Occlusal reconstruction and rebase procedure for distal extension removable partial dentures.
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Eleven commonly used methods of adjusting and polishing porcelain denture teeth were evaluated. They were compared to the surface of an unaltered denture tooth. Three methods (7, 10, and 11) resulted in surfaces which appeared polished under visual examination. These three methods produced finished surfaces comparable to the unaltered tooth. In attempting to avoid the undesirable sequelae of occlusal wear due to friction, the dentist may choose one of these techniques to complete the adjustment of vacuum-fired porcelain denture teeth prior to placement of the denture. Clinical significance of slight differences in surface roughness must be assessed through carefully controlled patient studies.
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Denture esthetics has been discussed in terms of the anatomic-physiologic and artistic phases. It is the responsibility of the dentist to apply the principles discussed in an effort to produce a natural appearing denture. Excessive dependence on auxiliary personnel in meeting the esthetic needs of the patient can only encourage the denturist movement and quick, low-cost denture clinics. Faced with this threat, we must not shirk our responsibilities.
The average fracture load during occlusal loading of pontics which were bonded to natural abutment teeth in vitro was found to be 56.1, 57.5 and 74.2 kg for natural, acrylic resin, and Restodent pontics, respectively. Coating the roots of the abutment teeth with a thin layer of silicone rubber before embedding them in stone slightly reduced the strength of the fixed partial dentures. Thermocycling the specimens with coated roots caused a considerable decrease in strength to fracture loads of 33.0, 17.9, and 37.3 kg for natural, acrylic resin, and Restodent pontics, respectively. Fracture of the enamel of natural tooth pontics was observed in a few specimens. The superior strength of the fixed partial dentures with natural tooth and Restodent pontics would indicate that these pontics are superior for clinical trials rather than acrylic resin pontics.
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Even under the best circumstances, posterior tooth color discrimination is still a subjective decision. Most shade guides do not follow a logical pattern in number or graduation of Hue, Value, and Chroma. Moreover, the shade guides are only obtainable with anterior teeth, usually maxillary central incisors. The fabrication of a first premolar shade guide is a step in the direction of making the posterior esthetic requirements more easily attainable for the dentist and the final result more satisfying for the patient. One can also use the various "broken sets" of acrylic resin teeth to achieve the necessary combination of posterior shades if cost is a factor and uniformity in molds is not required.
A practical approach to restoring the edentulous patient to full occlusion is no easy task. It requires the dentist to establish a philosophy of occlusion, select an occlusal concept to be used with the philosophy, and then choose an occlusal scheme to satisfy the concept and fulfill the philosophy. Several combinations of molds can be used in this manner. Of the three presented, the Trubyte functional/rational combination was found most acceptable. The requirements and techniques in the use of this combination were described.
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A technique has been described for fitting the tissue surface of a fixed partial denture pontic. It is important to adjust this surface prior to cementation to prevent tissue changes beneath the pontic.
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The ceramometal pontic has the greatest potential as an esthetic replacement for missing teeth. Maximum esthetic and mechanical properties are obtainable only with post-ceramic soldering. A means of maintaining positional stability for the pontic is offered, as well as some helpful hints in the use of the technique in various clinical situations.
A technique for duplication of a maxillary complete denture has been presented. This technique requires no special equipment and can be easily completed in the dental office.