Natural functionality, lifelike beauty.
On this page, fellow professionals will inspire you with intriguing case reports documenting the variety of application scenarios possible using VITAPAN EXCELL denture teeth.
From partial dentures and highly esthetic challenges, to comprehensive implant denture restorations, VITAPAN EXCELL meets all your requirements. You too can be a hero for your patients. Happy reading!
In the following case report, Darius Northey, Dental Technician (Buderim, Australia) shows how he was able to successfully use the new denture tooth for an implant-supported restoration.
INITIAL SITUATION: The insufficient restorations showed a midline displacement and functional disharmonies.
RESULT: The patient was very happy with the naturalness of the new restoration.
For predictable and functional esthetic results in restorations, in addition to dental technology experience, we need a denture tooth designed on the basis of the esthetic and functional standards set by nature. VITAPAN EXCELL (VITA Zahnfabrik, Bad Säckingen, Germany) is an example of this kind of anterior tooth, which is characterized by vibrant shapes with “golden proportions.” Tooth axes, the length/width ratio and angle characteristics are consistently patterned after nature. In addition, its special layered structure enables a natural play of shade. In the following case report, Darius Northey, Dental Technician (Buderim, Australia) shows how he was able to successfully use the new denture tooth for an implant-supported restoration.
A 78-year-old female patient was dissatisfied with the positional stability of her mandibular prosthesis. The acrylic teeth appeared abraded, stained and very dull. After the consultation, the patient decided on two implants in the mandibular in order to achieve greater functional stability, and was referred to an oral surgeon. After a healing period of three months, the implants were osseointegrated in the incisal region of the mandibular. First, the patient did not want a new total prosthesis in the maxilla, although the midline was shifted extremely to the right and functional disadvantages due to the well-worn and irregular occlusion were to be expected. She feared that her usual appearance would be altered by a new restoration. However, following a comprehensive consultation, she finally opted for a new restoration.
The insufficient restorations showed a midline displacement and functional disharmonies.
Two implants were inserted in the incisal region to functionally stabilize the restoration in the mandibular.
The restoration in the mandible began with an anatomical alginate impression. So that it could be oriented to the old maxillary prosthesis using the copy denture technique, this was duplicated with putty and reproduced with a cold polymer for denture bases. For the mandible, a custom-made impression tray was made, a mucodynamic impression was taken in several steps and the impression cap was affixed. Using the model, a simple bar construction was fabricated and affixed with synthetic material to the attachments. A wax rim was created over the bar in the mandible, and plates for the imaging of the gothic arch positioned on this and the maxillary duplicate. Laterotrusion, protrusion and centric were recorded and affixed. The duplicate was successively reduced in the setup area in order to first position and try in the VITAPAN EXCELL anterior tooth and then the VITAPAN LINGOFORM posterior tooth.
A custom-made tray was used in the mandibular for a mucodynamic fixation impression.
A simple bar construction was poured and fixed with synthetic material to the abutments.
The centric and temporomandibular movements were recorded with the gothic arch.
First, the esthetic zone of the maxillary duplicate was reduced, then replaced with VITAPAN EXCELL, and finally tried in.
The final wax setup in the articulator with molded gingival anatomy before the try-in.
After a complete functional and esthetic try-in, a mucodynamic impression with wax setup on a duplicate base was taken in the maxilla. The bite was registered with silicon. In the maxilla, a final master model was produced and articulated according to the vertical dimension. The maxilla and mandibular setups were embedded in cuvettes, boiled out and pressed with heat-curing polymer into different gingival shades. After polymerization, both works were rearticulated and an occlusion check was done. The prostheses were processed with fine-cut carbide milling tools and rubber polishers. The final polishing was done with pumice and polishing paste, as well as a buffing wheel. The patient was very satisfied with the functional and esthetic result. Thanks to the lifelike shapes with “golden proportions,” the three-dimensional anatomically layered construction and the multifaceted surface texture, the prosthetic restoration with VITAPAN EXCELL appears very natural.
