A new smile for Andrea

A patient of Eric D. Kukucka, DD (Canada)
“You and your team saved my life. I can now go out in public and not be ashamed. I can smile in pictures with my kids. I finally get to live life again. There is no way I could ever express how thankful I am to you and your team,” wrote Andrea. Digital Denture gave her a new lease of life. 
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The patient

Name: Andrea
Age: 25 years
Country: Canada
 
Starting situation
Andrea was 25 years old when she was referred to us by her dentist Dr Peter Siedlakowski. She presented to our practice in the company of her mother and told us about her ordeal. The young woman suffered from a genetic disorder, one of the symptoms of which presents as very weak tooth enamel. Furthermore, the patient was afflicted with a chronic pain syndrome also known as fibromyalgia*.
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The clinician

Eric D. Kukucka  |  Facebook  |  Instagram

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Over the previous few years, the patient had had to vomit three to four times per day on average. The resultant acid erosion had significantly damaged her already compromised dentition. In the previous few years, Andrea had to take “countless” courses of antibiotics, the effectiveness of which diminished over time. As a result of these infections, several teeth had to be extracted. Andrea’s grave oral health situation interfered with her ability to eat. The appearance of her teeth profoundly affected her emotionally. She did not dare to smile anymore. Her mental health and self-concept suffered. She ended up in a downward spiral.

*What is fibromyalgia?

Fibromyalgia is a chronical disorder characterized by musculoskeletal pain in different body regions and increased fatigue. Apart from the key symptoms, there are many attendant symptoms such as morning stiffness and concentration problems.
 

Andrea presented to our office with a gleaming personality, a wonderful spirit and great motivation to achieve a new smile. At first, she showed some reservations about what could be possible in her esthetic outcomes. However, with the collaborative efforts of Eric Kukucka and Dr Mark Shuren, we showed her what is possible. Not only did her smile change in the process, mine changed as well. This type of case reminds me of why I started in my profession.

Dr Peter Siedlakowski, BSc. MSc., referring dentist

The patient’s expectations on the treatment

  • Few interventions with only view appointments
  • No temporary toothlessness
  • An appropriate, esthetically and functionally pleasing result
Despite the options available to us, identifying the ideal treatment modality was quite difficult in the absence of certainty regarding the longevity of any restorative measures taken. As a result, we planned an initial provisional solution for Andrea as an interim treatment step.

Planned treatment procedure

  • Extraction of teeth that could not be saved, followed by immediate insertion of the temporary interim denture with Digital Denture
  • Therapeutical phase with Digital Denture
  • Implant-supported restoration
Andrea’s few remaining teeth were severely damaged and could not be saved. Because of her dental history, Andrea was terrified of undergoing major dental treatment.
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The remaining teeth in the upper and lower jaw could not be saved and had to be extracted. Since the patient did not wish to be toothless in any phase, an interim denture should be available at the time of extraction. In order to obtain an esthetically and functionally pleasing result and being able to produce an interim denture before the actual surgery, we decided to use Digital Denture*.

*What is Digital Denture?

Digital Denture comprises a complete manufacturing process for the efficient production of removable dentures. Exclusive design software combined with coordinated materials and specialized manufacturing strategies and the cutting-edge PrograMill milling equipment provide predictable and consistent results.
 

Production of the interim denture with Digital Denture

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The study models were digitized with a laboratory scanner (3Shape) and the data record was transferred to the Digital Denture software program. Before the interim denture could be designed, the remaining teeth had to be removed from the virtual model. For this purpose, the software program features a virtual extraction tool. Based on the maxillomandibular relationship record, the vertical dimension between the upper and the lower jaw was opened by 5.5 mm.

Conventional anatomical impression taking.

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Digitalized study models in the Digital Denture software​.

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Removal of the teeth with a special virtual tool​.

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Digital model measurement in accordance with the conventional process​.

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The tooth moulds were selected with the help of the Digital Denture Full Arch tooth library.
We selected the teeth from the Phonares II B71-L50-N3 range. The software automatically generated a suggestion for setting up the selected teeth. If necessary, this set-up can be customized.
 

Digital Denture CAD software. The process is fully automatic. However, individual adjustments can be made at every stage.

Selection of the tooth moulds from the Digital Denture Full Arch tooth library.

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Next, we evaluated the basic parameters and adjusted any details. We finalized the denture base and characterized the gingival contours. Digital Denture is easy to use due to its convenient virtual tools.

The program automatically sets up the teeth according to the model analysis. Adjustments can be made if necessary. 

