REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW.
2
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW. MDT DAMIANO FRIGERIO, RZM DEPARTMENT AT THE UNIVERSITY OF ZURICH
Advances in medicine, hygiene, nutrition, and general prosperity have led to higher life expectancy. At the start of the 20th century sixty-year-olds had on average another 13–14 years of life ahead of them, whereas those aged 60 today can expect between 22 years for men and 25 for women. By 2030 the additional life expectancy for sixty-year-olds will be between 25 and 28 years. Those with a life expectancy of 80 years or more have no reason to farewell this life at 60 years of age. On the contrary, opinions about age and therefore the lifestyle of older people are changing more and more. This naturally affects their consumption patterns. (Austrian Chamber of Commerce) This life expectancy means that people between 50 and 70 are the new Best Agers, those people with an active lifestyle who see opportunities in the future. We also know that social contacts and communal life improve the quality of people’s dental care. Under these conditions the attitude towards our own body and appearance also change. In the process, it can be seen how people are gradually changing and their appearance is becoming increasingly youthful (Fig. 1a). Dental reconstructions must take into account these new circumstances without degenerating into a stereotypical Hollywood style in which the natural appearance is replaced by a false, artificial one. The search for a balance between esthetics for Best Agers and a natural appearance starts firstly with the use of suitable materials and products. Creating denture teeth with this concept and style was the starting point for the development of PhysioSelect® TCR. If the good functionality of a denture is reflected in the quality of life, the chewing stability of full dentures quite obviously contributes to the quality of life of the patients.
Fig. 1a: With kind permission of Dr. med. dent. Fidel Ruggia
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
3
THE NEW PHYSIOSELECT® TCR
In the ongoing search for products to reconstruct completely or partly lost teeth or for fixed or removable implant reconstructions, the development of prefabricated teeth presents the Industrial Dentist Designer with exciting challenges. Firstly, the shape of the natural tooth must be considered (Fig. 1). The anterior surfaces of natural teeth can be divided along three lines: Fig. 1 a) cervical, b) mesial, c) incisal. Proper regard for these lines gives the tooth natural looking light reflections and the correct positioning to support the lips and the smile. For this reason, every prefabricated tooth shape is specifically developed and a correction strategy is planned (Fig. 2). The subsequent wax modeling and digitalization of the wax impressions was the next step along with the preparation of prototypes made of lithium disilicate (Fig. 3 to 5). Fig. 1: With kind permission of Dr. med. dent. Alessandro Pedrali Noy
Fig. 2: Planned correction strategy
Fig. 4: Prototypes made of lithium disilicate
Fig. 3: Prototypes made of lithium disilicate
Fig. 5: Prototypes made of lithium disilicate
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
4
The presented and discussed design for the layered structure (Fig. 6 and 7) was then thankfully fabricated by Candulor with the utmost professionalism. Naturally, a bio-emulation concept requires precise reproduction of all the features of a natural tooth: shape, color, layering, and surface morphology. In terms of the layer formation, it can be seen with a natural tooth that the thickness of the enamel varies and the dentin extends to the incisal edge (Fig. 8). Figure 9 shows the subsequent realization of the layered structure based on the bio-emulation concept.
MTD D. Frigerio
MTD D. Frigerio
Fig. 6: Design of the layered structure
MTD D. Frigerio
MTD D. Frigerio
Fig. 7: Design of the layered structure
Dentine
Fig. 8: Dentin that extends to the incisal edge
Cross-section of a natural tooth
Cross-section PhysioSelect® TCR
Fig. 9: Realization of the layered structure based on the bio-emulation concept
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
5
By increasing the contrast in the cross-section photos of the PhysioSelect® TCR teeth, it is apparent that the layout of the layered structure corresponds to the final product (Fig. 10 to 14). With the surface we have attempted to achieve a natural appearance using the microstructure (Fig. 15) and macrostructure (Fig. 16) without allowing too much roughness to form, which would otherwise favor the development of plaque deposits.
Fig. 10: Cross-section of PhysioSelect® TCR
Fig. 11: Cross-section of PhysioSelect® TCR, buccal view
Fig. 12: Cross-section of PhysioSelect® TCR, buccal view
Fig. 14: Cross-section of a natural tooth and
Fig. 13: Cross-section of PhysioSelect® TCR with gradual increase in contrast
Fig. 15: Microstructure of PhysioSelect® TCR
PhysioSelect® TCR
Fig. 16: Macrostructure of PhysioSelect® TCR
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
6
RECONSTRUCTIONS BASED ON THE PHILOSOPHY OF THE BEST AGERS
Reconstructions based on the philosophy of the Best Agers must take into account the new esthetic concepts. The modern options for software analysis are still too immature to achieve satisfactory results. Photographic support can provide us with suggestions and information for the total reconstruction (Fig. 17). The objective here is harmony between age and facial features but also between smile and lifestyle and particularly between smile and life expectancy. The fabricated teeth must consider these aspects and give our total reconstructions a fresh appearance. For the patient’s smile, the position of the teeth, the layered structure, the texture, and the natural shape and color are all essential for ensuring that it immediately appears natural. We must not forget that the incisal edge with its layered structure must be visible and certainly also after the wear surfaces have been adjusted. Figure 18 shows the details of the layered structure in the incisal area while Figure 19 shows the section that is visible when smiling (with the exception of gummy smiles).
