A fully digital workflow to register maxillomandibular relation using a jaw motion tracer for fixed prosthetic rehabilitation: A technical report

Objective

This technique aimed to describe a fully digital workflow to register maxillomandibular relation for fixed prosthetic rehabilitation.

Clinical Considerations

Mandibular kinematics could be reproduced in a four-dimensional (4D) virtual patient based on the intraoral scan, facial scan, cone beam computed tomography, and jaw motion trajectory, which helped record centric relation and determine a proper occlusal vertical dimension in a virtual environment. The therapeutic position could be exported directly to the dental computer-aided design software for digital waxing design with a facial scan. The 4D virtual patient was also used to verify the functional and esthetic outcomes of provisional restorations.

Conclusions

This novel approach digitized the process of determination, delivery, and double-check of maxillomandibular relation, thus contributing to the establishment of a completely digital workflow for fixed prosthetic rehabilitation.

Clinical Significance

Registration of maxillomandibular relation, including centric relation and occlusal vertical dimension is critical to the success of prosthetic rehabilitation. Traditional procedures are complex and time-consuming, and heavily rely on the clinical experience of dentists. A fully digital approach to creating a 4D virtual patient and registering the maxillomandibular relation is established, which guides to determine a proper occlusal vertical dimension in centric relation. Digital delivery and double-check can simplify the conventional procedure and ensure that the determined maxillomandibular relation is reliable.     

A Pilot Study to Evaluate Different Palate Materials for Maxillary Complete Dentures with Xerostomic Patients

PURPOSE: The hypothesis tested in this pilot study was that materials used for the palatal region of a maxillary denture affect the comfort of the maxillary denture in xerostomic patients. MATERIALS AND METHODS: Xerostomic complete denture wearers were selected to test three different maxillary dentures that were made with different palatal materials. Each denture was worn for a period of 2 weeks. The Kapur Index was used to measure retention. The Oral Health Index Profile (OHIP) was used to determine the patient's perception of each denture after the 2-week period. At the end of the study, the patients were asked to select which of the three dentures they would like as their primary denture. RESULTS: All participants chose the metal-palate dentures, and 4 of 5 selected the titanium-palate denture as their primary denture. Statistical analysis of the OHIP demonstrated that the metal-palate dentures were perceived as being more comfortable than the acrylic-resin dentures. CONCLUSION: This pilot study suggests that for xerostomic patients who have worn complete dentures, their selection of a metal-palate denture as their primary prosthesis strongly suggests that these dentures have properties that make them more comfortable to the patient than acrylic dentures. Subjective patient measurements supported this conclusion that the metal-palate dentures were preferable, while the evaluation method available to the clinician failed to discriminate among the prostheses.     

A Technique to Correct Anterior‐Posterior Tooth Discrepancy for a Maxillary Immediate Complete Denture

This article describes a chairside technique to correct inappropriate occlusal vertical dimension as well as the inaccurate anterior‐posterior tooth set‐up of a maxillary immediate complete denture. When fabricating an immediate denture, the inability of a wax‐denture trial and the potential for unpredictable complications during surgery, compromised esthetics and function of an immediate complete denture may pose a clinical problem, which needs instant correction. The technique described can provide an alternative method to correct and deliver a definitive immediate complete denture on the day of surgery.     

A Single Visit Direct Technique to Provisionally Restore Occlusion for a Full‐Mouth Rehabilitation: A Clinical Report

Attrition of the dentition can negatively affect esthetics and function. When reconstructing patients with attrition who require restoration at increased occlusal vertical dimension (OVD), it is necessary to first evaluate the OVD using a removable interim prosthesis to ensure that the patient will tolerate the new position. The transition to fixed interim prostheses has to be carefully planned to achieve the desired OVD. One approach is to prepare all teeth in a single day and place full‐arch interim prostheses; however, this can be tiring for the patient and prosthodontist. An alternative approach is to prepare one arch and place interim prostheses, while using composite resin in the opposing arch to maintain the newly established OVD. A diagnostic wax‐up at the proposed OVD is completed and duplicated in stone. A vacuform matrix is loaded with composite resin and applied to the unprepared etched teeth of the opposing arch to restore form and occlusion until full contour interim prostheses are placed at a later visit.     

Combining Conventional Impressions and Intraoral Scans: A Technique for the Treatment of Complete Denture Patients with Flabby Tissue

The conventional method for impressions of flabby tissue uses modified trays and highly flowable materials, but mucostatic impressions are difficult to achieve due to the viscous and the elastic natures of impression materials. In this report, a technique is presented in which conventional impression and intraoral scanning for a fully edentulous patient with flabby tissue are combined. The definitive impression was obtained by applying appropriate pressure to each tissue area, and the denture can be maintained passively and stable at rest and during function.     

A Digital Technique to Replicate Edentulous Arches with Functional Borders and Accurate Maxillomandibular Relationship for Digital Complete Denture

Correct functional border impression and jaw registration is a challenge when edentulous arches are directly digitized with an intraoral scanner. This article describes a digital workflow to replicate complete edentulous arches with full functional contour, and position them in the centric relation using an intraoral scanner, existing denture, and three‐dimensional image reversal technique. Based on the reconstructed images, the base and dental parts of the new denture can be designed efficiently and predictably.