RECENT ADVANCES IN COMPLETE

PRESENTED BY: DENTURES

REBECCA LILDA
2ND YEAR MDS
 TABLE OF CONTENTS
TABLE OF CONTENTS
• INTRODUCTION
 New classification of articulators
• RECENT ADVANCES
New concept of centric relation
 Mouldable impression trays
Magnets in complete denture
 Newer impression materials
Different methods of polymerization
 Improvements in alginate Valplast dentures

 Other advances BPS dentures

 New classification of articulators Articulating material

Modifications of denture base resins

New concept of Centric Relation
Nanotechnology
Magnets in Complete Denture
•DIGITAL ADVANCEMENTS
 Jaw tracking device & CBCT
Rapid prototyping
Trubyte Alma Gauge CAD CAM dentures

TruX digital system Tooth arrangement robot for complete dentures

•RELATED ARTICLES
T scan occlusal analysis
•CONCLUSION
Digital impressions
•LIST OF REFERENCES
Virtual ariculators
INTRODUCTION

THE ONLY THING IN LIFE THAT IS CONSTANT IS CHANGE, and development is the essence of any
change.
• Dentistry has come a long way from just replacing missing teeth to replacing lost alveolus,
supporting facial structures, recreating esthetics, reestablishing phonetics and many other
major developments.
• We can say that in prosthetics by using all the artificial materials as well as technologies, we
can give a nearly natural appearance to an individual to the best of mankind.
RECENT ADVANCES
MOULDABLE DISPOSABLE IMPRESSION TRAYS

• The mouldable complete denture tray design is based on Prof. J. Schreinemakers’ original
design.

ANATOMICAL DESIGN:

• Perfect anatomical extensions to accurately record all landmarks and extensions.

 SINGLE VISIT FINAL IMPRESSION
• The trays can be custom molded and adapted to the arch form. Subsequent border moulding
prior to making a final impression, circumvent the need of a special tray.

OPTIMAL TRAY SELECTION

• Distance between the retro molar pads in the mandible and the hamular notches in the
maxilla are measured for tray selection from the key chart.
BORDER LOCK
• Provides adequate locking of the impression material

• Allow easy removal of cast models

ADVANCED ANATOMICAL DESIGN & MOULDABLE

The mouldable feature of the tray effectively reduces and seals the impression space
which results in a highly accurate and detailed reproduction.
 STEPS IN MAKING IMPRESSION
.
• Measure the arch size with the help of caliper followed by selecting the relative mouldable
impression tray.

Mouldable dentulous tray Keep the tray immersed in water (70°c) for
one minute
Adapt the tray by hand.
• Keep desired form stable for 5 seconds.
•The tray cools down in 90 seconds and
returns to its original rigid state.
• Check the fit in the mouth and if
needed, repeat the moulding procedure
(1) Development of tray stops using high-viscosity VPS.

(2) Accomplishment of border-molding procedures using high- or medium-viscosity VPS.

(3) Trim tray overextensions using an acrylic resin carbide bur if the tray is seen to show through the
border molding material.

(4) Reduce border molding and tray stops by 1 mm to 2 mm in all dimensions and according to
selective pressure philosophy to provide impression space for the final wash material.
(5) Introduce medium-, low-, and extra-low viscosity VPS materials into the tray and make the
definitive impression. If excessively mobile soft tissues are present, care must be taken to
provide additional tray relief and use an extra-low viscosity VPS in the affected areas of the
impression.
IMPRESSION MATERIALS

Several investigators have recommended using newer elastomeric materials such as polyvinylsiloxane
and polyether for final impressions to replace the older and more traditional materials. VPS, an
addition-reaction silicone, offers a number of distinct advantages for making edentulous impression
which includes:

• Availability of different viscosities.

• Convenient delivery system (i.e., automix cartridges).

• Predictable material adhesion between sequential layers of different material viscosities.

• Materials with various working times are available to satisfy operator preference.
• The material is sufficiently elastic.

• The material has clinically acceptable tear strength.

• Newer materials have been chemically modified to improve wettability or hydrophilicity.

• The material is generally biocompatible.

• The material does not possess offensive taste or odor.

IMPROVED IMPRESSION MATERIALS

SPECIAL REINFORCING SYNTHETIC (SAS)

• SAS reduces viscosity to make silicone flow more easily. This “flow conditioning” effect, combined
with hydrophilicity, produces an impression with the highest precision ever achieved using a
condensation silicone system.
QUADRA FUNCTIONAL HYDROPHILIC SILOXANE

Unique combination of quadrafunctional modified siloxane resins, conventional cross-linkers and

bifunctional linear polymers not found in any other impression material.

