In our practice on a daily basis we are asked about removable prosthetics. Our job is to educate patients on what dentistry has to offer and let them make an informed decision. Although the majority of our patients choose implant treatment, some of our patients still choose removable prosthetics that are not implant supported. So what is a digital practice to do?
The thought of taking an impression and hoping it turns out has been in my rear view mirror for a while. Here is a RPD case showing that you can practice “old school” dentistry but with a new school twist.This particular patient presented to our practice with many chipped incisal edges and no posterior support (I wonder where the chipped edges came from?) We went over restorative options with him: implants, crown and bridge, and removable prosthetics. The patient chose to have a RPD fabricated to replace his missing posterior teeth. We restored the incisal edges of the maxillary anterior before making our digital impression. We will restore the incisal edges of the lower anteriors after delivery so we can move the force to the posterior.
We made our digital impression for the upper and lower arch and 3D printed the models. We sent the printed models to our lab who quickly called with many questions. Our lab technician only fabricates frameworks and had never seen a 3D printed model. We informed him of the material we used and the process we went through. From that point forward, the process continued as usual.
The lab fabricated refractory models, made the frameworks and sent them back for try in. After the framework try in we sent the cast frameworks off for teeth in wax (yes, I still do this the way I was taught in dental school, I have not been able to go start to finish in one shot on removables). We did our wax try in and reset some teeth for aesthetics. The frameworks are out for processing.
Digital impressions have ushered in a whole new era of impression taking. It is not just for implants or crown and bridge. Start thinking outside the box; just imagine what you can do with the technology at your fingertips. The time of rubber base has been gone, the poly vinyls and poly ethers will hang on a while longer. How long? It’s hard to tell but at the rate hardware and software are moving, I don’t expect it will be too long.