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Special Issues
July/August 2023
Volume 44, Issue 1
Peer-Reviewed

A Digital Path for Creating Accurate Immediate Dentures

Lori Trost, DMD

A terminal dentition treatment plan is often an overwhelming concept for patients when it comes to both the procedure and psychological acceptance. Former analog fabrication processes were cumbersome, complicated, and inefficient for the patient. The information transfer of impressions to models, then to wax rims and try-ins, to a final denture was laden with copy error. Resultantly, the actual production process was unpredictable due to approximating extraction sites, borders, and bony resorption. Each of these factors plays a critical role in the final delivery and patient comfort. With each procedural step, some accuracy is lost, which can translate to poor retention and discomfort. The digitizing of the immediate denture restorative workflow, beginning with the use of an iTero™ intraoral scanner (Align Technology, Inc., itero.com), has a significant impact on accuracy and predictability. This digital data improves lab communication while elevating patient outcomes and minimizing the number of appointments. As shown in the case presented, the final immediate denture design benefits from a digital design. Teeth can be virtually extracted. Occlusion can be digitally modified, exactly the opposite of a wax try-in where teeth can easily shift or move. Ultimately, the lab uses this organized data to create predictability in fit, function, and esthetics.

Key Takeaways

iTero intraoral scanners provide a digital path for information to be communicated to the lab
in an organized and
efficient manner.

A digital workflow
positively impacts denture production, reflected in improved accuracy and fewer patient appointments.

Immediate denture designs benefit from virtual extraction and accurate capture of vital landmarks. A monolithic denture can be leveraged as a try-in, allowing for any modifications before final delivery of the denture.

 

About the Author
Lori Trost, DMD
Private Practice, Red Bud, Illinois

Fig 1. Pretreatment panoramic x-ray of a 60-year-old female patient who presented with periodontally condemned maxillary teeth. Her treatment plan included maxillary extractions and an immediate maxillary denture.

Figure 1

Fig 2. The patient returned 1 month post-extraction of her premolars. Both arches and her bite were scanned using an iTero Element™ 5D Plus imaging system, as seen in this model view.

Figure 2

Fig 3. iTero prescription screenshot; this is an example of the iTero Element 5D Plus imaging system intuitive options and workflow sequencing for immediate denture fabrication from scan to delivery.

Figure 3

Fig 4. The patient returned for extractions.

Figure 4

Fig 5. From the initial scans, a monolithic (polymethyl methacrylate [PMMA]) (Carbon®, shade A1) printed healing denture with gingival characterization and glazing was requested from the lab.

Figure 5

Fig 6. Occlusal view of the immediate PMMA denture.

Figure 6

Fig 7. Immediate denture delivery. The patient tolerated the procedure very well and was pleased with the results.

Figure 7

Fig 8. Post-denture delivery 2-day appointment. The patient reported wearing the denture comfortably, noting one small sore spot. A new tissue conditioning soft liner (Coe-Comfort™, GC America) was placed and would remain in use for 1 month, followed by a soft reline to complete the healing for the final 3 months.

Figure 8

Fig 9. Final denture impression: border capture and wash impression. The monolithic PMMA denture was used as a final custom tray. A heavy-body impression material (Flexitime®, Kulzer) was used to capture the border. A light-body impression material (Flexitime) was syringed sparingly into the intaglio surface to finalize the functional impression process.

Figure 9

Fig 10. Final iTero intraoral scanner scans; this screenshot of scan information was sent to the lab to finalize the denture.

Figure 10

Fig 11. Final printed (Carbon) denture.

Figure 11

Fig 12. The patient returned for delivery of her definitive denture and was thrilled with the final “look” and “fit,” finding the denture to be highly retentive and comfortable.

Figure 12

Fig 13. Profile view of the patient with final denture demonstrating detail of the excellent esthetics and lip line.

Figure 13

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