena, they will “study behavior in the field” and strategize how the team can “play a better game”. This client scenario should help drive my point home, illustrating how like-minded advisors working together ensure fluidity and ease of transition.

Our firm was approached by a denturist interested in buying a practice from one of our clients. We began the process by facilitating communication between both parties until all indicators were clear that the practice could be sold to the interested denturist. After verbal agreement on buy/sell and transition requirements of seller and buyer, practice value and timelines, both parties then met to discuss. All the while, our firm continued to focus on and hammer out the details of this transaction in the practice’s core areas.

Positive, for ward momentum and communication continued to build because it became clear that buyer, seller and our firm shared a common approach to the process.

Even further, the seller happened to be an existing client of Miller/Canfield; a law firm who is part of the advisory group we work and lecture with. To round it out, we learned that the purchaser’s lawyer had previously represented other

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dental clients on transactions with Mrs. Jennifer Shilson and Mr. Marco Dolfi of Miller/Canfield.

Both seller and buyer could only benefit from the legal professionals working relationship. The lawyers had experience working with one another, and knew they were dealing with like-minds with whom they had completed transactions in the past. Not only were they familiar with each other’s approach and personality, but they were confident of their shared history and understanding of dental transitions. The clients then continued to experience this synchronicity of like-minded professionals coming together in yet another area.

Again, both buyer and seller happened to be clients of accounting firms who had extensive experience working with dental professionals during the buy/sell process. As was the case with the legal team, the accountants spoke the same language and were familiar with each other’s expectations in developing and implementing the right structure for the practice acquisition. Finally, considering the approach to the deal and to ensure that the structure and buy/sell could be incorporated into his overall financial plan, the buyer consulted with Mr. Timothy Leonard of Lifecycle Wealth Planning and Ms. Laura Fitzsimmons of Wealth Preservation Consulting Inc. Our role as consultants to this acquisition was to fuse the initial connection and communication between practice

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owner and interested buyer. We continued to be instrumental after the practice sale. With the new landscape, we were retained to implement business growth strategies as well as to manage the practice through the transition phase.

This case scenario is a realistic example of how a collection of essential advisors and professionals who share common philosophy and approach, can connect to work so efficiently and effectively. Keep the above picture in mind if and when you embark on transactions related to your practice that practically guarantee a more positive experience all around.

In an ever changing and challenging business environment the connectivity of your business advisors can be a competitive advantage. If your advisors are not singing from the same song sheet, it may be time for you to connect the dots! n

About the author

Dale Tucci is owner and president of Tucci Management Consultants Inc. Dale and her team offer a wide variety of custom practice management ser vices, transition planning, business coaching, associate recruiting, and marketing and human resource services. You can reach Dale Tucci directly at 416.450.8769 or via email at: tuccimgmt@rogers.com www.tuccimgmt.com or www.tuccimgmt.ca

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Spectrum Denturism – Vol. 6 No. 3 – June 2012

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People and Products The Friction Fit System creates precise fitting Telescopic Implant Overdentures

The FGP Friction Grip System provides an absolutely tension free fit and offers dental health professionals new options for the preparation and restoration of telescopic appliances with resin to resin restorations compared to metal to metal restorations. The friction fit system is a time saving, viable treatment protocol that extends the life of the restoration because of the renewable resin system, with added important benefits for the patient, such as ease of speech, comfort, aesthetic appearance and overdenture stability, thus promoting a greater quality of life for the patient. For further information contact Dent-Line of Canada Inc at 1-800-250-5111. _________________________________

Marly Skin Guard™

Marly Skin Guard™, the only skin barrier foam that absorbs into the top layer of the skin, not on the skin where it’s washed or worn off. It’s the only solvent-free pharmaceutical grade barrier foam, so it can be applied on skin irritations. It’s non-greasy and forms a barrier against allergens, bacteria, bodily fluids, chemicals, sanitizers, toxins and irritations caused by examination gloves. The skin breathes and perspires normally and it lasts 4-hours, even with washing and sanitizing. New to North America, European professionals have relied upon it since 1988. Marly Skin Guard™ - we’ve got you covered. Visit www.marlyskinguard.com. _________________________________

Finally a Cover for your Denture Brush!