Report 07/17
After the try-in, a mucodynamic impression with setup was taken in the maxilla.
The final occlusion-adjusted, mucodynamic impression in the duplicated denture base.
Based on the bite registration of the setups, the maxilla could be accurately rearticulated.
VITAPAN EXCELL and LINGOFORM were conditioned with VITACOLL to ensure good adhesion to the base.
The vestibular plate was customized with several synthetic material layers in different gingival shades.
The bridge and attachments were integrated by polymerization of the synthetic material base.
The finished restorations after elaboration and polishing in static occlusion.
RESULT: The patient was very happy with the naturalness of the new restoration.
Image source: Photo documentation by Marita Heeren, Oldenburg, Germany.
Fixed implant bridges on edentulous jaws are a real challenge, even for denture teeth. In the following case study, Master Dental Technician Maximilian Götsch (Ravensburg, Germany) shows how robust and highly esthetic implant-retained dentures can be achieved using VITAPAN EXCELL.
INITIAL SITUATION: Analogs were screwed on to the healed implants and impression caps positioned on the analogs.
RESULT: Finally, when opened slightly, it was possible to see a harmonious incisal edge gradient.
Fixed implant bridges on edentulous jaws are a real challenge, even for denture teeth. The force-absorbing characteristics of the periodontium are missing in the case of implants, which are rigidly anchored in the bone. As a result, they are subject to considerably greater forces. Due to the underlying substructure, the denture teeth must often be milled to a significant degree, yet still remain stable and maintain shade fidelity. The VITAPAN EXCELL anterior tooth set and all other VITA premium teeth are fabricated from highly cross-linked VITA MRP (Microfiller Reinforced Polymer Matrix) composite, which allows for a high level of abrasion stability, given the strong forces acting on implant restorations.* In the following case study, master dental technician Maximilian Götsch (Ravensburg, Germany) shows how robust and highly esthetic implant-retained dentures can be achieved using VITAPAN EXCELL.
A 68-year-old male patient had been provided with temporary dentures. After a year had passed, he wanted a fixed, light and palateless implant-retained restoration. The two temporary dentures could be used as the basis for the new implant-retained dentures, as the patient was able to function properly with them. Only the functional margins and the covered palate bothered him. For the purposes of DVT, the temporary restorations were modified to act as X-ray templates. During backward planning using this 3D diagnostic tool, it was possible to position the implants virtually in the bone and create a drill template on this basis. Once the implants had been inserted and healing was complete, fixation impressions were taken and master models fabricated that were articulated appropriately for the patient using the registered temporary dentures.
Analogs were screwed on to the healed implants and impression caps positioned on the analogs.
The fixation impressions were taken in the upper and lower jaw with a closed tray.
The fixation impressions were taken in the upper and lower jaw with a closed tray.
In consultation with the patient, the appropriate VITAPAN EXCELL mould was selected in the shade A2. Morphology that follows esthetic guidelines, a natural surface texture and anatomical layering provide these denture teeth with a lifelike appearance. For the posterior region, VITA PHYSIODENS was selected in A2 in order to quickly achieve unique centric occlusion. The patient wanted custom anterior positioning instead of straight positioning. Final verification of occlusion, phonetics and esthetics could then be performed during clinical try-in.
The wax setup was achieved using VITAPAN EXCELL Anterior and VITA PHYSIODENS Posterior.
The wax setup was achieved using VITAPAN EXCELL Anterior and VITA PHYSIODENS Posterior.
In the posterior area, VITA PHYSIODENS enabled efficient setup.
The nested VITAPAN EXCELL setup reflects its natural surface texture and morphology.
The wax setup during clinical try-in in the patient's mouth.
Function, facial expression, phonetics, and esthetics, were carefully verified on the patient.
In the occlusal rest position, an unbalanced incisal edge gradient became obvious.
The incisal excess at 12 and 22 was marked so that corresponding changes could be made.
