Tony DeAngelis | Wood Dale, IL - Depot Dental Lab Inc.

Technician's
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Tony DeAngelis C.D.T.

 

 

 

Relines | Wood Dale, IL - Depot Dental Lab Inc.

Relines – Operatory Protocol Post Date January 2017

Among the most challenging operatory procedures to conduct successfully is a maxillary full arch reline. In many cases, once the denture is returned to the patient, somehow or some way the VDO and anterior teeth have changed and the patient complains that they don’t “feel” or “look” the same. “Why is my denture feeling and looking Bucky?” is often remarked by the patient.

Crucial operatory steps conducted to ensure reline accuracy and patient comfort in the end:

  1. Confirm fit of the existing denture. Check for its looseness and communicate with the patient – share your findings. Establishing the current look of the denture simply sets the tone for patient expectations.
  2. Confirm that a reline is necessary by testing retention after a firm palatal push, then pulling down bi-laterally on the denture. The need for a reline can also be checked by shifting the denture left and right to observe movement. Anything better than a 1.0mm shift mandates a reline.
  3. Use a mirror to collectively agree that the front teeth are where they are and that you’re doing your best to reproduce that position. Use a mirror to confirm and share.
  4. Equilibrate the occlusion! This is a must. (VERY IMPORTANT)
    a. Most doctors overlook this step.
  5. Then, surface roughen the entire intaglio of the denture and place two flash holes in the palate near the anterior region of the denture lingual to #6 and #11. This will allow trapped impression material to escape and most importantly allow the denture to fully arrive at its point of proper position. This step will ensure that the denture doesn’t remain “out of position” during the process, making the front teeth appear Bucky at completion.
  6. Share protocol expectations with the patient. Communicate your operative expectations! Verbalize things like:
    a. I’m now going to fill the denture with impression material and place it in your mouth. When I do, I need you to bite down and fully press the denture in to its proper position. I want it to feel as normal as possible for you. You’ll hold that position for 3 minutes.
    b. When the denture is returned to you later or tomorrow, it will be tighter and much more comfortable.
    c. The relined denture may be so tight that it may need to be adjusted.
  7. After taking the impression trim as much flash impression material as possible and return the denture to the patient’s mouth. Confirm the bite, comfort and look of the denture before sending it to the lab for processing.
  8. Verbalize things chair-side like:
    a. How’s that feel Mrs. Jones?
    b. Do your teeth feel like they’re in their normal position?
    c. Pull out that mirror again and confirm anterior teeth position; How’s that look Mrs. Jones? Does everything look okay?
  9. Send the case for processing!

 

Mid-Line | Wood Dale, IL - Depot Dental Lab Inc.

“MID-LINE” MAGIC Post Date November 2016

Dear Doctor, about half the cases I receive in my lab that are in need of a set-up arrive without a mid-line mark on the bite-rim. There are three main purposes of using a lab fabricated bite-rim and using it correctly to relate crucial chair-side information to the technician:

  1. Confirm the fit and accuracy of the impression based on the fit and accuracy of the bite-rim vs. bite-rim stability.
  2. Attain records or bite relation.
  3. Mark (on the bite-rim) the patient’s mid-line and horizontal line.

(1): Most bite rims, as they are made to a cast of the patient’s mouth, often must negotiate undercuts that are sometimes quite severe. This means that the technician must “block-out” these undercuts prior to bite rim fabrication; especially when light-curing material is being used for the bite rim. Once cured, light-curing material becomes ridged. Once cured in to any undercut on the cast, it would be virtually impossible to remove without breaking the bite rim. So, block out material is used to fabricate the bite rim. As a result, the bite may be loose at the time of records and teeth confirmation.

a. Check that the bite rim is stable bi-laterally and anterior posteriorly. If no stability is evident, retake the final impression in the bite-rim itself for the lab to establish the cast of the patient’s mouth. If so, then all is good. Continue with records or try-in. The looseness will change to tightness once the denture is processed in acrylic, as it will re-engage all available undercuts on the cast.

b. Some clinicians will use denture adhesive to stabilize the bite rim. Remember that bite rim stability prior to using adhesive is fundamental.

