Lab Tribune Middle East & Africa No. 2, 2019

Lab Tribune Middle East & Africa No. 2, 2019

Cherry on top in complete denture prosthetics: individuality and naturalness / Driving innovation forward / Interview: “We defi nitely passed a tipping point for 3-D printers”

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Published in Dubai

www.dental-tribune.me

March-April | No. 2, Vol. 9

Cherry on top in complete denture prosthetics:
individuality and naturalness
By Erwin Eitler, Switzerland
Restorative treatment of the edentulous jaw requires, above all, sound
knowledge of the function and statics of dental prosthetics. Customised pink-and-white aesthetics that
match the expectation of the patient
represent the “cherry on top” here,
adding extra quality to the treatment.
We all know it, but let’s say it again:
The number of edentulous patients
will increase sharply over the coming
years due to ongoing changes in demographics. The older people grow,
the larger the number of edentulous patients will become. Complete
prosthetics will therefore remain of
high relevance for both clinicians
and technicians and should not be
neglected neither in the education
and training nor in the day-to-day
work of dental professionals. Sound
knowledge coupled with clinical and
technical expertise are essential to
achieve satisfactory results. Upfront,
complete dentures for edentulous
patients appear to hold little promise from an economic point of view.
However, the writer of this report
maintains that this is a question
of perspective. Complete denture
prosthetics is a supreme discipline
that allows a customised approach
for each individual patient. An appropriate treatment strategy can be
selected from a range of processing
techniques to meet the individual
needs of the patient being treated.
Accordingly, outcomes range form
e.g. highly aesthetic, custom-made
tooth replacements to “basic” complete dentures manufactured using
a digital method. Whichever method
is used, function and statics will always be at a high level. Any compromises in statics and function would
not be acceptable.

Preoperative situation

The 75-year-old female patient presented with severe periodontal
damage in the upper and lower jaw
(Figs 1 and 2). The oral cavity was

free of inflammation and looked
well maintained. However, the periodontium had been irreversibly
damaged by periodontal disease.
The clinical diagnosis showed that
the teeth in the upper jaw could no
longer be preserved. Some of the
lower teeth also had to be removed.
However, the lower premolars and
canines were still in a good enough
condition to be used as anchors for
a dental prosthesis. A conversation
was held with the patient to discuss
her expectations and treatment options. She wanted to have dentures
that could give her stability. Most
important of all, she wanted. to be
able to chew normally again. She also
described her difficulties in speaking
and expressed her discomfort about
her appearance. She wished to have
a “beautiful” smile again and be able
to speak without impediment. In addition, the dentures should be easy
to clean and handle and they should
be hard-wearing. Implant-based
treatment measures were not an option, as she wanted to avoid any additional surgical intervention. It was
therefore decided to restore the upper jaw with a complete denture and
the lower jaw with a partial model
cast denture.

Treatment planning

Crafting a tooth replacement for a
family member is always a special
task for a dental technician; especially if, as in this case, said family member was the technician’s own grandma. This increases the challenge of
a task that is already demanding
(complete dentures). The goal was to
create dentures that harmonize with
the face of the patient in a naturally
beautiful and discreet way. Functional and yet highly aesthetic dentures
should be achieved.
Primary requirements of the patient
on the dentures:
– Restored chewing function
– Improved phonetics
– Discreet integration of the dentures
– Individualized aesthetics
– Easy to clean

Removable prosthetics as high-quality restorative treatment in the edentulous patient

Figs: 1 and 2: Preoperative situation.
The aesthetic and functional shortcomings are clearly visible on the baseline pictures.