The optimized setup and the master models were then scanned individually and in articulation (IScan D104i, Imetric, Courgenay, Switzerland). In the CAD software (Exocad, Darmstadt, Germany), full virtual shrinkage of the setups was performed as part of a first step in order to achieve an anatomically supported, dimensionally accurate structure from which the substructure could gradually be constructed. The substructure was fabricated from a non-precious metal blank using CAD/CAM technology (Millhouse, Wallau, Germany). Using a silicone key, it was possible to transfer the denture teeth in wax to the substructures. During wax modelling, the teeth were extended morphologically in the cervical area and the alveolar process was shaped. The situation was duplicated using dental putty.
The setup was shrunk in the CAD software so that an anatomically reduced substructure could be constructed.
The substructures (after controlled shrinkage) harmonized from a denture perspective with the setup.
The substructures (before clinical try-in) were seated without tension on the master models.
Using a silicone key, the setup was transferred to the substructures and the base modeled in full using wax.
Following wax extraction, cleaning and conditioning, the denture teeth were fixed in the duplicating key using superglue, and VITACOLL bonding agent was applied in the basal-cervical area. The silicone matrix was then repositioned on the master model. It was then possible to inject the tooth-colored cold-curing polymer resin VITA VM CC A2 via a posterior opening. Following removal of the key, the shade fidelity could be seen between the homogeneously shaped cold-curing polymer resin and the denture teeth. Once finishing had been completed, the gingival appearance of the patient was replicated in the vestibular area using the flowable light-curing veneering composite VITA VM LC flow. Finishing was performed using a fine diamond instrument and fine pumice, followed by diamond polishing paste
The tooth-colored VITACOLL CC cold-curing polymer resin was injected into the silicone matrix via a posterior access.
It was possible to then finish the polymerized base.
In the vestibular region, the mucogingival areas were individualized using VITA VM LC flow veneering composite.
Following wax extraction, cleaning and conditioning, the denture teeth were fixed in the duplicating key using superglue, and VITACOLL bonding agent was applied in the basal-cervical area. The silicone matrix was then repositioned on the master model. It was then possible to inject the tooth-colored cold-curing polymer resin VITA VM CC A2 via a posterior opening. Following removal of the key, the shade fidelity could be seen between the homogeneously shaped cold-curing polymer resin and the denture teeth. Once finishing had been completed, the gingival appearance of the patient was replicated in the vestibular area using the flowable light-curing veneering composite VITA VM LC flow. Finishing was performed using a fine diamond instrument and fine pumice, followed by diamond polishing paste
The natural morphology and surface texture of the upper incisors in reflected light.
The lifelike setup and the custom gingival gradient provide for a natural appearance.
The finalized restoration with screwed-on implant analogs was very light.
The slight basal supporting surface ensures effective cleaning around the implants.
Finally, when opened slightly, it was possible to see a harmonious incisal edge gradient.
In the occlusal rest position, an optimum interplay was also visible between the lip line and incisal edges.
Image source: Photo documentation by Marita Heeren, Oldenburg, Germany.
Publication in Quintessenz Zahntechnik magazine, 1/18, available via www.quintessence-publishing.com
These days, younger denture wearers in particular want their dentures to look natural rather than artificial. The patient of Denturist Daniel Lavrin (London, UK) was delighted with the highly esthetic result and the stable seating of her new dentures, and was already more confident immediately after placement.
INITIAL SITUATION: The insufficient restorations showed a midline displacement and functional disharmonies.
RESULT: The patient was very happy with the naturalness of the new restoration.
When a smile is revitalized using ceramic restorations, esthetic guidelines are followed and implemented meticulously so that optimal results can be achieved. Smile Design – that's what everybody is talking about when it comes to fixed ceramics. Attention to detail is also an established practice when fabricating restorations. The anatomy of the hard tooth substance is reproduced three-dimensionally during ceramic layering. Dentin and enamel materials form a natural unit. So why should these standards not apply for full dentures too? After all, denture wearers want an esthetic outcome just like any other patient. These days, younger denture wearers in particular want their dentures to look natural rather than artificial. As a dental technician, if you have the opportunity of completely reworking the red-white esthetics, then you should take advantage of the opportunity.