• Exceptional tear strength and the surfactant produces a wetting ability equivalent to polyethers.

• Provides surface detail in a moist environment unmatched by other siloxane impression materials.

• Stays where you place it-in the tray- and then flows in the sulcus when the tray is seated. In addition
they flow under extremely low pressure.
“ALGINATE ALTERNATIVES” (AA)

• They can be poured repeatedly and they have long-term stability

• Time saving
 IMPROVEMENTS IN ALGINATES

l. Flavour Added - Spearmint / Mango / Mint

2. Rapid Set - Hydrogum Normal Set - Neocolloid

3. Dust free - Aliginoplast

4. Chromatic Alginate - TRIALGIN / KROMALGIN

5. Paste form - (Catalyst + Base)

6. Alginate Containing Microbials

a) Chlorhexidine

b) Quatenary Aluminium
SILICONISED ALGINATE

• Two paste system one containing the alginate sol and the second containing the calcium reactor.

• The components incorporate a silicone polymer component which makes material tear resistant
compared to unmodified alginates.
ANTISEPTIC ALGINATE IMPRESSION MATERIAL

• Contains 0.01 to 7 parts by weight of an antiseptic such as glutaraldehyde and chlorhexidine

gluconate per 100 parts by weight of a cured product of an alginate impression material.

• Antiseptic may be encapsulated in a microcapsule.

IMPRESSION MATERIAL MIXING INSTRUMENT - PENTAMIX 2

ADVANTAGES :

a) Top quality mix in less time

b) More flexible mix

c) Homogenous void free mix

d) Direct filling of syringes and trays

When changing impression materials, cartridges and penta mixing tip has to be changed.
 IMPREGNUM PENTA SOFT HEAVY BODY/LIGHT BODY
IMPRESSION MATERIAL
• With Impression materials, the better the detail, the more accurate the final restoration.

• Introducing Impregnum TM and Penta TM Soft Heavy Body/Light Body Impression material,
a precision polyether impression material that is accurate and hydrophillic, resulting in
outstanding details even in moist environment, right from start of mixing.

• The Soft Technology makes the material less rigid for easier removal from the mouth
while improving the taste for better patient's satisfaction.

• Intrinsic presetting hydrophilicity helps capture and reproduce outstanding details.

 FLASKING STONE - GC ADVASTONE

Specially designed for flasking techniques in denture fabrication

ADVANTAGES:

a) Minimal setting expansion

b) Comfortable working time

c) High compressive strength

d) Yet diminished strength after setting for easy divesting

e) Excellent accuracy
 GC STONE GLAZE LIQUID

Stone Glaze liquid specifically designed for the surface t/t/ of GC Fujirock EP plaster/white

ADVANTAGES:

a) Better visibility of details

b) First class presentation of prosthesis

c) Bio compatible
 DISSOLVING AGENT FOR DENTAL STONE AND PLASTER

Agent for dissolving dental stone and plaster residues by immersion

ADVANTAGES:

• High dissolving capacity

• Suitable for stone + Gypsum Bonded Investment Cements

DISINFECTING SOLUTION

COEZYME
• Dual enzymatic Detergent Concentrate.

ADVANTAGES:

• Co enzyme has highly concentrated dual enzymatic detergent.

• The ionic surfactant in Coezyme help the powerful solution to access and clean hard-to-reach areas.

• The synergistic enzymes dissolve and lifts proteins and the low sudsiding neutral pH detergent
component removes the dissolve particulates.
 DENTURE COMFORT WITH STERADENT

Steradent has launched Steradent Denture Comfort Fixative Cream.

• In addition to ensuring secure and comfortable hold of the dentures, the cream includes camonite,
claimed to help prevent gum inflammation.

• The current range of steradent products include Steradent Triple action original and Fresh Cleaning
Tablets Steradent Extra length.
GC ACRON MC
GC Acron MC is a microwave curing denture resin in which polymerization takes place in a microwave
at a much shorter time. This is supplied same as powder and liquid form.

