Digital Techniques for Determining Vertical Dimension in Edentulous Patients

Digital Techniques for Determining Vertical Dimensionin Edentulous Patients

In prosthetic dentistry, accurately setting the vertical dimension (VD) of occlusion is crucial, especially for patients lacking teeth in both dental arches. This blog explores the blend of traditional methods and digital advancements in determining the VD, providing a comprehensive guide for practitioners aiming to enhance both the efficacy and efficiency of full mouth restorations.

 

Traditional Methods for Determining Vertical Dimension in Edentulous Patients

The journey to a perfect denture begins with the foundational practice of traditional methods. These involve:

  1. Patient Evaluation: Observing the patient’s face to determine the optimal height for restoring lip support and facial contours. This often involves referencing pre-extraction photographs and physical examinations.
  2. Physiological Rest Position: This is measured from the nose tip to the chin while the patient relaxes, which provides a baseline for further measurements.
  3. Occlusal Vertical Dimension (OVD): The OVD is typically set by subtracting 2 to 4 millimeters from the physiological rest position to allow for the natural movement during mastication.
  4. Phonetic Techniques: Having patients pronounce specific sounds helps in refining the VD by ensuring that the teeth are at an optimal distance for effective speech.
  5. Trial Dentures: A prototype denture is created and adjusted based on the patient’s feedback on aesthetics and functionality.
  6. Final Adjustments: Revising the denture based on detailed feedback ensures optimal fit, function, and comfort before the final product is delivered.

 

Integrating Digital Technologies with Traditional Methods

Digital methods are revolutionizing the way dental professionals approach VD measurements by introducing precision and streamlining processes:

  1. Digital Impressions: Utilizing intraoral scanners, digital impressions replace traditional alginate impressions, reducing discomfort and enhancing the accuracy of the measurements.
  2. Computer-Aided Design (CAD): This technology allows for the precise design of dentures. It enables the visualization of end results before the physical production begins, facilitating modifications based on predictive analytics.
  3. 3D Printing: With CAD designs in place, 3D printing offers rapid prototyping and production of dentures, allowing for multiple iterations without extensive delays or material wastage.
  4. Dynamic Feedback Loops: Real-time adjustments are made possible as patients provide immediate feedback on digitally created trial dentures, ensuring a perfect fit and function.

 

Detailed Case Studies: Hybrid Methods in Practice

Case 1: Integrating Traditional Impressions with Digital Scanning

  • Initial Step: An intraoral scan provides a precise digital map of the oral cavity, setting a foundation for accurate measurements.
  • Traditional Touch: A centric tray, embedded with impression material, captures the initial jaw relationships. This traditional method establishes a base that digital tools later refine.
  • Final Adjustments: Using Medit Design and Medit Splints, fine-tune the initial impressions, ensuring that the final denture perfectly aligns with the patient’s oral anatomy for optimal functionality and comfort.

 

Case 2: 3D Printable Gothic Arch Tray

  • Innovation in Action: This case employs a 3D printable Gothic arch tray designed to streamline the process of measuring centric relations.
  • Digital Precision: The use of 3D printing technology ensures that the tray is perfectly tailored to the patient’s specific oral dimensions, enhancing the accuracy of the measurements.
  • Efficiency Gains: This approach reduces the number of appointments required, significantly speeding up the entire process from initial impression to final denture fabrication.

 

Case 3: Combination of Digital Scanning and Custom Trays

  • Digital Start: The process begins with a detailed digital scan of the patient’s edentulous arches, capturing critical soft tissue details.
  • Custom Tray Design: Utilizing the digital scans, a custom tray is designed and 3D printed, precisely tailored to the patient’s anatomical features, using Medit Splints for accurate and efficient fabrication.
  • Comprehensive Final Impression: The custom tray is used to take a final impression, ensuring a highly accurate and detailed capture of the oral landscape, which is crucial for the perfect fit and function of the final denture.

 

Balancing Digital and Traditional Methods

Although digital advancements offer numerous benefits, certain traditional techniques remain irreplaceable. The combination of both ensures comprehensive care by capturing the nuances of each patient’s oral landscape and personal preferences.

 


Q&A Insights

The webinar concluded with a Q&A session, where Dr. Kim addressed specific queries related to the digital and traditional techniques in setting the vertical dimension.

 

Question 1: Are there any key parts to be considered when restoring an edentulous case digitally?

Dr. Kim emphasized the importance of high-resolution scanners to capture accurate soft tissue details which are crucial for the fitting of dentures. He also highlighted the cost-effectiveness of digital methods, as they often reduce the need for physical tools and materials traditionally used in dental practices.

 

Question 2: What is the clinical tip when studying VD in a digital way?

In his response, Dr. Kim discussed the utility of simple alternatives like cotton rolls, which can stabilize the jaw temporarily and bridge the upper and lower scans without specialized equipment. He also noted the benefits of designing custom trays digitally for accurate centric relation determination, which speeds up the process and enhances patient comfort.

 

Question 3: If you’re making a bite rim with 3D printing, do you think digital bite rim can replace conventional wax rim?

Dr. Kim affirmed that digital bite rims created through 3D printing could effectively replace traditional wax rims. He explained that digital trays incorporate precise Gothic arch tracing, providing superior accuracy in establishing jaw relations and simplifying adjustments during the trial fitting.

 

Question 4: Is there any specific process in the conventional way that is still essential and can’t be replaced with digital methods when restoring an edentulous case digitally?

The doctor acknowledged that while digital advancements offer numerous benefits, certain traditional techniques remain irreplaceable. Specifically, the tactile feedback from manual methods is crucial for assessing the fit and comfort of the dentures during the trial phase. Furthermore, he mentioned the challenges with capturing mobile soft tissues and potential durability concerns of materials used in 3D printed dentures.

 


 

While digital technologies have revolutionized many aspects of dental prosthetics, a comprehensive approach that includes both traditional and modern techniques ensures the highest standards of care. This methodical integration addresses the complexities of setting the vertical dimension in edentulous patients, ensuring both functional efficiency and patient satisfaction.

 

Watch the full webinar for detailed expert tips on digitally setting the vertical dimension in edentulous patients.

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