After all, the esthetic guidelines that hold true for all disciplines in dental technology should, of course, also apply for full dentures: the tooth axes, contact surfaces, angle characteristics, cervical dimension, gingival margin and length-width ratio should be designed like natural dentition. The basic requirement in this respect is a denture tooth that meets esthetic guidelines and provides an anatomical structure similar to that of natural dentition. And that's the challenge: denture teeth generally – for whatever reason – do not meet esthetic guidelines and have a lifeless and monotonous appearance when it comes to layering. The vestibular morphology is a flat surface between two ridges without any texture at all, which is why denture teeth of this kind simply cannot offer a natural appearance. The VITAPAN EXCELL (VITA Zahnfabrik, Bad Säckingen, Germany) denture tooth meets esthetic guidelines, is layered three-dimensionally using enamel, dentin and cervical material, and is pressed from a single mold and cured. The morphology and texture of real teeth was consistently implemented when creating the mould. The following case report demonstrates the resulting benefits, not just in terms of esthetics but also for setup.
A 58-year-old female patient presented in the dental practice, as she was dissatisfied with both the function and the esthetics of her current restoration. When chewing, the partial denture (lower jaw) and the full denture (upper jaw) would slip back and forth and did not provide a secure grip. The denture teeth appeared lifeless and the mucogingival areas were smooth and level with an artificial appearance. Following extractions in the lower jaw, region 31 to 34 did not have any restoration, as the partial denture had not been extended. Only tooth 46 was still present, which the patient insisted she wanted to keep. The molar proved worth retaining and showed no clinical or radiological signs of severe periodontal damage. Once the impact of a partial denture on the only remaining tooth (46) had been explained to the patient, it was decided that the new lower denture should be designed so that in the event of tooth loss, a denture tooth could be added by making minimal changes to the design of the denture. The decision was therefore taken to work around tooth 46 during fabrication of both dentures. The patient wanted a new restoration with a natural appearance that offered her peace of mind with a secure grip when chewing and speaking. After detailed consultation, she decided to have a new full denture made. For this purpose, the VITAPAN EXCELL denture tooth was selected in the appropriate tooth shape to ensure a natural appearance and setup in accordance with esthetic guidelines. In the posterior area, VITAPAN LINGOFORM was used. As an initial basis for the work to be completed, anatomical situation impressions were taken with alginate in order to create custom trays in the laboratory. These were used in a second session to take mucodynamic impressions. The first impression was taken using Heavy Body, and the second, fine impression using Light Body A-silicone. Once the master model had been fabricated, this was used as a basis for fabricating bite registrations with wax rims for determining jaw relation. The spatial arrangement of the jaws in relation to one another could be transferred to the articulator using the intraorally encoded registration data. Following analysis of the model, the appropriate wax setup for the patient was started.
The patient's insufficient dentures needed to be restored.
Two-phase mucodynamic impressions were taken of the upper and lower jaw.
The master models were articulated using jaw relation determination.
After model analysis, it was possible to begin setup.