ADVANTAGES :
1. 3 minutes polymerization time in a standard household microwave oven.
2. Uniform polymerization even in thick sections.
3. Excellent dimensional stability.
4. Excellent fit to the tissue surfaces.
5. High Surface Hardness.
6. High Strength.
7. Color stability.
 SURFACE CONDITIONS AND VISCOELASTIC PROPERTIES OF
DENTURE LINER

• When patients suffer from fragile supporting mucosa, excessive residual ridge resorption, substantial
undercuts and/or traumatic or pathologic tissue, the clinician may opt for the use of a soft lining
material between the intaglio surface of a prosthesis and the supporting tissue.

• Soft liners are useful to attenuate the discomfort resulting from the instability of improper adaptation
of the prosthesis.
The selected material must
• minimize bone resorption
• protect the supporting gingival tissues
• provide good surface conditioning
Materials included in this family of Denture liners are
• Dentimex BV
• Perma
• Dimethyl polysiloxanes (DMPS-Flexor)
• Ethylene Vinyl Acetate Copolymers

All of these materials behave viscoelastically, depending on their flexibility, which can vary

according to the selected thickness. Therefore, clinical choice between these different families

is determined by the problems presented by the supporting tissues and the design of the

prosthesis.

• Among the new denture liners is Benzene dimethyl polysiloxane materials and permaflex

which establishes the efficiency of the material as resilient denture liners.

 NEW CLASSIFICATION OF ARTICULATORS

• New classification system (Dental relater classification system)

Open-end dental relaters:

• This is an alternative classification system. It is comprehensive but complex. Advantages of

this system allows for organization of instruments based on a historical and heuristic
relationship. If it is open-ended that means further development beyond todays current
technology can be expected.
Class A Simple hinge with vertical stop.
Class B  Hanau twin stage occluder.
 Jelenko verticulator
Class C  Bonwill 1858
 Spring hinge, reusable, metal.
 Spring hinge, disposable, plastic.
Class D  Balancer Jr, Hagman.
 Mandibulomaxillary instrument, Monson, 1925.
Class E  Gysi, Simplex.
 Stephan.
 Phillips, Student.
 Hanau, 147-I.
 Denture tripod, Stansberry.
 Steele’s.
Class F Non arcon
 Hanau, 96H2o.
 Hanau, University.
 Gysi, Adjustable.
 Dentatus, ARL.
 Hanau, Kinscope.
 House, Rotary grinder.
Arcon
 Whip Mix, 8500.
 Hanau, H2 Arcon.
 Dentatus, ARA.
Class G  Hanau, Adjustable.
 Ney.
 TMJ.
 Denar, D5A.
 Stewart, Gnathological computer.
 Grager, Gnatholater.
Class H Sub-class 1 (H1)
 Digital representation similar to class G.
Sub-class 2 (H2)
 Digital representation similar to class C.
 A NEW CONCEPT OF CENTRIC RELATION

• A new concept of Centric Relation is defined as "A clinically determined position of the mandible where both
condyles articulate into their anterior uppermost position.”

• The old definition defines centric relation as the relationship of the mandible to maxilla when the condyles are
in the most posterior portion of the glenoid fossa.

• In Centric Relation all the load of the mandibular residual ridge are transferred to the joint cavity pushing the
head of the condyle against the avascular disc and the cavity wall.

• Recently it has been found that there is evidence of nerve and blood vessels in this posterior aspect which can
get compressed causing pain to the individuals. But such pain is not noted in the patient thereby suspecting the
actual position of this condylar head in the joint cavity. So recently authors have suggested its position to be
anterior uppermost position of joint cavity.
 MAGNETS IN COMPLETE DENTURE

• The reason for their popularity is related to their small size and strong attractive forces which allows
them to be placed in prosthesis without being an obstruction in the mouth. The main magnetic
materials used are the rare earth elements Neodynium-Iron Boron (Nd,Fe,B).

• Other materials include RE Alloy, Samarium-Cobalt (Sm-Co). Samarium iron nitride is a promising
new candidate for permanent magnet application because of its high resistance to demagnetization
and better resistance than Nd Fe B to temperature and corrosion.

• Another advancement includes the encapsulation of the pre-existing magnets within relatively inert
alloys such as stainless steel or titanium.

International Journal of Oral Health Dentistry, July - September, 2015;1(3):133-137

• Various mechanical attachments have been used to retain over denture by friction. But the
retention may be lost gradually due to wear and moreover masticatory forces produce lateral forces
to the abutment through the attachment and the teeth may be loosened and finally extracted.
Magnetic forces are suitable for the retention and overcoming these difficulties. Devices retaining
the over denture magnetically are called as ‘magnetic attachments’.