Finally a Cover for your Denture Brush. Ventilated Cover protects Bristles from germs and dust.

Whether traveling or at home it's the perfect solution. This universal Cover will fit every Denture Brush. For more information, contact cuspident@videotron.ca or 1-888-379-2425. Juna Imports is looking for a distributor for ON, MB, SK, AB, BC and NWT. Please contact Juna Imports at 1-877-818-3681 or junainc@hotmail.com. _________________________________

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Spectrum Denturism – Vol. 6 No. 3 – June 2012

Medicool’s 2100 Super Handpiece

Zahn Canada is excited to announce the new 2100 Super handpiece. It is easy to operate with no vibration.

The 2100 Super is also high torque with a light weight. It also has low noise and vibration at the max 35,000RPM working speed. It is a great valued handpiece that is CSA approved! Many of the handpieces on the market in this price range do not even come close to passing electrical inspection. Customers can have the confidence that this unit is not only safe, but a real work horse!

To order, please call Zahn Canada at 1-800-496-9500. _________________________________

Dentsply Canada — Genios

Dentsply has introduced the first among its generation of prefabricated denture teeth. Genios makes a huge impression with its brilliant aesthetics and perfect shape. Its unique patented interdental closures ensure harmonious integration with adjacent teeth while unique blending and excellent surface texture give this versatile line of denture teeth a natural and lifelike appearance. Genios teeth look impressively natural thanks to its unique multi-zone design with five distinct zones and an excellent surface texture. Genios Posteriors can be used in tooth-to-tooth or tooth-to-two teeth relationships. Thanks to the occlusal surfaces of Genios Posteriors, designed by Michael H. Polz following the original biochemical concept of occlusion, intercuspiation occurs practically all by itself when the denture teeth are set-up. Genios teeth are also available in XL moulds which is ideal for RPDs and Implants. The high quality IPN material is the chemical basis of DENTSPLY denture teeth.

It’s highly connected copolymers give this material its superior properties. The result: High Quality and long lasting denture teeth. For more information visit www.dentsply.ca. _________________________________

Smile Brite® Professional Strength Denture Cleaner

Safe and effective professional strength cleaning agent for all types of denture resins. Restores worn appliances to "like-new" appearance. Use on full dentures, soft liners, light-cured resins, partial dentures and orthodonic appliances.

Easy to use. Especially powerful for removal of scalem tartar and stains. Cleans and deodorizes dental

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appliances and helps prevent irritation to gum tissue. Will not corrode stainless steel.

Available in 6 oz., 1 lb., 2lb., 25 lb., or 12 pre-measured packets for 3 month supply.

For more information, visit our website at www.americandentalsupply.net or contact us at 610-252-1464 or Toll Free in U.S. 800-558-5925. _________________________________

NOVUS™ Definitive Resilient Denture Liner

Denture wearers will appreciate the long-term benefits of improved fit, function and comfort when Novus™, ‘Definitive Resilient Denture Liner’ is applied to their denture. It has permanent resiliency over extended time; it absorbs shock while chewing; resistant to fungal growth; low water absorption; easy adjustments and polishing; bonds chemically to acrylic denture base resins; bonds chemically to acrylic denture base resins; processed, packed and cured using conventional lab processing procedures; can be trial-packed; can be molded around implant, bar and overdenture abutments; resistant to fungal growth. For more information, please call Central Dental, Ltd. at 1-800-268-4442. _________________________________

The UltraSuction™ System

OnCore Dental Inc. is proud to introduce the UltraSuction™ System, by offering the denture patient an alternative to implants for improved retention of an upper or lower denture. The system is a painless, cost effective alternative to implants and over dentures. Clinical results and studies have shown the UltraSuction™ system will increase suction for stability, as the patient continues to use their denture and maintain their maintenance programs.

