Complete Dentures on a Tight Schedule
The Baltic Denture System offers quick turnaround and improved comfort
Richard Zimmermann, DDS
Complete dentures are benefiting from digital workflows. From chairside to laboratory fabrication, digital denture workflows are decreasing the time it takes for dentists and technicians to deliver high-quality affordable prostheses to patients.
A 65-year-old male experiencing a transition in his life presented for a new set of dentures. Given his circumstances, the final prosthesis needed to be delivered in a timely and efficient manner to help him with this transition. The Baltic Denture System (BDS) utilizes a specialized key set (BDKEY®) that allows a dentist to capture functional impression, occlusal plane, and esthetics in one appointment. Also, special milling blanks are used to fabricate the dentures in less time than traditional methods, resulting in faster turnaround for the patient.
First, the dentist selected the BDKEY that best approximated the patient's maxillary arch (Figure 1), and then performed border molding using a thermoplastic material that was heated in a hot water bath. Once the border molding was completed, the maxillary BDKEY was filled with impression material to obtain the functional final impression (Figure 2). At this point, the occlusal plane and midline were verified by using the BDKEY Plane and BDKEY Fin that attach to the BDKEY. With thermoplastic material applied to the basal area, the mandibular BDKEY was then attached to the maxillary BDKEY via a Keylock and the patient's mandible was moved vertically to achieve the predetermined position. Once obtained, a functional impression of the mandible was made using the same technique as for the maxillary arch. The last step was the final esthetic evaluation of the BDKEY Set (Figure 3).
The completed BDKEY Set was sent to the laboratory for scanning and fabrication of the dentures (Figure 4). Baltic Denture Systems' BDCreator software is user-friendly CAD software that allows the technician to design the complete dentures in just a few simple steps. Two versions of the software are available, with the more robust version incorporating virtual articulator functions and the ability to remove undercuts. The initial steps had the technician identifying anatomical landmarks on the impression, which guided the CAD software to evaluate which tooth configurations were best suited for the case (Figure 5). Once that was completed and the baseplates were designed, it was time to determine which tooth configuration would be best for this patient.
At the center of the BDS system are the BDLoads, specific PMMA milling blanks with an integrated tooth set-up (Figure 6). Both maxillary and mandibular teeth are pre-set in lingualized occlusion with semi-anatomical posterior teeth. The BDLoads come in various sizes and classic VITA shades, thus providing multiple options for both the technician and the dentist. BDCreator provides the technician with tooth configurations that are best suited for a case based on the previously entered information (Figure 7). For this case, the software indicated that a blank with a "medium" arch and "medium"-sized teeth would provide an optimal tooth configuration. If desired, other tooth configurations could be chosen; however, those sets that do not fit within the identified anatomic landmarks would be indicated in red. To help with this step, a photograph of the patient with the BDKEY Set was also sent to the technician. This photograph can also help the technician determine if any adjustment to the occlusal plane is needed. If it is, the software has simple controls that allow movement of the occlusal plane.
The patient had noticed that his past maxillary denture had a smooth palate, unlike his own palate, which had robust rugae. To address palatal anatomy, BDCreator has a function that allows the technician to copy the patient's rugae and transpose them on the palatal surface (Figure 8). This is quickly and easily done with a few clicks of a button. After some virtual waxing and smoothing of the denture base, the technician sent the file to be milled. Milling both the maxillary and mandibular denture took a little over 5 hours (Figure 9). The milled dentures were removed from the puck and polished using traditional denture polishing techniques to achieve a smooth finish. From design to polish, fabrication of both dentures was accomplished within 1 day.
The patient was excited to get his new set of dentures and could not stop smiling (Figure 10). A few adjustments had to be made, mainly sharp line angles on the palate intaglio surface and a slight overextension of the flange. The maxillary denture exhibited good retention. While the mandibular retention was not as good, this was related more to the patient's resorbed ridge than the actual prosthesis. The patient commented that the new dentures felt more comfortable than his previous set, and he noticed the palatal anatomy.
Overall, providing this patient new dentures within a shortened timeframe was a great benefit to all parties. Not all patients have the time it takes to get dentures, whether going to a dental office or waiting for the fabrication process. The Baltic Denture System provides both dentists and technicians a way to serve those patients.
About the Author
Richard Zimmermann, DDS, is an Assistant Professor of Comprehensive Dentistry at the University of Texas San Antonio School of Dentistry in San Antonio, Texas.
Disclaimer: The statements and opinions contained in the preceding material are not of the editors, publisher, or the Editorial Board of Inside Dental Technology.