ADVANTAGES OF MAGNETIC ATTACHMENTS

a) Small size within overdenture
b) Magnetic force work together with the negative pressure and adhesive retention over denture base
c) Increases the stability
d) Easily constructed without special technique
e) Insertion and removal of ovedenture is easy
f) Reduces lateral forces on the abutment tooth.
MICROWAVE ACTIVATED RESINS

• Microwaves are electromagnetic waves in the megahertz frequency activate the polymerization of
acrylic resin base.

• The procedure was greatly simplified in 1983 with the introduction of a special fibre reinforced plastic
flask, suitable for use in a microwave oven.

• . In 1984 and 1985, the light fiber-reinforced plastic (FRP) flask was substituted for the heavy brass
flask and compress, and the water-bath curing tank gave way to a microwave oven
• Methyl methacrylate (MMA) is a polar liquid at room temperature. The microwaves cause the MMA
molecules within the acrylic resin to orient themselves in the electromagnetic field at a frequency of
2450 MHz, and numerous polarized molecules are flipped over rapidly and generate heat due to
molecular friction. Initiating radicals are then able to react with monomers to start polymerization.
Microwave heating is independent of thermal conductivity; therefore, curing cycles involving the
application of rapid heat may be used without the development of a high exothermic temperature.
The major advantages of microwave heating over conventional heating are:
(1) The inside and outside of substance are almost equally heated, and
(2) Temperature rises rapidly as a result of numerous rapid intermolecular collisions.
(3) More time efficient & cleaner than conventional technique
(4) Greater dimensional stability of the resin
(5) Reduced porosity & good fit

Polymerization cycle:
• Short cycle: 3 mins at 500W
• Long cycle: 13 min at 90 W followed by 2 min at 500 W.
 LIGHT ACTIVATED RESINS

•Light activated resins (VLC resins) are copolymers of urethane dimethacylate & acrylic resin copolymer
along with microfine silica fillers dispensed as paste system

• Polymerisation is activated by high intensity visible light of 400-500nm for 10mins.

•After an initial cure of the resin base, teeth are repositioned on the base using a light cured template
& contouring is carried out followed by a final cure in the light chamber.
ADVANTAGES:
•Absence of methacrylate monomers so could be readily used in monomer sensitive patients.

•Produced resin contains high molecular weight oligomers which results in low polymerization
shrinkage (1/2 of that of conventional resins).

•High impact strength and hardness.

LIMITATIONS:
• Lower elastic moduli

• Slightly lower flexural strength which could increase deformation for dentures during function

• Inferior bond strength of VLC resins to resin denture teeth.

FLUID RESIN TECHNIQUE (POUR-TYPE ACRYLIC RESINS)

• The chemical composition of the pour type of denture resin is similar to the poly methyl
methacrylate.

• They are polymerized at room temperature.

• Principal difference is that the pour type of denture resins have high molecular weight powder
particles that are much smaller when they are mixed with monomer.
• The resulting mix is very fluid.

• Therefore they are referred as ‘fluid resins’.

• They are used with significantly lower powder liquid ratio, i.e., it ranges from 2:1 to 2.5:1.

• This aids to prevent undue increase in viscosity during mixing and pouring stages.
 HIGH IMPACT ACRYLIC
• This type of acrylic is also made by the heat cure method. These materials are butadiene styrene
rubber-reinforced poly methyl methacrylate.

• Certain rubbers dissolve in methyl methacrylate monomer notably copolymers of butadiene with
styrene.

• Impact resistance arises from the incorporation of rubber phase into the beads during their
suspension polymerization.
 RAPID HEAT-POLYMERIZED RESINS
• These are hybrid acrylics that are polymerized in boiling water immediately after being packed into
a denture flask.
• After being placed into the boiling water, the water is brought back to a full boil for 20 minutes.
• After the usual bench cooling to room temperature, the denture is deflasked, trimmed, and polished
in the usual manner. The initiator is formulated to allow for rapid polymerization without the
porosity that one might expect.
 NEWER DENTURE BASE RESINS
Knoop Rockwell Rockwell
Processing
Material Hardness Indundation Recovery
condition
Kg/mm2 (m) (%)
20 min cure 1000C, 20mins. 15 – 17 70 – 74 74 – 78
PMMA
Light cured 10min in light 18 73 72
PMMA chamber