Anterior teeth and setup in
the oral cavity

First, the teeth in the upper and
lower jaw that could no longer be
preserved were extracted and the
extraction wounds were allowed to
heal. After that, impressions of the
oral situation were taken. The diagnostic casts were used to establish
the arrangement of the upper anterior teeth. For this task, high-quality
prefabricated denture teeth (SR
Vivodent® S PE) were used. These
moulds provide impressive individualized aesthetics for the anterior
region. The expressive texture and
internal stratification of the teeth
lend an age-appropriate natural liveliness to the dentures. In addition,
the teeth are made of a material that
meets the requirements for durability, consisting of highly cross-linked
DCL (Double Cross Linked) polymer.
According to the manufacturer, the

DCL polymer is a modified polymethyl methacrylate variant that offers
higher compressive strength and
better durability than conventional
PMMAs – while the material’s flexibility is similar as that of conventional resins.
After the casts had been analysed,
the teeth were set up according to
the known parameters. Despite
clearly defined aesthetic guidelines,
it is crucial to check the setup on the
patient and to adjust it as needed.
The anterior setup was adjusted in
the mouth of the patient to meet
her individual aesthetic and phonetic requirements. The patient was
instructed to perform various phonetic exercises and produce certain
sounds so that her speech pattern
could be observed. These observations were then used to adjust the arrangement of the teeth (Fig. 3). In this
way, an ideal setup was achieved for

the upper anterior tooth row.

Tooth setup

Master models were created on the
basis of a mucostatic impression
of the upper jaw. The models were
then mounted on the articulator
in a centric relation in line with the
bite registration. The four anterior
teeth in the lower jaw were set up to
match the setup established in the
oral cavity (Figs 4 and 5). In an intermediate step, a posterior try-in was
performed with the help of wax rims
to check the bite height defined in
the oral cavity. Posterior setup was
then performed accordingly. The
teeth were set up in a one-tooth-totwo-teeth relation taking all the principles of complete denture prosthetics into account. The SR Orthotyp® S
PE posterior moulds are also made
from DCL polymer. The beautifully
shaped tooth necks of the anterior
and posterior moulds, modelled on
nature, merit particular mentioning here. They facilitate the aesthetic
conversion into composite because
the shape imitates the appearance of
solid teeth growing from the “gums”.
A try-in of the setup in the oral cavity
helped to verify the arrangement of
the anterior teeth established in wax
stage by stage.

Completing the dentures

A model cast framework was produced for the lower jaw. The denFigs: 3: The anterior setup was tried in
and the phonetic and aesthetic details
adjusted as required.

Figs: 4 and 5: The teeth were set up on the models that were articulated in line with the jaw relation.

ÿPage B2

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LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 2/2019

◊Page B1

Fig: 6. The denture base was injection moulded and thenreduced to
create space for creating soft tissue customisations.

Figs: 7 and 8. The completed upper denture distinguishes itself through its characterizations with gingival composite and phonetically aligned teeth.

Fig: 9. Model cast denture in the lower jaw with an open periodontal
design (self-cleansing).

Figs: 10. Completed dentures on the upper and lower jaw models.

Figs: 12. Upper and lower dentures in situ. The customized pink and
white esthetic effects make the dentures look very natural – the teeth
look as though they have grown from the gums like natural teeth.

Figs: 13 and 14. View of the lips with inserted dentures in function.

tures are locked into place in the
mouth with the help of six clasps.
If the patient should lose another
tooth, the denture can be easily extended. Special care was taken to ensure that the model cast framework
featured an open periodontal design
to facilitate self-cleansing.
The SR IvoBase® system was used
for transferring the maxillary waxup into resin – a system that couples efficiency with reliability. The
injection procedure offsets the
chemical shrinkage of the resin during polymerization. High-strength
PMMA-based IvoBase was used for
the manufacture of the denture
base. The waxed-up dentures were
invested and the sprues attached. After the moulds had been cast and the
wax boiled out from the plaster, the
flask and the denture teeth were prepared for the application of the denture base material with the injection
moulding technique. The predosed

denture base material was mixed
and filled into the injector together
with the flask. The appropriate program was selected and the injection
process started. The accuracy of fit
on the plaster model was ideal on
the first try; reworking was minimal.
A try-in of the setup in the oral cavity
helped to verify the arrangement of
the anterior teeth established in wax
stage by stage. The patient was able
to speak and laugh without any difficulty. She was pleased with her new
set of teeth already at this stage.