(2): The bite rim is used not only to establish the maxillary and mandibular relationship as portrayed in the patient’s mouth but to relate that relationship to the technician to help them do their work.

a. Running through phonetics and comfort are important too and must be done early-on to avoid reset or even remake charges.

b. This is also a great time to establish patient expectations of how the denture will feel and look. Choose teeth shade and shape but more importantly, for replacement dentures: What would you like to see different Mrs. Smith? Would you like straighter, lighter, longer, shorter, smaller teeth?

(3): Marking the mid-line on the bite rim as well as the horizontal line are crucial steps to not only ensure proper teeth position but to minimize the cost of fabrication of the denture by minimizing the number of “resets” needed to achieve the final goal.

Both the Mid-line and Horizontal lines serve a purpose:

  1. The mid-line> represents the patient’s face split down the middle; from the top of the forehead to the bottom of the chin. This line divides the two middle teeth (centrals) on either arch: #24, 25 and #8, 9.
  2. Horizontal lines> represents the perpendicular line to the mid-line; from ear lobe to ear lobe. This line is not the “smile-line.”

In proper order to align the “centrals” for the try-in, the horizontal line MUST BE perpendicular to the vertical line represented. The patient’s two front teeth should be in proper relationship to: the face’s center line, the chin, the canine teeth, the nose etc.

The only time the exception exists is when there is a specific request by the patient to set the front teeth differently, to make them appear “out-of-line.”
Some patient’s believe this LOOKS more natural and in some cases this is true.
In most cases, this request is non-existent and the rules preceding should apply as stated.

Doctor, thank you for taking the time to take the appropriate steps and make the appropriate marks on those bite-rims because it makes all the difference in how that denture will service the patient. Fit, accuracy, bite attainment and mid-face alignment marks are all so important in delivering a denture to your patient successfully the First Time. Eliminate the need for additional try-ins and laboratory resets. Use the bite-rim for what it is made for…Sharing the information of what you see chair-side, to the bench of the technician.

Keep your dentures clean Post-Date October 2016

The question always comes up about cleaning dentures and what method should be used. Although there are a few important guide-lines that are recommended and a few dangerous chemicals to avoid, I have always firmly stood with the belief that each denture wearer should embrace the regimen that works best for them.

The most important element in denture or partial hygiene is consistency!

As a daily regimen, dentures or partials should be cleaned well. Most denture wearers haven’t adopted a well regimented daily habit of cleaning. We’ll go through what might be a daily regimen that you can adopt:

  1. Using a toothbrush, Luke-warm water and a toothpaste of your choice, brush your dentures/partials in your mouth thoroughly.
  2. Then, place a wash cloth at the bottom of the sink or fill the sink slightly with water. This will prevent breakage of the denture if dropped.
  3. Remove the denture(s) or partial(s) and using the same brush, brush any remaining teeth. Remember, AGITATION – DURATION.
  4. At the same time, gently massage your gums with the same tooth brush. Don’t brush your gums, massage them. This will revitalize your tissue and remove any debris and minimize bacteria associated with bad breath.
  5. Using a denture brush and hotter water, now give the dentures a good scrubbing. Much the way you would scrub an egg, carefully yet diligently. Scrub all aspects of the denture inside and out. AGITATION – DURATION applies here as well.
  6. Rinse your mouth and the dentures and replace them for the day.

Chemicals to avoid as cleaners:
Bleach          Efferdent         Polydent

If your dentures fit poorly or give you soreness, immediately make an appointment with your dentist to have them adjusted. Dentures shouldn’t hurt and if they do, they were either made improperly or are in need of adjusting.

A Comfortable Lower Denture Finally Arrives on the Market! Post-date September 2016

Lower denture comfort is now available through the use of a new product called Novus™ DENTURE LINER. Novus is a custom made denture liner that helps a lower denture fit better, feel better and function better for a longer period of time.