Rubber 740C, 9 hrs. 14 79 73

reinforced PMMA
Auto 450C, 0.14 MPa 16 73 76
polymerizing
PMMA
Microwave cured 500W – 3 Mins. 17 74 75
PMMA
 Flexural Flexural Izod impact
Material Strength Modulus strength
MPa (GPa) (J/cm)

20 min cure PMMA 79 – 86 1.3 - 1.6 12 – 14

Light cured PMMA 80 2.1 13

Rubber reinforced PMMA 78 1.1 31

Auto polymerizing PMMA 84 1.6 15

Microwave cured PMMA 92 1.7 14

VALPLAST DENTURES
•Valplast® is a Flexible/Unbreakable Denture System, established in the USA since the early 1950's.
•It is a nylon based material
•By using tissue retention the clasping is invisible making the denture almost undetectable in the mouth.
The advantages of the Valplast® Denture system are :
1. Translucency of the material picks up underlying tissue tones, making it almost impossible to detect
in the mouth.
2. The material is exceptionally strong. The manufacturers proclaim it unbreakable, making it ideal
when constant fracturing occurs.
3. Stresses are almost entirely removed from the underlying bone and tissue structures.
4. Free movement allowed by the overall flexibility is referred to as 'a builtin stress breaker'.
5. Complete biocompatibility is achieved because the material is free of monomer and metal, these
being the principle causes of allergic reactions in conventional denture materials.
6. The long-term health of tissues is maintained due to the dentures’ gentle massaging action,
achieved without adversely loading the abutments.
VALPLAST KEY BENEFITS ARE:
•Retention - flexes into a retentive position, below the undercut.
•Comfort - thin, lightweight and flexible.
•Esthetics - pink shades that allow your patient's natural tissue tone to appear through the
material.
• Strength - clinically unbreakable, more durable than acrylic and won't absorb stains or
odors.
• Ease - No tooth or tissue preparation is required so you can offer patients a conservative
and pain-free solution.
BIO-FUNCTIONAL PROSTHETIC SYSTEM (BPS)

• A Bio functional Prosthetic System denture is the result of a coordinated system of products,
instruments, set-up techniques fabricated using continuous injection molding technique.

CONTINUOUS INJECTION MOLDING TECHNIQUE:

A continuous pressure injection (CPI) moulding technique purportedly reduces processing error and

increases resin density through layered polymerization of the resin with no processing flash. The use

of prepackaged liquid/powder capsules, a mechanical mixing procedure, and injection of the mixed

resin into the flask under continuous pressure during processing all help produce a homogenous

denture.
 ADVANTAGES:
• Improved dimensional stability

• Better control of polymerization shrinkage

• Reduced vertical dimension of occlusion changes

• BPS Dentures reproduce the functions of the natural teeth during mastication & speaking to a very
high extent.

• The patient will get a well fitting denture which is stable during functions like chewing, eating, &
speaking because the processing of the denture is done by continuous injection moulding technique.

• Even harder foods can be consumed immediately after denture insertion. The usage of high quality
teeth sets & the work in the articulator according to the BPS principles makes BPS dentures a
masterpiece.

• BPS dentures have high fracture resistant and 25 years clinical approved material.
ARTICULATING MATERIAL

Current tooth replacement materials are very hard and durable more likely to abrade and damage
the opposing natural tooth structure.

• Roll Foil
• Troll Dental
TROLL DENTAL’S TROLL FOIL
• A unique articulating material that is packaged in its own individual intraoral plastic application
frame.

• It is only 8 µm thick, and the surface is filled with color on both sides. Thus, even a light contact
readily releases the color on both arches.

• The markings are very distinct and specific. It clearly indicates the high spots

• It marks well on dry, wet, or damp surfaces, and it can be clearly seen on highly polished surfaces of
composite, ceramic, and gold.
MODIFICATION OF DENTURE BASE RESIN

Many attempts have been made to enhance the strength properties of acrylic denture bases.
 Rubber reinforcement: However due to its cost, its use is limited
 Mechanical reinforcements are done by metallic and non metallic inserts
a) metal wire reinforcement, , cast metal plates and fillers
b) Polyethylene glycol dimethacrylate or copolymerization with rubber. (Cross linking agent)
c) Carbon fiber
d) Whisker fiber
e) Aramid fiber
f) Polyethylene fiber
g) Glass fibre and E-Glass fibre.
h) Kevlar fibre
i) UHMPE (ultra high modulus polyethylene) fibre.
EFFECTS ON PHYSICAL PROPERTIES:

• Reinforcement with fibres enhances the mechanical strength characteristics of denture bases, such as
the transverse strength, ultimate tensile strength and impact strength.

