A Predictable Outcome Is Predictable Income

To continue to offer patient-specific solutions, the technician emphasizes the obligation of laboratories to remain current in new techniques and the ever-advancing technologies at hand. The creative element that technicians add to their creations includes thinking outside the box and leveraging these new strides in dentistry to the patient's advantage. This is the dance in which strength and esthetics must work together. In this role, laboratories are constantly looking for tools and materials that they may use to solve for those seemingly compromised and especially challenging cases.

This article presents one such recent case. The given patient first refused to accept any solution that was removable or covered her palate. The patient also insisted on receiving the teeth in the same day the technician was given the case. As an additional challenge, there was insufficient clearance over all of the preexisting implants.

Due to the time restraints and the necessary healing period, creating a removable appliance was the only viable option. This was an immediate removable restoration over the extraction sites that would fit on the existing adjacent implants that had to be made and seated next day. As such, the technician did not have the option to send the case out to a larger laboratory to mill a framework to fit to the implants. Presented with this challenge, he could only utilize the tools available on-hand.

The implants and the teeth proposed for extraction were picked up in an impression. This was poured, and the models were scanned for digital records to help with the design. The technician then removed the teeth from the model and scanned again. A digital denture was designed using both scans to set the teeth close to the natural dentition that was extracted. The technician created a subframe out of TriLor (PREAT Corporation; preat.com) (Figure 1). Then, using the digital denture design he created, he scanned the framework on the model and redesigned the intaglio to fit over it (Figure 2 and Figure 3). Next, he luted it all together. This was made easier because TriLor is bone colored and is very easy to cover with Pala cre-active (Kulzer, kulzer.com) and the dima Print material (Kulzer). The fiber-reinforced TriLor material forms a covalent bond to acrylic or composite veneering material. So although the print was thin over the framework, there was a strong chemical bond with TriLor. The technician used the dima Print denture teeth material for the whole print and then went back to the tissue areas so they could be touched up with pink cre-active (Figure 4 and Figure 5).

Digital design is a great tool to use for these cases because once the mouth has an opportunity to heal and the new implants are placed, the team can then return to what was digitally proposed and re-create the design to fit on the new foundation. With milling and 3D printing becoming so easily available, laboratory turnaround times for final and temporary products are getting shorter and shorter.

TriLor's ability to be hand milled and to bond to a cylinder provides a non-restrictive solution. It also bonds to acrylics and composites. Now TriLor is the technician's go-to for same-day, in-laboratory substructure needs.

Jeremy Wohlers, CDT, is the owner of Esthetics In Function Dental Lab in Yakima, Washington.

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800-232-7732