Full dentures at the highest esthetic level
A contribution to the 13th International CANDULOR KunstZahnWerk Competition 2023
Skender Ramadani, Switzerland
There are many reasons for the computer-aided fabrication of dental restorations. However, when it comes to fabricating full dentures which differ from the ordinary due to their individuality and natural beauty, then conventional fabrication techniques often remain superior to this day. They offer users greater flexibility and enable them to apply their own creativity as well as dental technical skills in a more targeted manner. This results in restorations that even help patients with the highest esthetic demands to achieve a better quality of life.
Such a restoration was to be fabricated as part of the 13th International CANDULOR KunstZahnWerk Competition 2023: the challenge was to fabricate a mucosa-supported maxillary and mandibular full denture based on a detailed model analysis. A choice could be made between a tooth-to-tooth or a tooth-to-two-tooth setup for the dynamic occlusion concept which was to be applied. Detailed information on the initial situation was provided (summarized in the following section Case Description), as well as the matching maxillary and mandibular plaster models, the physiognomic bite key and the denture teeth: PhysioSelect TCR (maxilla) / shape 674, shade A3, PhysioSelect TCR (mandible) / shape 64, shade A3 and BonSelect TCR (maxilla and mandible) / shape 04, shade A3 (Fig. 1). In addition, the briefing included an image of the interim denture, recent extraoral images of the patient with the denture in place, and a youth photograph (Figs. 2 to 5). It was also mentioned that the labial lip contact of the maxillary anterior teeth and the buccal cheek contact of the posterior teeth correspond to the bite key. The condylar path inclination was given as 45 degrees on the right and 47 degrees on the left, the relationship: Camper's plane = occlusal plane.
The female patient was 69 years old at the beginning of treatment and had already been provided with full dentures for 15 years. Whereas teeth 21, 22 and 23* as well as 35 to 42 and 46* could initially be preserved and were restored with double crowns, the teeth in the maxilla had been extracted over time. Subsequently, the teeth in the mandible also had to be extracted due to advanced periodontitis. The patient had been wearing an interim restoration for two years.
No general medical conditions relevant to treatment were known at the start of treatment. Clinical examination revealed pronounced atrophy of the mandible. Also noteworthy were a slightly pronounced flabby ridge in region 32 to 42* as well as leukoplakia crestally in region 35*. A new restoration with mucosa-supported full dentures was indicated due to both unsatisfactory esthetics as well as unsatisfactory function. The esthetic deficiencies included the unsightly resin of the interim restoration (Fig. 2) as well as the fact that the anterior teeth in the maxilla and mandible were not sufficiently visible (Fig. 3). In addition, the lower third of the face clearly appeared too small when the jaw was closed in the resting position. This gave the chin a more "pointed" appearance than is usual (Figs. 4 and 5). The unsatisfactory function was due to insufficient denture retention, which only allowed food comminution in conjunction with the use of adhesive cream. However, it remains questionable whether it is at all possible to achieve satisfactory prosthetic function in the mandible into old age without implants (Marburg "Concept 75+" Dr. H. Gloerfeld/Dr. D. Weber, Marburg).