Dental technicians have internalized the esthetic guidelines. In addition to their fundamental knowledge of esthetics, they spend every day looking at what works esthetically and what doesn't. A logical consequence is that they find it easier to set up with anterior teeth that comply with these esthetic rules than, for example, with a set of teeth whose axis and angle characteristics do not harmonize with each other on the dental plate. Even with these kinds of denture teeth, every user will try to find the ideal setup, although they will find it difficult to find the correct tooth position, given the fundamental discrepancies. That's why VITAPAN EXCELL was designed with tooth axes, contact surfaces, angle characteristics, cervical dimensions, gingival margins and length-width ratios that consistently meet the generally-applicable esthetic guidelines of natural dentition. As a result, setup using this anterior tooth set was intuitive and easy to complete. The wide palatal ridges additionally support optimal shaping of the papilla. For new restorations, it is important to always consider the previous appearance of the patient's dentition. The basis is the anatomy of the oral cavity on the day treatment started, which is where I begin restoration in accordance with the parameters of esthetics, function and stability. All clinical information must be taken into consideration here to achieve optimal restoration results in the patient's mouth. Due to the position and the mesial displacement of tooth 46, space for the lower anterior setup was restricted and was implemented with overlap in order to facilitate physiological molar contact between the denture teeth. The patient was in agreement, as her natural lower anterior teeth had also overlapped and had never been evened out by orthodontic treatment. In the posterior area, efficient setup with precisely defined centricity, but with the necessary freedom for excentric movement, was ensured by VITAPAN LINGOFORM. The multifunctional occlusal surface design based on the cog wheel principle, is universally suited for all conventional tooth-to-tooth or tooth-to-two-tooth setup concepts.
Due to the morphology of VITAPAN EXCELL, setup took place automatically in accordance with esthetic guidelines.
Tooth 22 was slightly inclined in the palatal direction to facilitate an individual appearance.
It was possible to complete the anterior setup quickly through integrated esthetics.
Since the gradient of the gingival garland is not defined by a stepped transition between the tooth and the cervical area, but the transition is natural, the mucogingival structure could be modeled in a patient-friendly way. The alveolar process, palatal ridges and palatal suture, as well as the incisive papilla, were also modeled in wax in order to simulate the final dentures as accurately as possible during clinical try-in. Following careful analysis, the posterior teeth were adjusted to a more distal position in order to achieve a more individual and natural appearance. The single tooth (46) was enclosed in a circular fashion by the base to provide the upper setup with greater occlusal stability and to compensate for distal movement of the tooth. The patient responded well phonetically and functionally, and was delighted with the natural appearance of the denture teeth. Thanks to the three-dimensional anatomical structure in multiple layers, and the harmonious shade gradient from the neck to the incisal area, the VITAPAN EXCELL anterior tooth set had an incredibly lifelike appearance. Its natural morphology and nuanced surface texture facilitated a brilliant play of shade and light in the patient's mouth, even during try-in. The distinctive incisal characteristics with a white incisal margin and integrated mamelon structure created an organic shade effect, while the balanced light transmission resulted in natural light dynamics.
The upper denture with modeling complete and the natural play of light of VITAPAN EXCELL.
The palatal anatomy was also precisely simulated for try-in.
The upper and lower denture with modeling complete in the articulator.
The patient was already delighted with the esthetic result during try-in.
A silicone key was fabricated from the wax setups; the teeth were removed, cleaned and conditioned in the base and cervical areas for acrylic fabrication. Following repositioning of the denture teeth in the silicone key and prior to pouring, the complete denture base was customized with Castdon polymer, and the vestibular labial shield and palate area customized using shades from the Denture Art system (both products from Dreve Dentamid, Unna, Germany). Following repositioning of the master model in the key and autopolymerization, both dentures were finished using a rotating instrument. Final polishing was carried out using a pumice stone, polishing paste and a polishing wheel. Depending on the age of the patient, the age of the teeth can be controlled by reducing the surface texture to a greater or lesser degree by quickly polishing. In this case, the surface texture of the teeth were consistently avoided by using a handpiece in order to maintain a more youthful appearance for the denture teeth.
The cleaned and conditioned denture teeth repositioned in the silicone key.
The completed, finished upper denture had a completely natural appearance.
The slight overlap in the lower anterior area provided an individual appearance.
This case shows that by using the right denture teeth in accordance with esthetic guidelines, and by working with a creative dental technician, it is possible to create full denture restorations that compare favorably with complete ceramic jaw restorations. The patient was delighted with the highly esthetic result and the stable seating of her new dentures, and was already more confident immediately after placement. The denture teeth showed a lifelike play of light and gave the patient an age-appropriate appearance again.