•Chen et al showed that impact strength increased with fibre length and concentration.

EFFECT ON ESTHETICS:

• Fibre reinforcement has advantages compared with other reinforcement methods, in improved
esthetics.
RELATIONSHIP WITH POLYMERIZATION

Luiz and Grayson et al in 2008 showed that for auto polymerized reinforced acrylic resins,
prepolymerization of impregnated reinforcing fibres resulted in a higher flexural strength and elastic
modulus than postpolymerization.and for heat-polymerized reinforced acrylic resins,
prepolymerization of fibres provided lower elastic modulus as compared to post polymerization.
•Other modifications done are to improve radio opacity of denture bases.
•These attempts include the use of metal inserts, radio opaque salts & fillers, organometallic
compounds.
•Eg: barium sulfate, bismuth, halogen containing copolymers or additives such as 2,3-dibromopropyl
methacrylate.
NYLON/ POLYAMIDE FIBRES
• These are condensation polymers that result from reaction of diacid with diamine.

• The mechanical properties depend on linking between acid or amine groups.

• The first dental use of nylon was a failure as it absorbed excessive water which resulted
in excessive creep and some biodegradation.
• But later glass reinforced nylons were introduced with much lower water absorption.
• These nylons are either filled with specially coated glass beads or chopped glass fibers.
• The glass fibers increase the stiffness of nylon to about that of a conventional heat cured denture
base.
• Glass fiber reinforcement should be done with care and patients should be warned not to abrade
the fitting surfaces so as to avoid exposing irritation causing fibers.
 NANOTECHNOLOGY

NANOIMPRESSION MATERIALS
• Addition silicone vinyl polysiloxane impression material when integrated with nanofillers
provide the following advantages.
a) Better flow
b) Improved hydrophilic properties
c) Lesser voids at the margins
d) High tear strength
e) Resistance to distorsion & heat
f) Snap set- reduces error by micromovement
Trade name: Nanotech Elite H-D
NANO DENTURE BASE RESINS
• Titanium dioxide (TiO2), Ferric oxide (Fe2O3) nanoparticles when added as pigments in
PMMA provide color of the gingiva.

• Low porosity and prevents the adherence of Candida albicans.

• Addition of carbon nanotubes provides superior strength.

NANOPARTICLES PROPERTIES
Al2O3 NPs Thermal stability, flexural strength, water sorption, solubility, and biocompatibility

ZiO2 NPs Impact strength, flexural strength and radio-opacity, Compressive strength,
fatigue strength, fracture toughness and hardness as well as color properties
Zirconia nanotubes Flexural strength

Silver NP Antifungal properties,thermal conductivity, and compressive strength, non

cytotoxic, viscoelastic properties

TiO2 NPs Flexure strength, fracture toughness, and hardness, Impact strength, water
sorption, and solubility

Nano-carbon Impact strength and flexural strength.

NANO COMPOSITE DENTURE TEETH
• Possesses unique characteristics in terms of homogenicity as the material contains
nanosized inorganic fillers that are well dispersed without agglomeration in the matrix.

• Stain resistant and harder than other commercially present denture teeth

• Wear resistant
 STAFNE' S BONE CAVITY AND ITS UTILIZATION IN
COMPLETE DENTURE RETENTION

• In 1942, Stafne described a series of asymptomatic radiolucent lesions located near the angle of
the mandible. Subsequent reports have shown that this condition represents a well-defined
concavity of the cortical bone on the lingual surface of the mandible.

• Engagement of a mandibular denture in bilateral Stafne's bone cavity aids in retention and
stability of mandibular dentures.
 EFFECT OF LOW ENERGY LASER APPLICATION IN THE
TREATMENT OF DENTURE-INDUCED MUCOSAL LESION

• Used to relieve pain, reduce inflammation and edema and accelerate healing. Studies on the biologic effects
of low energy lasers have been concerned with the ability of such light to increase blood circulation within
regenerated tissues to increase production of collagen by fibroblasts and to promote a suppressive effect on
the immune system.

• Furthermore, increased mitotic activity has been reported, which indicates growth stimulation.