Customising
the denture base

The denture base was reduced –
similar to a cut-back – for individual
veneering to make the dentures
look as discreet and natural-looking
as possible (Fig. 6). The soft tissue
(pink) aesthetics of the denture base
could now be designed with a vari-

Figs: 15 and 16. The patient with her dentures. New quality of life and stability

ety of shades to resemble the natural
gums. With its comprehensive range
of gingiva shades, the light-curing SR
Nexco® lab composite is well suited
for reproducing soft tissue characteristics. The material is easy to process
due to its exceptional properties. It
is optimally matched to the IvoBase
denture base materials.
Generally, key anatomical features
should be borne in mind when characterizing soft tissue parts to achieve
a lifelike reproduction. For instance,
keratinized gingiva has a light pink
colour because less blood normally
flows through it. By contrast, the
mucogingival areas receive a far larger supply of blood (dark red) and are
interspersed with fine blood vessels.
Given the versatile range of gingiva
shades, SR Nexco offers abundant
possibilities for creating customised
characterizations in these cases. The
interplay of convex and concave
surfaces in the area of the alveoli

Figs: 11. Upper and lower dentures in situ. The customized pink and
white esthetic effects make the dentures look very natural – the teeth
look as though they have grown from the gums like natural teeth.

and subtle stippling effects lend
three-dimensionality and depth to
the gingiva and these characteristics
were reproduced with the help of
the paste-like materials. Although
they looked already very natural,
the anterior teeth were additionally
slightly customised using SR Nexco –
a step that in this case was motivated
by the high aesthetic ambitions of
the dental technician (who, just to
remind you, is the grandson of the
patient). Step by step, the complete
upper denture was given a natural
look with the help of the light-curing
lab composites. Final polymerization was followed by mechanical
polishing (Figs 7 and 8). The model
cast denture for the lower jaw was
also completed (Figs 9 and 10).

The result

The patient was impressed with her
new upper and lower dentures right
away. Once inserted, their natural
and highly aesthetic effect became
even more apparent (Figs 11 and 12).
This effect can be attributed, among
other things, to the micro- and macro-texture of the anterior teeth and
the vibrant interplay of shades between the teeth and gingiva. The harmonious interaction between the
white and pink aesthetics is impressive. With the dentures in situ, the
functional, aesthetic and phonetic
parameters were again verified (Figs
13 and 14). The preliminary work was
worth it. The dentures met all the requirements. The patient was happy
and relieved that her grandson had
mastered the double challenge so
well.
In her own words, she discovered a
whole new zest for life (Figs 15 and
16). Her tooth replacements offer her
a much more satisfying situation
than her own “old” teeth did in the
past few years. Not only is she able to
speak and eat again without impediment but she can also laugh again
with all her heart. She has received
positive feedback from her circle of
friends and acquaintances and that

has encouraged her even more. My
grandma’s quality of life has improved considerably and she feels
much more positive about life. She
is now interested in meeting up with
friends again and become involved
in the social life around her.

Summary

Processing technologies that enable
restorative treatments customised
to the needs of the individual patient are increasingly becoming established in complete denture prosthetics. For instance, digital methods
allow the fabrication of solid“basic”
dentures using relatively little effort. Alternatively, these basic applications can be supplemented with
high-quality materials combined
with – as cherry on top – a manual
layering technique (gingiva) to create highly aesthetic results. Irrespective of economic aspects, the basic
functional and static parameters
always remain the same. Every complete denture ought to restore full
functionality. Sound knowledge
and experience in complete denture
prosthetics provide the basis for
achieving this.