The highly esthetic full denture restoration prior to insertion.
Both dentures could be integrated harmoniously in the oral cavity.
Denture teeth and mucogingival reproduction formed a natural-looking restoration.
The patient was completely satisfied with the highly esthetic result.
Image source: Photo documentation by Marita Heeren, Oldenburg, Germany.
Her expectations were understandably high after years of frustration. Dental Technician José María Fonollosa PhD (Barcelona, Spain) demonstrates that by combining the prefabricated teeth VITAPAN EXCELL Anterior and VITAPAN LINGOFORM Posterior, the situation was functionally and esthetically restored.
The initial situation with the uneven line of the incisal edges in the upper jaw.
RESULT: The course of the incisal edge harmonized with the lower lip, which no longer protruded forward.
The expectations of a full denture restoration are always the same – the patients want to be able to chew with their dentures without any problems and regain an age-appropriate appearance. Neither was present in the following case, which is why the affected 63-year-old patient wanted new dentures. Her expectations were understandably high after years of frustration. Dental technician José María Fonollosa PhD (Barcelona, Spain) demonstrates that by combining the prefabricated teeth VITAPAN EXCELL Anterior and VITAPAN LINGOFORM Posterior, the situation was functionally and esthetically restored.
The clinical inspection revealed a total prosthetic restoration. The denture teeth of this restoration appeared lifeless at first glance and showed unsightly discoloration. The incisal edges of the maxillary teeth did not follow the line of the lips, but were in infraposition in the first quadrant and supraposition in the second. The incisal edge of tooth 22 was also longer than that of the neighboring tooth 21. This made the esthetic zone appear asymmetrical and bumpy. The front featured a progenic bite (Angle class III), as well as a frontal open bite, which made it difficult to bite off food, and the lower lip bulged forward. Occlusal contact existed only between the incisors in the maxilla, and the lateral incisor and canine in the mandible, which led to instability and point loading during chewing.
The initial situation with the uneven line of the incisal edges in the upper jaw.
The progenic bite situation with occlusal stress on particular points.
The aim was to change the current dentition of an Angle class III to a neutral bite position (Angle class I) in the full denture restoration, which was statically and dynamically possible, due to the positional relationship of the jaw ridges, and by changing the tooth setup. After the mucodynamic impression and determination of the jaw relation, the patient's situation was transferred to the articulator and the wax setup was started. Thanks to the diverse selection of shades and shapes, it was possible to find the VITAPAN EXCELL anterior tooth set in the desired shade that matched the shape of the face and the jaw ridge conditions. The three-dimensional anatomical layering and the natural surface texture of the denture tooth ensured a natural and lively appearance. In the posterior region, a simple and intuitive setup was possible by closing the articulator, and thanks to the VITAPAN LINGOFORM with automatic centric finding based on the gear wheel principle.
New restoration: Surface texture, shape and shade were age-appropriate after the integration.
A Class III became a Class I (neutral bite position) as a result of the realignment.
During the clinical try-in, the patient gave her consent and the two wax setups were implemented in resin. After finishing the denture bases, the teeth were only selectively polished with the handpiece to prevent the reduction of the juvenile surface texture of the VITAPAN EXCELL. After the integration, the patient was absolutely satisfied with her new smile and the optimized dentition. Thanks to the right choice of denture teeth and dental technology, she now had the full denture function and esthetics that she had desired for so long.
The patient with her new full denture restoration.
RESULT: The course of the incisal edge harmonized with the lower lip, which no longer protruded forward.
In the following, Dental Technician and Laboratory Owner Toni Tauste (Barcelona, Spain) demonstrates the decisive contribution made by the VITAPAN EXCELL anterior set to rapid patient acceptance.
The juvenile surface texture of the VITAPAN EXCELL was lightly polished to achieve an age-appropriate appearance.
