Full denture prosthetics - the ultimate discipline: craftsmanship and individual specifications
KunstZahnWerk and the importance of traditional manufacturing methods in a digital age
MDT Sebastian Guttenberger, Pirk
Candulor's 13th KunstZahnWerk competition once again showcased the sound skills and know-how of dental technicians in 2023. This year again focused on the fabrication of mucosa-supported full dentures in the maxilla and mandible. The participants completed their competition work based on a detailed model analysis. Among them, Sebastian Guttenberger (Zahntechnik Hierold, Pirk). He accepted the challenge and won first place. In fact, he achieved a double victory, as he also took first place for the documentation of his work. What at first seemed unachievable thus turned into a personal achievement for him and a confirmation of his technical dental skills. In this article he describes his work philosophy and goes into detail about the competition work.
When dental technology meets passion, the result is a combination of craftsmanship and anatomical-functional understanding. Dental technology competitions such as the KunstZahnWerk are venues for this energy and provide a stage for measuring one's talents and further one's advancing skills. Participation in the KunstZahnWerk, which is all about full dentures and where dental technicians from all over the world have their work judged by a renowned jury of experts, may at first sight seem unattainable. For me, too, the dream of participating had been there for a long time. But my master craftsman's examination had priority. After successful graduation - and apart from the daily work of fabricating high-quality dental restorations - came the question of which further professional goals to pursue. And that is when KunstZahnWerk sprang to mind again. It was time to face the dream. Backing from my employer and the family provided the necessary incentive. So, full dentures occupied my mind for several weeks.
Patient-customized full dentures
What is the role of full dentures in the age of artificial intelligence (AI), automation and CAD/CAM manufacturing? What relevance do manual skills still have? These questions occupy the minds of many of my colleagues. Digitization undoubtedly offers many advantages. However, full dentures still represent handcrafted work. The realization of esthetic, functional and patient-specific aspects which make up a "good" full denture requires skills such as observation as well as creativity and an understanding of functional relationships. The basic idea behind the fabrication of dentures is always the same: a denture should be comfortable to wear and inconspicuous for the patient. The focus is on the natural shape of the teeth and - depending on the tooth replacement solution - of the gingiva. Be it digital or analog, a number of preliminary considerations are required prior to realization to prevent problems from occurring in the first place. Digitization is particularly helpful for fixed denture solutions. Digital design not only allows the frameworks to be created, but also enables a fully anatomical situation to be defined as the target. This can, for example, be realized by means of 3D printing. Digital technologies can also prove helpful for full dentures. In principle, however, full dentures are based on a sound knowledge of traditional fabrication methods and on taking the patient's individual circumstances into account.
Competition entry (KunstZahnWerk 2023)
Female patient and task
A mucosa-supported maxillary and mandibular denture is to be created for a 69-year-old female patient. In the maxilla, the patient has been fitted with a denture for 15 years. Initially anchored via double crowns, abutment teeth 21, 22 and 23* had to be removed. She wears an interim denture in the mandible after teeth 35 - 44 and 46* had to be extracted due to advanced periodontitis.
- The task: natural-looking dentures according to the dynamic occlusion concepts tooth-to-tooth or tooth-to-two-tooth setup.
This is aggravated by a pronounced atrophy in the mandible, a slight flabby ridge in region 32 to 42* and a change in the mucosa (leukoplakia) in region 35*. The existing dentures exhibit several deficits. The anterior teeth are barely visible in both the upper and lower jaws. Due to the low vertical proportion, the lower third of the face appears squat and the chin pointed. The patient complains about inadequate denture retention. She can only eat by using adhesive cream to fixate the denture in her mouth. She would like a denture with a firm hold, visually more prominent anterior teeth and age-appropriate esthetics, as well as adequate chewing performance. Also important to her is an appealing facial appearance, where the chin appears less pointed. Youth photos serve as an orientation.
- The challenge: age-appropriate dentures (full dentures) at pronounced atrophy in the mandible.
Preparatory steps by the dental technician
The models of the maxilla and mandible are duplicated and the master models are fitted with rotation locks (brass cones, milled grooves, magnet) for a Splitcast base (Figs. 1 and 2).
Preliminary technical dental considerations:
- The increase in vertical relation must be taken into account when articulating.
- As the flabby ridge can lead to a poor suction effect of the denture, adequate finishing of the denture body is required (buccinator support, muscle-gripping denture body, margin design).
- For an individual setup of the maxillary teeth according to the physiognomic bite key, a silicone matrix is helpful as a control element (Fig. 3).