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Episode 5 - Prosthetic Design Essentials

Full-Arch Restoration - Mission Possible (Mini-Series)

The concept of, “Teeth in Space” is perhaps the most critical aspect of completing a successful full arch restoration. In episode 5 of “Full Arch Restoration…Mission Possible,” Dr. Frank LaMar will discuss how the “Teeth in Space" concept is essential to ensuring patient function, diction, comfort, and esthetics.

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Episode 5 - Prosthetic Design Essentials 

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Watch the Hybridge Podcast Video: Episode 5 - Prosthetic Design Essentials


Randal: Dr. LaMar, what are some of the design considerations related to the prosthetics that will ensure a patient has not only good function, but an esthetically pleasing out come?

Dr. LaMar: I'll break that down. Functionally the things that I usually think about are related to the contours and the tooth position of the final prostheses. These are all related to not only the position of teeth in space, as restorative doctors the teeth in space have to be in the right position. So, horizontal position of the anterior teeth, vertical position of the incisal edges, arch form, occlusion, how the teeth are going to come together is important, all of these things are important to the feel of a prosthesis. Lip support might feel less than adequate or maybe there’s too much lip support. The teeth, the arch form might be too wide, I've had our patients say they feel the teeth, which would give a sense of feeling like they're all teeth. If the arch form is too narrow, the tongue is crowded and can't brace properly, so their becomes phonetic issues. The teeth truly do dictate the phonetics and the way in which we make our sounds. So, from a functional stand point it's not only the ability to chew but it's the ability to function and speak. And so, the teeth in space is a really critical component to full arch restoration and nobody ever really talks about that. The training tends to be about putting the implants in, and putting an immediate load prosthesis that day, but there's very little focus these days on where the teeth belong in space and how do we get them there, how do we get them at the right prosthetic determinants as we like to say. The right incisal edge position, the right vertical dimension of occlusion. A patient who is not at the right vertical dimension will know they're not at the right vertical dimension. Unfortunately, they don't know what that means, so they can't articulate it very well.

The other part of your question was all the things that can go wrong relative to the function of the esthetics. With the materials today, and there are various materials available, the restorative doctor has to choose between acrylic denture teeth, milled acrylics, which are new to the market, and zirconia restorations. All of them in my opinion have a place, but what I would say is that they don't all look the same. And so sometimes we make these decisions based on which material we're going to use based on what is the esthetic requirement of that patient.

Randal: So the patient really has a lot to say about the type of material you might choose?

Dr. LaMar: It's important that the patient, what they say, is heard by the dentist, and the right decision tree, the right path is taken based on all of the factors. Not only the esthetics, but the functional requirements and they all kind of got together when you're determining what materials you're going to choose for your full arch.

Randal: Well, I think in a process this complex and comprehensive it is important to have the patients input on that and obviously you've given them a chance to look at different types of materials and different types of outcomes and I think that's probably the best way to approach the process.

Dr. LaMar: We do walk a patient through our three prosthetic options of materials that we offer. We actually have what we call showcase models and we have a showcase model for each of the three materials and we talk about the pros and cons of each because they each have their own advantages and disadvantages. Then we try to couple that with some of their functional requirements. If a patient is going to be very hard on their teeth, there are certain materials we're not going to choose. If a patient has a very high expectation of esthetics and there's a very small percentage of our patients that fall into that category, then we need to make sure we design for that as well.

Randal: Well I appreciate the sensitivity you take with your approach and I'm sure your patients do as well. Thank you for joining me today.

Dr. LaMar: Yes, thank you Randal.

Randal: And thank you ladies and gentlemen, for joining us on Full Arch Restoration: Mission Possible.

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