The loss of natural teeth and having to depend on dentures can be a very challenging experience, especially for "youthful" patients. In these cases, any denture is initially perceived as a foreign body. For immediate acceptance, it is essential that patients are satisfied with their appearance, the hold of the dentures and functionality when chewing and speaking, right after integration. This is the only way that the feeling of a foreign body fades into the background and rapid acclimation is possible. In the following article, dental technician and laboratory owner Toni Tauste (Barcelona, Spain) shows us the critical contribution made by the anterior tooth set VITAPAN EXCELL (VITA Zahnfabrik, Bad Säckingen, Germany) to rapid patient acceptance.
A 48-year-old patient had a high degree of tooth mobility and massive bone deterioration due to generalized, chronic periodontitis. Due to the severe periodontal damage, none of the natural teeth were worth saving and had to be extracted. For a secure hold of the dentures and palatal freedom in the upper jaw, implants with ball head anchors were to be placed in the same session. We planned to reinforce the upper jaw restoration for sufficient stability of the construction with a metal framework. The VITAPAN EXCELL anterior set and the VITAPAN LINGOFORM posterior set were to be used for removable implant prosthetics. Both prefabricated tooth lines consist of the highly crosslinked VITA MRP (Microfiller Reinforced Polymer Matrix) composite formula, which promises high abrasion resistance.
The implant- and mucus membrane-supported full denture after implementation in resin.
The selection of the anterior teeth together with the patient played a key role in future acceptance. In this case, it was possible to use the natural teeth that were still present as a guide. However, the patient wanted a lighter tooth shade and a younger appearance. Thanks to the rich selection of shades and shapes of the VITAPAN EXCELL, the appropriate anterior sets for the upper and lower jaw were quickly found. The surgical pretreatment was carried out as planned so that the final removable work could be fabricated after the appropriate recovery and healing time.
VITAPAN EXCELL is based on the morphology of natural teeth.
The denture in the upper jaw, reinforced with a metal framework, was designed to be palate-free.
The juvenile surface texture of the VITAPAN EXCELL was lightly polished to achieve an age-appropriate appearance.
A healthy periodontium was simulated with the papilla design.
When the two dentures were fitted, the patient immediately took on a significantly younger appearance. The three-dimensional anatomical layering of incisal, neck and dentin material, and the resulting shade and translucency progression appeared lively and authentic. Since the tooth axes, angular characteristics and the length-width ratio of the VITAPAN EXCELL sets correspond to the golden ratio, the esthetic zone was characterized by a harmonious overall appearance. The juvenile surface texture of the denture teeth was only lightly polished in the course of finalization to adjust it to the patient's age. Thanks to the wide interdental marginal ridges, the papillae could be designed in such a way that the adjacent gingival parts simulated a healthy periodontium. The patient was immediately enthusiastic about his new, youthful smile.
The patient was very enthusiastic about his new, youthful smile. VITAPAN EXCELL made possible an appropriate makeover that led to rapid patient acceptance.
In the following, dental technician Yasunori Tanaka, in collaboration with dentist Dr. Eiji Kuroki (both Kōbe, Japan), shows how he was able to solve a functionally challenging case in a patient-friendly manner using the VITAPAN EXCELL anterior set and the VITAPAN LINGOFORM posterior set.
he initial situation with the facial features of the patient without dentures.
The patient was satisfied with the new restoration.
For full dentures, a comprehensive selection of shades and shapes for the prefabricated teeth selected is essential in order to provide patient-friendly care. The shape of the teeth must match the gender, as well as the shape of the head and the patient's character. Lost natural teeth should be taken into account when selecting the denture teeth, and at the same time, the new space conditions on the atrophied jaw ridge should be considered. In the posterior region, the correct occlusal expansion must be found in order to fit the anatomical conditions and the patient's dental occlusion, or to change this towards a neutral bite position without losing the centric condyle position. The selected shape should also be available in the patient's desired shade. In the following, Dental Technician Yasunori Tanaka, in collaboration with Dentist Dr. Eiji Kuroki (both of Kōbe, Japan), will demonstrate how he was able to resolve a functionally challenging case with the VITAPAN EXCELL anterior set and the VITAPAN LINGOFORM posterior set (VITA Zahnfabrik, Bad Säckingen, Germany).
