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Masterpiece: Carlo Montesarchio

Masterpiece Carlo Montesarchio 1
Masterpiece Carlo Montesarchio 2

Carlo Montesarchio's patient case

Technical procedure for the fabrication of full upper and lower dentures

Step 1 Initial situation
Step 1 Initial situation

Step 1 Medical history

The patient, a 58-year-old woman, presented in our practice. Her medical history indicated satisfactory general health. During the clinical examination, the practitioner identified difficulties in function and speech that had had a negative impact on her social relationships. The patient wanted complete restoration of the oral situation. The goal of restoration was the fabrication of full dentures that would offer optimum esthetics in addition to perfect function.

Step 2
Step 2

Step 2

The technician fabricates the base plates for the upper bite template. Light-curing acrylic is used in order to fabricate the bite template bases. To facilitate controlled contraction of the material, this process is carried out in several stages.

Step 3
Step 3

Step 3

The amount of wax required for the tooth is removed from the rim and replaced by tooth 21.

In order to be able to continue to use the markings on the bite rims during anterior setup, Carlo Montesarchio always removes only as much wax from the bite rim as is required for the tooth that has been set up. In this way, the teeth are gradually positioned in optimum fashion until all the anterior teeth have been set up.

Aufstellung der Zähne 32 und 42 in die entstandene Lücke.
Aufstellung der Zähne 32 und 42 in die entstandene Lücke.

Step 4

Tooth 33 and 43 are set up in such a way that the palatal surfaces of the upper canines slide over the lower canines, thus avoiding diastemata in the posterior area. As a result, an appropriate balance is achieved between overbite (frontal overbite) and overjet (sagittal frontal protrusion).

Tooth 32 und 42 are fitted into the gap that has been created. Setup is completed while taking esthetic and functional aspects into consideration.

Step 5
Step 5

Step 5

Assessment of the correct relation between esthetics and function.

Step 6 ndividualization of the incisal area
Step 6 ndividualization of the incisal area

Step 6

Verification of the correct relation between esthetics and function.

Step 7 The result prior to placement of the veneers.
Step 7 The result prior to placement of the veneers.

Step 7

Following completion of the upper jaw, setup is carried out for the lower quadrants, beginning with tooth 36 and taking the Angle classification into consideration. Tooth 35 and 34 are positioned in such a way that they each have contact with two antagonist teeth. In this respect it should be noted that the upper cusps interlock with the fissures of the lower dentition.

Step 8 Final prepared restoration prior to placement.
Step 8 Final prepared restoration prior to placement.

Step 8

Shaping the alveolar process and the gingival contours.

In order to achieve optimum esthetics, considerable importance is attached to the gingival margin of the dental restoration as well as the corresponding color. The gingival contours are shaped in advance with a view to replicating the morphology of the papilla and the gingival margin as naturally as possible.

Step 9 End result
Step 9 End result

Step 9

Upper acrylic dentures: assessment of the occlusion together with the lower wax setup in the articulator.

The dentures modeled in wax are invested in flasks one after another in order to be able to assess reassembly in the articulator in each case. Following divesting from the flasks, the dentures are cleaned and finished, during which any impurities are removed.

Step 9 End result
Step 9 End result

Step 10

The flanges of the dentures are similar in appearance to gingival tissue with a natural blood supply, because their surfaces are anatomically shaped as if they were interspersed with natural blood vessels.

Step 11
Step 11

Step 11

Characterization of the denture flanges is carried out using composite. Layers of acrylic are intentionally removed and replaced with composite material in order to shape the transition between the gingiva and the alveolar mucosa. Polishing of the dentures is carried out in two stages: using the polishing machine and using the handpiece in the working area.

Step 12
Step 12

Step 12

Characterized denture flange with composite material.

Step 12
Step 12

Step 13

The final dentures in the mouth.

The criteria for esthetic evaluation of full dentures depend on the individual perspective of the observer. Although the loss of natural dentition cannot be reversed, the negative impact on the patient's enjoyment of life can be lessened in this way.

Step 12
Step 12

Step 13

Almost all patients would like teeth that are white, completely straight and without any defects. In addition to the restoration of masticatory function, practitioners and dental technicians should, by contrast, always aim to restore shade, surface structure, characterization and anatomic shaping in such a way that the teeth and tissue have as natural and as realistic an appearance as possible. 

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