For more information visit www.oncore-dental.com or call 1-360-841-8426. _________________________________

Fit!

Synca introduces Fit!® Made in Germany, Fit!® Putty and Light body material offer best in class hydrophilic and setting properties at a savings of as much as 50% over leading brands. For more information call 1-800-667-9622 or visit www.synca.com (not available in the U.S.) _________________________________

Synca — Fiber Force

Synca Direct Inc. introduces the Fiber Force® fiber reinforcement system. Pre-impregnated, light-curable e-glass fibers are easy to use.

Create light, thin, comfortable and aesthetic dentures and other removable or temporary appliances with this versatile range of materials. Fiber Force® is ideally suited as a strengthener for new appliances as well as a repair material for existing ones, providing a level of reinforcement that is superior to metallic options. For more information call 1-888-582-8115 or visit www.fiberforcedental.com.

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S P E C T R U M

www.SpectrumDenturism.com

Ad Link Aluwax Dental Products ..........................................www.aluwaxdental.com ...............................................1.616.895.4385 ....................................................50 American Dental Supply ............................................................................................................................................................................................................47 Baluke Dental Studios.............................................www.baluke.com .........................................................1.800.263.3099 ......................................................9 Central Dental Supplies...........................................www.centraldentalltd.com............................................1.800.268.4442 ......................................................2 CM..........................................................................www.cmsa.ch/dental ...................................................1.800.554.5504 ....................................................46 Dent-line of Canada Inc. ........................................www.dent-line.com.....................................................1.800.250.5111 ....................................................23 Dentsply Canada.....................................................www.dentsply.ca..........................................................1.800.263.1437 ....................................................21 Estrabillo Dental Group ................................................................................................................................1.905.841.2332 ....................................................34 Flexite.....................................................................www.flexitecompany.com ............................................1.516.746.2622 ....................................................17 Henry Schein / Zahn Canada...................................www.henryschein.ca....................................................1.800.496.9500 ......................................................5 Juna Imports................................................................................................................................................1.877.818.3681 ....................................................29 Keystone Industries.................................................www.keystoneind.com .................................................1.800.333.3131 ....................................................11 OnCore ...................................................................www.oncore-dental.com .............................................1.360.841.8426 ....................................................49 Perfecting Your Practice..........................................www.denturistassociation.ca........................................1.800.461.4393 ....................................................37 Rhein 83. ................................................................www.rhein83.com........................................................1.877.778.8383 ....................................................25 Specialty Tooth Supply Ltd......................................www.specialtytoothsupply.com ....................................1.800.661.2044 ....................................................27 Swiss NF Metals, Inc...............................................www.swissnf.com........................................................1.800.387.5031 ....................................................15 Synca .....................................................................www.synca.com...........................................................1.800.667.9622 ....................................................51 Tucci Management Consultants Inc. .......................www.tuccimgmt.com ...................................................1.888.454.1373 ....................................................45 Unique Dental Supply..............................................www.uniquedentalsupply.com .....................................1.888.532.0554 ....................................................15 Vident .....................................................................www.vident.com ..........................................................1.800.263.4778 ....................................................52

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BOLD NEW DENTURE TEETH FROM VITA Because failure is not an option, choose denture teeth from the brand you rely on.

VITAPAN® Plus anterior denture teeth are the result of two years of intensive research with dental technicians around the world. VITAPAN Plus offer true-to-nature tooth anatomy and a well-proportioned design, insuring coverage for any indication. And VITAPAN Plus are made with highquality Microfiller Reinforced Polyacrylic for superior

plaque resistance and wear as well as strength values that satisfy even the highest patient demands. Available in a compact assortment of popular moulds in VITA Classical and 3D-Master® shades, VITAPAN PLUS are perfect for use with all VITA posterior denture teeth.

800-828-3839 www.vident.com

© Vident 2011. Vitapan is a registered trademark of VITA Zahnfabrik.