A 74-year-old patient visited the practice, as she was dissatisfied with the function and esthetics of her current full denture. The restorations were the result of original partial dentures that had been successively expanded, since tooth 16 and the anterior of the lower jaw had been preserved for a long time. The patient did not want the new restoration to change her facial features in any way. Only the curvature of the philtrum was to be slightly reduced to harmonize better with the dental support of the soft tissue in the lower jaw. The wear on the current denture teeth suggested an approximate increase in bite of 1 -2 mm. However, due to the patient's cardiovascular disease, it was decided to maintain the current occlusal height. The centric position was unstable and could not be identically reproduced.
The initial situation with the facial features of the patient without dentures.
Trays for the mucodynamic impressions were developed on the basis of anatomical impressions, and in turn, were used to fabricate the master model. Based on this, a support pin registration followed in order to determine the maxillo-mandibular relationship. Since clear deviations to the left and right were repeatedly noted during laterotrusion, the support pin registration was carried out using a number of superimposed trajectories. Since the diurnal centric could only be registered diffusely in a larger area that extended far in the distal direction, it was decided to code the centric position 0.5 mm in front of the anterior area of the support pin marks. The denture teeth in the posterior region should be given more space to compensate for the existing class II angle. In the old dentures, the prefabricated teeth were severely abraded and the front teeth were in contact. Based on our observations, this protrusive tendency is generally more pronounced in Japanese patients.
For a support pin registration, bite templates were fabricated on master models.
The support pin registration revealed an unstable diurnal centric.
The keyed determination of the maxillo-mandibular relationship in the articulator.
The master models were articulated based on the determination of the maxillo-mandibular relationship in order to provide the basis for the fabrication of the new full denture work. The denture teeth VITAPAN EXCELL (anterior) and VITAPAN LINGOFORM (posterior) were selected for the new restoration, as these are based on the highly cross-linked composite formulation VITA MRP (Microfiller Reinforced Polymer), which means that a high level of wear resistance can be expected over the clinical course. When choosing the anterior tooth set, the decision was made against the T-shape in order to prevent the lip from sagging too much in the upper jaw. The O- and the R-shape proved to be closer choices. We selected VITAPAN EXCELL O45 in the upper jaw and L35 in the lower jaw, due to the patient's gender and the shape of her head. In the posterior region, VITAPAN LINGOFORM L21, which has small mesio-distal dimensions, was to be used in order to have room to dentally compensate for the distal occlusal position. Upon request, a lighter shade of A2 was selected as the tooth shade.
The setup in wax with the anterior tooth set VITAPAN EXCELL.
Despite the angle class II, we succeeded in creating a neutral bite position.
In the posterior region, the multi-functional VITAPAN LINGOFORM was used.
Since VITAPAN EXCELL corresponds to the esthetic rules, the anterior teeth were set up intuitively. Thanks to the multifunctional occlusal relief of the VITAPAN LINGOFORM, stable dentition with the closing of the articulator could be produced quickly in the posterior teeth. This was followed by the clinical wax try-in, with final corrections and the transfer of the dentures to resin. When finishing and polishing, care was taken not to reduce the surface texture of the VITAPAN EXCELL too much in order to obtain an age-appropriate effect. Upon integration, the patient was satisfied with her new appearance, which was the fundamental requirement for acceptance of the new restoration. VITAPAN EXCELL had given her the tooth shape and shade that met her expectations, while also suiting her personality and appearance.
The full denture restoration after implementation in resin.
Tooth 47 had not been set up due to a lack of space.
The surface texture of the VITAPAN EXCELL, adjusted by polishing, appeared vibrant and age-appropriate.
The patient was satisfied with the new restoration.