Tips from John Nosti, DMD, FAGD, FACE, FICOI
His first tip? Apply smile design principals to denture cases. This not only makes denture cases faster, more predictable and profitable, it also makes them more fun. To get started, he suggests investing in Ivoclar Vivadent’s Smile Design Kit and to use the Ivoclar Vivadent Removable System in your practice to provide a comprehensive systematic approach to removable dentistry. The kit is an important part of that approach, and includes the tools you’ll need to provide better records to your lab, and that will lead to improved appearance and fit. You can learn more about the Ivoclar Removable System and its benefits at morethanadenture.com/pro, a website committed to helping dentists provide patients with quality, esthetic and predictable restorative solutions.
The kit features three key products that you should use during the first visit: The papillameter, the denture gauge and the centric tray. These tools require you to add a few extra steps to that first visit, but they’ll also enable you to provide your lab with the most accurate information possible, and that will mean faster, more predictable second, third and fourth visits.
If the patient doesn’t already have a denture, after you take impressions, you’ll use the papillameter to measure the length of the patient’s lip relative to the incisive papilla both at rest and while smiling. Providing this information to the lab will help ensure the gingival contours won’t be excessively displayed when the patient smiles, and that the selected teeth are a sufficient length.
Why is this so important? Without a papillameter measurement the laboratory has to rely on average values to create the wax rims. A stock maxillary rim normally provided by a laboratory measure 22mm. Dr. Nosti has treated patients with very different measurements, both at rest and while smiling. He’s treated a patient with a 19 mm at rest lip line, and one with a 7.5 mm measurement. These patients need very different maxillary wax rims for optimal esthetics, and these measurements will help your lab technician create a custom maxillary wax rim called an “Esthetic Control Base” that is nearly perfect when the patient’s lip is at rest. If you don’t measure, there’s a good chance you’ll either spend time cutting or adding wax during the esthetic evaluation appointment.
If the patient already has a denture she likes and doesn’t want to part with it so you can send it to your lab, you can use the denture gauge to accurately and efficiently evaluate that denture, and then communicate the measurements to your lab. This is more effective than simply taking an impression of the denture, and will help ensure your lab knows exactly what to do to create a new denture that will not only look exactly the same, but also will fit the patient perfectly.
The last thing you’ll need to do at the first visit is employ the centric tray, which is designed to provide a fast preliminary reading of the Centric and Vertical Dimension Record. It also provides a predictable means of communicating “jaw relationship” to your lab before fabrication of the wax bite rims.
When you order the bite rims based on all these readings and results from the centric tray, you’ll have a more successful second visit, where you’ll do your final Centric and Vertical Dimension Record and talk with patients about esthetics and how they want the denture to look in their mouth. This is where you determine what adjustments need to be made (and you can use other tools from the Smile Design Kit to help take measurements and communicate any adjustments to the lab). This of course will lead to a more successful wax try-in during the third visit, and a happy patient when it’s time to deliver the denture during the fourth visit.
Dr. John Nosti, who practices at Advanced Cosmetic and General Dentistry in both New Jersey and New York, is passionate about offering patients beautiful, dependable dentures—and about helping other dentists to do the same. Through his CE courses and articles, Dr. Nosti shares tips and tricks to providing patients with high-quality removable prosthetics they’ll love.