• For denture induced mucosal lesions, it provides therapeutic effect on both soft tissue and bone
with subsequent improvement in denture foundation.
DIGITAL ADVANCEMENTS

The development of digital technologies in dentistry has changed the therapeutic approach
in edentulous patients both in the preliminary stages of clinical case studies and when
supporting the actual fabrication phases. The goals of digital fabrication are to reduce the
number of patient appointments and improve the predictability of treatment outcome.
THE TRUBYTE® ALMA GAUGE TECHNIQUE - A NEW LEVEL OF
ACCURACY IN ANTERIOR DENTURE TEETH SETUP

• A technique has been developed which uses the

incisive papilla, an important landmark, in defining
and/or reproducing denture tooth position.

• The Alma Gauge confirms the exact position of the

teeth relative to the soft tissues.
TRU X’ DIGITAL SYSTEM

• A novel approach to esthetic preview of removable prostheses employs standard

digital photography with imaging software capable of orienting various artificial
tooth moulds and shades, in correlation with facial shape in a photo of the
patient prior to any treatment.
ADVANTAGES:
• Select the desired tooth shade, prescribed moulds with arrangement preferences and
denture base materials.

• Minimizes the potential for miscommunication

T-SCAN OCCLUSAL ANALYSIS SYSTEM

In 1987, the T-Scan Occlusal Analysis system (Tekscan, Inc) was developed by the Chairman of
Prosthodontics of Boston University at that time, Professor William L. Maness in partnership with
M.I.T.54. T-Scan System is a computerized device that consists of
1) hand-held device with flat U-shaped pressure-measuring sensor (60 μm thick, consists of an X-Y
coordinate system with 1500 sensitive receptor points made of conductive ink, and is subject to elastic
deformation)
2) computer software
• It is designed to obtain reliable measurements of occlusal biting forces on
individual teeth by analyzing occlusal forces quantitatively.

• When the patient bites on the sensor, the electrical resistance of the conductive
sensor is lessened since the force applied compresses the particles together; this
is recorded as quantitative force data.
APPLICATIONS
• Natural dentition with occlusal disturbances

• Implant placement, orthodontics

• Temporomandibular disorders, myofacial pain

• Prosthodontics (checking for high points and excessive contact locations)

• Patient education (treatment acceptance, improve longevity, enhanced comfort, eliminate

extra visits)

• Occlusal diagnosis and equilibration

DIGITAL IMPRESSIONS

• Data acquisition is either performed directly in the patient’s mouth (intraoral) or indirectly
after making an impression and fabricating a master cast (extraoral).
There are four major systems in the market today

1) iTero by CADent

2) LAVA COS COS by 3M ESPE iTero Lava COS

3) CEREC by Sirona

4) E4D by D4D Technologies.

CEREC E4 D image
ADVANTAGES
• Less patient discomfort

• Time-efficient

• Simplified clinical procedures

• No more plaster casts

• Better communication with the dental technician

• Better communication with patients

VIRTUAL ARTICULATOR

• The virtual articulator requires digital 3D representations of the jaws and patient specific data on jaw
movements. It then simulates jaw movements and provides a dynamic visualization of the occlusal
contacts. I

• Two types are there:

Completely adjustable and Mathematically simulated

ADVANTAGES

• Provides best quality of communication between the dentist and dental technician

• Simulating real patient specific data

• Analyses both static and dynamic occlusions

• Acts as a 3D navigator
LIMITATIONS

• Cost effective as it requires the digital scanners, digital sensors, softwares and different
types of virtual articulator models mimicking the mechanical ones according to the patient
need.
RECENT DEVELOPMENTS IN THE VIRTUAL ARTICULATOR

The development of 3D virtual articulator system (Zebris Company, D-Isny) requires three main
unit devices namely:
• An input device in form of a 3D scanner.
• A 3D virtual articulator software
• An output device in the form of “rapid prototyping system” with stereoscopic inkjet
technology.
The advantage with this 3D virtual articulator system is that in addition to analysis of
mandibular movements, even masticatory movements can be analysed including force at the
points of contact and the frequency of contacts in relation to time.
 RAPID PROTOTYPING

Rapid prototyping is a group of technique used to quickly fabricate a scale model of a physical part or assembly
using three-dimensional computer aided design (CAD) data.