Fig. 17: With kind permission of Dr. med. dent. Massimo Ciocco
Fig. 18: Details of the layered structure in the
Fig. 19: Section that is visible when smiling
incisal area
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
7
CASE REPORT
We present a case here that was carried out at the University of Zurich in the Clinic for Reconstructive Dentistry (RZM, UZH) under the guidance of Prof. Dr. Dr. h.c. C. Hämmerle by Senior Dentist Dr. med. dent. Bruna Ernst. Patient S.J., 59 years, total edentulism, prosthetic restoration using the Prof. Dr. A. Gerber method with PhysioSelect® TCR teeth, shapes 786 and 64, shade A2 and Condyloform II NFC+, shade M2. Resin prosthesis AESTHETIC BLUE color 34 with the intensive shades AESTHETIC Intensive Colors from Candulor.
TOOTH MOLDS
The selection of the teeth should not depend on fixed notions such as sex or age. In this case, for example, a shape was selected from the masculine group (Group 7), which nevertheless fits well in the feminine face (Fig. 20).
Fig. 20: PhysioSelect® TCR from the masculine group 7
Fig. 21: Setup method from Prof. Dr. A. Gerber
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
8
The setup method from Prof. Dr. A. Gerber (micro condyle in micro fossa) is the current method that we apply (Fig. 21). The setup is carried out in this case with normal occlusion because crossbite setup is not an option due to the bone resorption (Fig. 22, 22a, and 22b). Of course, customization of the plate is also part of the state of the art with a full denture restoration. Particularly with today’s societies comprising people with different backgrounds, we cannot be content with standard colors for pigmented mucosa. Our task is to give our patients a genuine and confident smile. To this end, we now have intensive colors that are added to the base color of the resin to achieve an individualized shading (Fig. 23).
Fig. 22: Setup with normal occlusion
Fig. 22a: Setup with normal occlusion
Fig. 22b: Setup with normal occlusion
Fig. 23: Individualized shading with the AESTHETIC Intensive Colors from Candulor
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
9
With the individual shade samples (Fig. 24 and 25 from Dr. med. dent. B. Mandolesi) and the reproduction of the composites according to the selected shades, highly realistic shading is achieved.
Fig. 24: AESTHETIC BLUE color 34 individual
Fig. 25: AESTHETIC BLUE color 34 individual shade sample (f.l.t.r.: AESTHETIC
shade sample with progressive
BLUE 34, AESTHETIC BLUE 34 + 1/5 white, AESTHETIC BLUE 34 + 1/12 blue,
white increment
AESTHETIC BLUE 34 + 1/10 blue)
Happy patient with prefabricated denture (Fig. 26 to 32)
Fig. 26: Intraoral photo
Fig. 29: Final denture
Fig. 27: Final denture
Fig. 30: Final denture
Fig. 28: Final denture
Fig. 31: Final denture
Fig. 32: Final denture
With special thanks to: Dr. med. dent. B. Ernst for many years of masterful esthetics of full dentures that were carried out | Prof. Dr. Dr. h.c. C. Hämmerle, Clinic Director RZM at the University of Zurich, where I have now taught classes for 20 years and where the case reported originated from | Prof. Dr. Sandro Palla for everything that I learned from him | Dr. med. dent. Fidel Ruggia, with whom I collaborate since he became Senior Dentist at the University of Zurich with case 1a | Dr. med. dent. Massimo Ciocco from Lugano for 20 years of pleasant daily work and for the case in Fig. 17 | Dr. med. dent. Alessandro Pedrali Noy for Fig. 1 | Lastly, I would like to thank DT Marisa Fieni for her active and vital cooperation in the development of the PhysioSelect® TCR tooth as well as my team from Labor Estetiker in Lugano for their ongoing support.
REMOVABLE DENTURES: NEW ESTHETIC CONCEPTS FOR THE CUSTOMERS OF TOMORROW — DAMIANO FRIGERIO | MAY 2022
Create the best
CANDULOR AG Boulevard Lilienthal 8 CH-8152 Glattpark (Opfikon) T +41 (0)44 805 90 00 F +41 (0)44 805 90 90 candulor.com candulor@candulor.ch