Novus™ is a PNFTM based denture liner. PNFTM is made from dichloropolymer ("DCP") and is an inorganic polyphosphazene material. The material was manufactured and sold in the 1980's and 1990's. PNFTM based products were originally developed and manufactured on a commercial scale by Firestone Corporation with US Department of Defense funding. Novus™ was developed with a National Institute of Health grant and funding. Hygenic Corporation first commercially introduced the product into the international dental market in the late 1980's.

The need for a comfortable denture is in more demand today than ever. The advancements of technology coupled with the tremendously high number of dentists coming out of school has propelled a failure rate in the fabrication and fitting of lower dentures like never before. Two thirds of all denture wearers are unhappy with the fit of their dentures. Novus has come along at just the right time: Hypo allergenic, Hydrophilic, antifungal, radiopaque, low surface tension, low water absorption, firm yet a permanent resiliency, no hormonal or carcinogenic concerns, absorbs shock while chewing, completely adjustable with traditional rotary dental instruments and finally, supported by the FDA.

On the part of WSQ – White Square Chemical, and the Novus team, the mission is simple. To bring back the comfortable lower denture and change the way denture wearing is experienced.

The application of Novus™ to an existing denture or during the creation of a new denture is routine and similar to what dentists and technicians already know about the clinical protocol and laboratory application of soft liners. Like with any new product, there is a slight learning curve to understanding the proper application of Novus™ but once learned the process becomes ho-hum, with lasting and life changing benefits for the denture wearer.

Personal testimonial:

I’ve been in the denture laboratory industry for many years. I started as a child. I would visit my Father’s lab as a very young boy. I remember the sights and sounds of the lab. There were smells of all sorts of chemicals and boiling pots of water that threw copious amounts of humidity in to the already wax laden air. Today I’m 51 years old and I think back to my sensory experiences and I remember Dad tending to patients with doctor in the operatory over dentures and the usual complaints that accompanied them, and Dad always had a way to resolve the problem. The patient always left happy. Well…happier anyway. The problems with lower dentures never really went away completely for most patients. Oh, there were a few that arrived at comfort but not a majority.

I’ve since taken over the dental lab from my parents, Nick and Carmen DeAngelis and even 30 years later I still see the same issues with patients and their lower denture concerns. Of course today, with the advances of dental implants, many of today’s denture problems have gone away for the few that can afford it. For those that cannot however, there’s Novus™. We spend much time applying Novus™ to lower dentures mostly and some upper dentures as well. Upper denture Novus application I will visit and explore various applications and techniques in later blogs. As for now, here are some of the direct questions and quotes; conversations that have taken place between doctor and patient concerning the Novus™ liner as it pertains to comfort and function:

Q = Doctor asking A = Patient response

Q. So, how do you like the Novus liner?

A. I like it a lot. Never really felt anything like this before.

Q. What’s different about Novus compared to your other denture?

A. It’s just more comfortable all around.

Q. Give me an example please.

A. Well, when I eat, it doesn’t move around on me like my other denture. And the pain isn’t there either. I’m very comfortable.

Q. How often are you wearing your dentures?

A. I use to wear them only when I needed to: going to the store or out and about in general, having company over or just to get through a meal and that would be it, out they’d come.

Q. We’re going to conduct a test. I’d like to remove Novus™ from your denture and see how well you do, better or worse. Are you okay with that?

A. Sure

Q. So, it’s been a week now. How are things with your denture?

A. Could you please put that stuff back on my denture? I would really prefer it. This denture is too hard and uncomfortable.

Doctor: Sure Mrs. Smith. Right away.

Here are the facts about Novus:

Novus | Wood Dale, IL - Depot Dental Lab Inc. For years patients have complained about their lower dentures. Across America the statistics are in. More than two thirds of all denture wearers are unhappy with their teeth. TWO THIRDS!!! Wow..

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