• Additive manufacturing

• Substractive manufacturing

Frequent technologies that are adopted in dental practice

a) Stereolithography (SLA)

b) Inkjet-based system (3DP)

c) Selective laser sintering (SLS) and

d) Fused deposition modeling (FDM)

APPLICATIONS IN COMPLETE DENTURES

• 3D graphic record of artificial teeth

• 3D data of edentulous models and rims in centric relation

• Fabricating physical flasks (molds) by 3DP

Rapid Prototyping Technologies and their Applications in Prosthodontics, a Review of Literature. J Dent . 2015
Mar; 16(1): 1–9.
CAD/CAM DENTURES

• It is a system by which impressions, interocclusal records and tooth selection can be

completed in one appointment.
2 visits

• First visit: Impressions, jaw relation records, occlusal plane orientation, tooth mold and
shade selection and maxillary anterior tooth positioning record.

• Second visit: Placement of dentures

AVADENT DENTURE SYSTEM
ANATOMICAL MEASURING DEVICE
• Establish maxillomandibular relationship
• Perform Gothic arch tracing
• Establish lip fullness
• Assist in teeth selection
• The impression together with the customized AMD and the selected mold are sent to the
specialized labs where they are digitized and a virtual denture is designed.

Mold tabs are used for teeth selection.

• The denture base without teeth is milled from blanks and the teeth are bonded subsequently
using a proprietary glue.

CAD CAM blanks

ADVANTAGES
• Less number of appointments

• Less chairside time

• Less waiting period for final denture

• Low shrinkage as no polymerization process is involved

• Duplicate dentures easy to make as records are stored digitally

FABRICATING COMPLETE DENTURES WITH CAD/CAM TECHNOLOGY
INFANTE L, YILMAZ B, MCGLUMPHY E, FINGER I.J PROSTHET DENT. 2014;111:351–5.

The technique allows the generation of a virtual denture, which is milled to exact specifications
without the use of conventional stone casts, flasking, or processing techniques
A technique for the fabrication of CAD-CAM denture was described.
TOOTH ARRANGEMENT ROBOT FOR COMPLETE DENTURES

• CRS Robotics Corporation, Canada, produced a single manipulator robotic system with 6 DOFs.

• The main components of the system are

(1) CRS robot

(2) electromagnetic gripper

(3) a computer

(4) a central control system with tooth-arrangement and robot control software for tooth-arrangement, motion
planning and control

(5) denture base

(6) light source device

(7) light-sensitive glue (Wang and Li. 2001).

The three dimensional virtual tooth-arrangement software of the robotic system helps to

• Create medical history files of a patient

• Draw a jaw arch and dental arch curves by expert’s experience according to the jaw arch parameters
of the patient

• Adjust the dental arch curve.

The maximum load this robot system can handle is 3 kg, the maximum line velocity is 4.35 m/s,

and the repeated positioning accuracy is ±0.05 mm

• The system relies on the use of a special light sensitive material that hardens under lighting. In this
system, a robot grasps selected standard teeth and implants them in fixed positions. However it
was found that the system had difficulty in grasping and manipulating the artificial teeth accurately.
This led to the development of more improved robotic systems with more number of DOFs.

• High cost and lack of operational knowledge of the system are the main hindrance.
TOOTH ARRANGEMENT ROBOT FOR COMPLETE DENTURES

• CRS Robotics Corporation, Canada, produced a single manipulator robotic system with 6 DOFs.

• The main components of the system are

(1) CRS robot

(2) electromagnetic gripper

(3) a computer

(4) a central control system with tooth-arrangement and robot control software for tooth-arrangement, motion
planning and control

(5) denture base

(6) light source device

(7) light-sensitive glue (Wang and Li. 2001).

The three dimensional virtual tooth-arrangement software of the robotic system helps to

• Create medical history files of a patient

• Draw a jaw arch and dental arch curves by expert’s experience according to the jaw arch parameters
of the patient

• Adjust the dental arch curve.

The maximum load this robot system can handle is 3 kg, the maximum line velocity is 4.35 m/s,

and the repeated positioning accuracy is ±0.05 mm

• The system relies on the use of a special light sensitive material that hardens under lighting. In this
system, a robot grasps selected standard teeth and implants them in fixed positions. However it
was found that the system had difficulty in grasping and manipulating the artificial teeth accurately.
This led to the development of more improved robotic systems with more number of DOFs.

• High cost and lack of operational knowledge of the system are the main hindrance.
CONCLUSION
In spite of the growing technology and the increasing needs of clinical efficiency, the quest
for better materials grows more and more……..
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