Erwin Eitler, Dental Technician
Zahnmanufaktur Zimmermann
Maeder AG
Hirschengraben 2
3011 Bern, Switzerland
www.zmdental.ch

und

For further information, please contact:
Ivoclar Vivadent AG
Bendererstrasse 2
FL-9494 Schaan
Web: www.ivoclarvivadent.com

[3] => DTMEA_No.2. Vol.9_LT.indd

[4] => DTMEA_No.2. Vol.9_LT.indd

LAB TRIBUNE

Dental Tribune Middle East & Africa Edition | 2/2019

Driving innovation forward
By Dentsply Sirona
As the Director of Research and Development at Dentsply Sirona Lab,
Markus plays a central role in terms
of our innovation pipeline. He is
the person who drives new product
developments, for example, innovative materials such as Celtra® Press.
Thanks to his expertise, great communication skills and inventive
thinking, Markus understands our
customers’ needs and turns them
into new and smart product ideas.
His work philosophy reflects Dentsply Sirona’s unique positioning
by always laying out the whole picture of the workflow. He is working
closely together with other Dentsply
Sirona business units to generate
valuable links to related workflows.
This means that you can benefit
from thought out end-to-end solutions, and subsequently benefit from
tangible improvements in your daily
work.
In this interview, Markus explains
the various facets of his work as well
as the secret behind real innovation.
Tell us a little about your role as
Director of Research & Development? What are some of your daily
endeavors and/or challenges?
A typical day for me is full of reviewing the statuses of all running product development projects, anticipating and identifying what obstacles
or surprises (sometimes positive,
sometimes negative) there are or
might be, and how we can manage
all of these things in order to either
meet existing timelines and deadlines or to be able to start new projects which are fitting in the overall
portfolio of the company.

single surrounding detail, which
includes being completely receptive and having a comprehensive,
up-to-date understanding of our
production, quality assurance, product management, and even logistic
teams. In R&D you need constant curiosity, great communication skills
and inventive thinking.
How does science, clinical studies,
and research all ﬁt under the Dentsply Sirona Lab name? Can you provide a little background on what
goes into testing a product before
it actually goes into development,
and ultimately goes to market?
Due to the fact we are working in the
medical devices market, we fulfill a
great number of demands for testing
and design control processes. For example, when developing a new material for dentistry we need to look
at the biocompatibility as well as
risk management starting from the
production process, to the user, all
the way to the end result — our patients. Besides proving and surpassing all requirements from applicable
standards, we also want to know how
our customers accept the workflow
of the product. Before we launch, we
take a close look at how it fits into
the actual workflow of real-life dental laboratories, and we then start
additional vigorous clinical testing
after the launch as well. We include
our customers quite early on in this
process to allow us to react to their
outcomes and feedback, and then be

able to improve the product within
the development timeline.

concerns and ongoing daily challenges.

What makes Dentsply Sirona unique
is that the entire workflow is shown,
and it can be linked to other workflows and combined into an integrated solution.

Can you tell us a little about Celtra®
Press, the newest material for laboratories? What was the industry
missing (doctor, labs, and patients)
that this material now offers?
Celtra® Press has significantly improved the workflow in the lab by
being easier to press (with excellent flowability) and excluding the
time-consuming and dangerous
use of hydrofluoric acid to get rid of
the reaction layer. Despite this, it is
stronger than other pressable highstrength glass-ceramic materials on
the market. Therefore, Celtra® Press
provides a simpler workflow in the
lab, the dentist receives a robust material with a very good fit and easy
polishability, and the patient absolutely loves the natural looking aesthetics and beauty of his or her new
teeth.

When it comes to the prosthetic
treatment of an implant using an
abutment and full ceramic crown,
for example, Dentsply Sirona Lab
is the right partner for laboratories.
But the treatment workflow as a
whole starts from the earlier stage
of diagnostics and the implantological treatment, and ends with the restoration finally being cemented or
screwed in place. For this purpose,
Dentsply Sirona and its Imaging,
Implants, and Restorative business
create integrated workflows for both
dentists and dental laboratories.
One of your roles within Dentsply
Sirona is to constantly provide material innovations that expand lab
offerings to their dentist clients,
while improving their workﬂow.
How do you gather the information needed to improve upon these
offerings?
We use groups of our core customers, labs and dentists. Sometimes the
most effective feedback comes from
our labs and dentists who are everyday partners because they know
their ideal workflow routine, and are
able to communicate their emerging

For more information about Dentsply
Sirona Lab portfolio please contact your
local representative
Dentsply Sirona
21st Floor, The Bay Gate Tower
Business Bay, Al Sa’ada Street
Dubai, United Arab Emirates
Tel.: +971 (0)4 523 0600
Web: www.dentsplysirona.com/en
E-mail: MEA-Marketing@dentsplysirona.com

What do you foresee Dentsply Sirona off ering in the near or distant
future as far as material advancements?
We will soon present a new generation of CAD/CAM material, hand in
hand with the lab material combining Celtra® Ceram porcelain that is
suitable for every all ceramic case.
We are also planning further material improvements on other
material sectors coming
very soon!