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The CAD file was saved and the software generated two CAM output files:
  • a CAM output file for milling the dental arch 
  • a CAM output file for milling the denture base
The Digital Denture process incorporates a number of different PMMA discs; in the present case, we used IvoBase CAD Pink V. The dental arch was milled from a polychromatic DCL* (SR Vivodent CAD Multi). A gingiva-coloured PMMA disc (IvoBase CAD) was used to mill the denture base.

*What is a DCL acrylic?

DCL is the acronym of Double-Cross-Linked. The material displays a higher compressive strength but a similar flexibility to conventional PMMA.The tooth-coloured SR Vivodent CAD Multi discs feature multiple shade layers. They are characterized by the Pearl Structure Effect which ensures a balanced progression of the shade. This effect imparts the monolithic teeth with a very natural-looking appearance. 

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The dental arch and denture base were milled in oversized form (PrograMill PM7*). While the occlusal surfaces of the dental arch were produced in oversized form, the basal surfaces were exactly milled to fit the denture base. In the next step, the tooth arch and the denture base were bonded together. A two-component bonding agent was used (IvoBase CAD Bond) for this purpose. The tooth arch and the denture base were finalized in the subsequent precision milling and finishing process.

 

*What makes PrograMill PM7 special?

PrograMill PM7 sets new industrial standards. The high-power machine is capable of processing a variety of materials in wet and dry mode. The high dynamics and efficiency of the machine result in precise and fast production results. The 5-axis machining process is controlled via the integrated PC with touch-screen monitor.

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The IvoBase CAD PMMA disc (shade Pink V) for milling the denture base.

Milled tooth arch milled in the SR Vivodent CAD Multi disc.

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The discs immediately following coarse milling in the oversize process​.

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The second milling cycle takes place after the permanent bonding of the two segments with IvoBase CAD Bond…

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... and after bonding, the interim denture is separated from the disc.​

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After the CAD/CAM milling process, the interim Digital Denture required only minimal manual finishing.​

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The manual finishing work was reduced to a minimum. The morphology of the vestibular areas of the denture base was created with the help of the software and then machined in a 1:1 ratio. The soft transition from the tooth to the gums was created with a fine fissure bur. The teeth were separated with an elastic glass-fibre reinforced separating disc. The dentures were pre-polished with a dental handpiece and then polished to a final high gloss in a polishing unit, using pumice and polishing paste and a cotton buffing wheel. The digitally manufactured interim dentures were ready in the surgery at the tooth extraction appointment. 

Separation of the teeth with a separating disc​.

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The digitally manufactured interim dentures look very natural. Evenly thin denture base for the upper jaw.​

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On the surgery day, the interim dentures produced with the Digital Denture process were ready and waiting. Andrea’s remaining teeth were extracted under full anaesthetic. In addition, slight alveoloplasty* was conducted to provide optimal esthetic results. The surgery was successful. When she woke up from the anaesthetic, Andrea was fitted with her interim dentures. She was released in the care of her mother. One week later she presented to the practice for a recall appointment. At that time, it seemed like she had been transformed into a new person. Not only her appearance, but also her demeanour had changed remarkably. She radiated vitality and self-confidence.

The patient attained not only a beautiful smile, but also – more importantly in this case – a measurably improved quality of life. Due to the Digital Denture process, the patient experienced very little discomfort. The number of dental appointments was reduced to a minimum, while the results were maximized.

*What is alveoloplasty?

Alveoloplasty is a surgical procedure of shaping the alveolar ridges to reconstruct the jawbone.

Digital Denture is an automated digital manufacturing process for the efficient production of removable dentures. This innovative process offered the young patient a way out of her difficult and distressful situation. It allowed us to create removable dentures using CAD/CAM methods without having to change any of the usual clinical dental processes. At the time of the surgical intervention, the dentures were ready for insertion.

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There are times in the course of your career when you really feel that you have markedly improved a patient’s appearance and outlook on life. As an oral and maxillofacial surgeon, this is usually achieved with the correction of skeletal deformities via complex orthognathic reconstructive surgery. To obtain such results with nothing further than full mouth extraction of the terminal dentition followed by denture delivery, is nothing short of extraordinary. When Eric Kukucka approached me about working with him on this case, I was intrigued because he said that he was trying out a new process. Although the surgery was routine, the prosthesis was anything but routine. It has truly been an honour to be involved in this feel-good case.

Dr Mark Shuren, Hon BSC, DDS, FRCD(c), oral surgeon

In the next phase, we will provide Andrea with dental implants. She has great confidence in our team and is well-prepared to face the upcoming challenges.

We are all here to support Andrea on her journey to regaining her quality of life: Her new dentures are only the beginning.

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