hello and welcome to episode 159 of chairside live I'm Megan strong and we've got a great
show for you today we're digging into the world of digital dentistry with dr. by in this case
the patient needs a full lower denture dr. Bai will show us the CAD cam process to digitally
fabricate a denture it's exciting stuff so let's go take a look okay welcome back to the Gladwell
International Technology Center I want to go through a case where a patient was in need of
a mandibular immediate denture in this scenario I've had the mounted stone casts on articulator
this is a semi adjustable articulator it's called the art X and I've actually went ahead and removed
the teeth from the casts but to get to this point let me show you all the steps that I have to take
first the patient came in for the initial appointment and I went ahead and I captured
a very nice and clean preliminary impression now this impression as a putty wash technique
so I went ahead and placed the putty into the impression tray place it in the patient's mouth
wiggled it around a little bit and I wanted to create a little space for the teeth by wiggling
it around and then I took it out before this sets and I relined it with impression with light body
impression material and then I placed it back into the patient's mouth and let it set that way I can
capture a very nice and clean impression into the vestibules and I want to make sure that I
go as far into the vestibules as I can because the fabrication of my custom tray is going to
be dependent on this on on the depth of the vestibules of this impression so I send this
to the laboratory and the laboratory fabricates a custom tray which you see here with the impression
already in there so the custom tray is tried in the patient's mouth I go ahead and I do my
border molding and then I capture a very nice final impression now this impression is going
to be for my working cast for the fabrication of the immediate dentures so what you see here on
this cast is the articulated final impression or working cast opposing the maxillary natural teeth
now the patient obviously needs a lot of work done in the maxillary arch what I want to do is
address the mandibular arch first set my plane of occlusion set my Tia curve is B & kerrville
Wilson first and then I can go ahead and design my temporaries for the maxillary arch and decide
what we're going to do there so obviously we have to go through a set of comprehensive exam
and radiographs and hopefully for the lower arch eventually a cone beam CT scan and be
able to place some implants so in the laboratory we have the option of actually scanning our final
impressions and after scanning them we can print out through stereo lithography we can print out
the cast basically or the working models so you have that for the mandibular arch and we also
have that for the maxillary arch now with the digitized models our technician can go ahead
and design a final denture and in this case it's a final immediate denture and through the CAD cam
design we can go ahead and process an immediate denture what I want to do next is go through all
the steps with one of our technicians on how she goes and designs this immediate denture
and processes it okay so let's go ahead and take a look at the digital design of this week's case
of the week with the design of the mandibular immediate denture what my technician has done
is she has already scanned at the maxillary arch and the mandibular arch I had removed the teeth
from the cast so she actually had to go ahead and make a bite jig on my articulator so that she can
digitize the information now you can digitize the information in many different ways you can
for example scan the impressions themselves or you can scan the the cast and in this case the
technicians scanned the cast and in this scenario she's outlining basically the outline of the final
denture that I want and going into the depth of the vestibule capturing all the borders and as
you can see with the with the CAD cam design of this denture you have the freedom and the
ability to actually go around and adjust your margins adjust the the different points on the
outline of of the denture so once you have your essentially your base plate marked out
the technician can go ahead and import from a library of teeth and bring into view some of
the teeth that we want to set in this case all the teeth are set together so the technician has the
ability to move them as one unit and also she can go ahead and select the plane of occlusion there
are some minor adjustments that needs to be made obviously so you see our technician going through
and selecting some of the borders and making the slight modification so this type of software gives
the clinician and the technician a lot of benefits one of the biggest benefits for me has been that
the time consuming aspect of setting denture teeth has been really canceled out by cad/cam
technology so the technician can really quickly go through and set the teeth you can see that she's
festooning this would really literally take me hours to do I actually still like to set my own
teeth because I'd like to have a little bit of control in terms of what I want to give to the
technician and communicate with the technician so usually what I like to do is actually set the
teeth and have the technician replicated digitally for me so the festooning is done digitally as well
and the other good part about these software's is that you can set a thickness for your denture
base so you have a uniform thickness sometimes when I'm using wax it's hard to tell how thick
my denture base is going to be and in some areas it might be a little bit thinner than other areas
in this situation the technician has full control of that so in areas that you can see it's a little
bit darker pink the technician can go in add a little bit more wax to make things even so once
the festooning is done and once the denture teeth are set the technician can go ahead and process
this denture now there's a couple of different ways of processing one of them is you can actually
print a denture using a stereo lithography printer and have two different colors of material the the
white for the denture teeth and the pink now the technology needs to catch up a little bit
because obviously the material hasn't caught up with the aesthetics yet so I think in the
near future dentures can be fully printed also another way is to invest this denture now once
it's printed from from a regular material you can invest the denture and you can process it like a
normal denture and a third way of processing this is to actually mill the denture plate so that the
base of the denture is milled and the teeth can be essentially glued in there for final fabrication
well I hope you enjoyed this week's case of the week and I hope to see you here next week
for another case of the week thank you for that doctor bye and you know I always like to remind
you to take advantage of our free CD credits so earn while you learn by watching chair side
live visit w-w-w calm well that about wraps it up for this episode of chair side live on behalf of
everyone here at Glidewell laboratories thank you for watching and come and see me here next week
you