For the development team, one
needs an open ear to absorb every

Interview: “We deﬁnitely
passed a tipping point for 3-D printers”
By Brendan Day, DTI
Powered by 3D Systems’ proprietary
Figure 4 technology, the NextDent
5100 is a high-speed dental 3-D
printer designed to save time for
both patient and practitioner. Dental Tribune International spoke with
Rik Jacobs, dental vice president and
general manager at 3D Systems; Sebastiaan Cornelissen, CEO of Cordent
and Core3dcentres; and Dr Michael
Scherer, an American prosthodontist, about the NextDent 5100 and
future trends in dentistry.
Is the NextDent 5100 designed
speciﬁcally with the dental lab in
mind, or can it be used in a dental
practice as well?
Rik Jacobs: Essentially, I designed
this product to be used by both labs
and clinicians with success.
Sebastiaan Cornelissen: We found
that the most important thing was
to have a system that can incorpo-

rate multiple machines and multiple
materials if necessary. This flexibility
was the main feature that we were
looking for, and the NextDent 5100
delivers this.
Dr Michael Scherer: For a clinician
like myself, there’s been an embrace
of 3-D printing in recent years. However, it’s always been the lower-cost
models that have been prioritised.
With the multiple materials and
extremely fast printing that the
NextDent 5100 offers, I think that
clinicians can now offer a realistic
chairside solution for patients.
What are the beneﬁts of the NextDent 5100 for dental labs?
Cornelissen: In the dental lab, you
have similar time pressure issues to
a dental practice. You need to be able
to produce things fast, in multiple
colours and often in large quantities. To be frank, these are all easily
achievable with this printer.

Often, a dentist will send some scans
to us so that we can quickly create a
smile design for the dentist to print
a mock-up of in his or her office.
Though we are based in the Netherlands and have clinicians working
with us from Germany, the NextDent 5100 allows for this entire procedure to be conducted in less than
2 hours.
What has the feedback been since
the launch of this printer? What
have customers most liked about
it?
Jacobs: What was important for us,
besides what these gentlemen have
already mentioned, was that the
printer have a high level of accuracy.
With ten years of experience in the
3-D dental printing industry, I’ve
learnt that a lot of printers work fine
in the beginning but lose their accuracy over time. When 3D Systems
acquired my company, we decided
to make sure that our printer would
work without issue, day in and day

out, for at least three years. Flexibility, speed, accuracy and, ultimately,
affordability of the machine and the
materials—these, along with training and ongoing support from our
outstanding resellers, are the foundations of the NextDent 5100.
We got a lot of feedback from users
of this printer, like Michael and Sebastiaan, and thankfully, our R & D
team in San Diego really listened to
what they asked for, what the market asked for. I think this is what our
company should always do: listen
carefully to our customers and deliver what they need and want.
Are software updates included?
Jacobs: Automatically. As long as the
user is connected to the Internet, he
or she will be able to have the latest
updates automatically downloaded
to the printer.
It’s predicted that, within three to
ﬁve years, more than 50 per cent

of dental labs globally will have an
in-house 3-D printer. What, in your
opinion, is driving this growth?
Jacobs: Well in 2018, we definitely
passed a tipping point for 3-D printers here at 3D Systems. Thanks to
easier registration, certification, improved ease of use, and a range of
other factors, it has become much
more achievable to integrate a 3-D
printer into one’s daily workflow.
Scherer: Clinicians are now expecting dental labs to be digital and to
have printing capabilities. It’s no
longer a case of whether a lab will
take your files, but rather if they
print themselves or still outsource
it. That’s how fast 3-D printing has
grown in dentistry.

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