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Polident – REF-LINE: Report on experience with a new line of teeth Erik Lauter Christiane Poppitz Rübeling + Klar Dental Labor GmbH Ruwersteig 43 – 12681 Berlin Tel: (030) 54 99 34-0 Fax: (030) 54 99 34-111 [email protected] www.ruebeling-klar.de There comes a new one... Polident – REF-LINE: Report on experience with a new line of teeth Erik Lauter Christiane Poppitz For all staff responsible for prosthodontics at the Dental Laboratory Rübeling & Klar in Berlin it is not unusual to be constantly confronted with new dental industry products. Therefore it came as no surprise when our head requested that we test a foreign line of teeth, more specifically Polident's REF-LINE. This article summarises our findings and results. Our initial scepticism... Before we even managed to see »the new teeth«, we were pondering on the many adjustments that might be needed in our laboratory and, particularly, how we should be tackling them: Will the contact between the occlusal surfaces be satisfactory? Will the teeth require setting up according to a different prosthodontic concept, and if yes, how can we transmit this knowledge in the quickest and most sustainable manner to our colleagues in the removable prosthodontics department? Are these teeth suitable for use both in complete as well as in partial and implant prosthodontics? If yes, how will our client's patients be able to cope with this? Will the patients who are already using a denture and need a new one possibly feel a significant difference? … was soon replaced by deep interest Our extensive experience with the introduction of new products demonstrates that change is often inevitable, both in the use and finishing. If it results in an improved workflow and greater satisfaction of clients, we are certainly favourably inclined to such a necessity. We suspected that, indeed, REF-LINE teeth were such a positive product when after a lengthy narration by our head and the producer we finally got to see the »new teeth«. The REF-LINE line of teeth looks as if it is straight out of the picture book: it has beautiful surfaces, delicate layers of the front and side teeth, and beautiful morphology of occlusal surfaces of the side teeth (Images 1a, b). In view of this appearance it was not surprising that our colleagues and ourselves set about using these teeth in our everyday practice without the usual prejudice. 1a 1b 1a, 1b: Already at first sight, the front and side teeth of Polident's REF-LINE make a very good impression in terms of form and occlusion. Rübeling+Klar Dental Labor GmbH 3 Distinctive features of the teeth Before embarking on the setup, we were pleasantly surprised by the fact that the front teeth were not simply flatly positioned on a carrier, but rather arranged in a dental arch with the help of centrally slightly elevated wax. The teeth are only gently pressed into dark fixing wax, thus contact between the incisal edge of a tooth and wax is avoided. This allows sufficient light to fall on the incisal sections, accentuating the natural colours of teeth. In the opposite case, which we often come across, the entire tooth would reflect the dark colour of the set-up wax, which would shine through the transparent enamel layer, giving a tooth lifeless appearance (Images 2a-c). 2a 2b 2c 2a, 2b: The front teeth are not flatly positioned on a carrier, but rather arranged in a dental arch with the help of centrally slightly elevated wax. 2c: Due to this special arrangement on the carriers/supports, the front teeth are only gently pressed into dark fixing/blocking wax, therefore contact between the incisal edge of a tooth and wax is avoided. This way, the incisal sections are shown in their true character. Looking at individual prefabricated teeth of this line, we particularly note that vestibularly and palatally they appear very corporeal and that the proximal sides run virtually parallel from the incisal edge to the tooth neck. This way, gaps in the cervical area are avoided, as we will also be able to observe later during the setup. Interdentally, teeth can be positioned close next to each other, whereby large, unnatural and dark triangles are avoided also during the final gum modelling (Images 3a, b and later 6a, b, 7a, b). 3a 3b 3a, 3b: The incisal and proximal surfaces of teeth are clean and practically without any seams. 4 Rübeling+Klar Dental Labor GmbH The arrangement and the overall appearance of layers come across very natural. A more detailed inspection of individual teeth prior to the setup shows that the incisal and proximal surfaces are clean and practically without any seams (distortions) caused by processing. The palatal surfaces are not too heavily shaped, meaning that they are tongue-friendly for the patients and their cleanliness can easily be maintained. Setup and control In the setup of teeth, our laboratory generally follows the Ti F© system developed by Karl-Heinz Köhrholz, which is also taught at vocational and specialist colleges. This procedure and the pertaining criteria were taken as the basis and verified with the appropriate control measures. Since Polident's side teeth have pronounced occlusal cusps, they were not set-up with a lingual inclination of app. 3° as similar fully anatomical side teeth of competitive brands, but rather with an inclination of 7° (Image 4a). 4a 4b 4c 4a, 4b: The setup of Polident's side tooth and possibilities of control: When set-up ideally, the molars only have a slight lingual inclination (7°). The lingual inclination is the same with the first and second molars, which are parallel to each other. 4c: From top view, the control pins or drills on occlusal surfaces are at a slight angle to each other. This occurs correspondingly in both opposite quadrants and is transferred in parallel to the first and second molars (Image 4b). From top view, the control pins or drills on occlusal surfaces are at a slight angle to each other (Image 4c). With a Ti F©-Safe-Guard the correct alignment of molars can be checked in a quick and simple manner both during the setup as well as final control (Images 4d, e). In our view, the possibility of self-control, as was performed here during the setup, and of a similar check during the final control is a reliable criterion for the achievement of a constant quality standard, not least in our customer communication. 4d 4e 4d, 4e: The correct lingual inclination of molars can be checked in a simple and precise manner with a TiF©-Safe-Guard. Rübeling+Klar Dental Labor GmbH 5 The upper side teeth can very simply and quickly be setup against the antagonists, if the inclination of the lower side teeth does not exceed 7°. If the inclination chosen is too high, it is more difficult to bring the palatal cusps of the upper molars and premolars into contact.In the optimum setup of upper and lower teeth, these are in the “one-tooth-to-two-teeth” relationship (Image 5a). The gaps in the setup can be avoided both in the upper and lower jaw. The incisal overjet of the upper front teeth is predominantly even and parallel to the lower teeth, both in the event of a straight setup or individual production as was the case here (Image 5b). 5a 5b 5a: In the optimum setup of upper and lower teeth, these are in the “one-tooth-to-two-teeth” relationship. 5b: The gaps in the setup can be avoided both in the upper and lower jaw. The incisal overjet of the upper front teeth is predominantly even and parallel to the lower teeth, both in the event of a straight setup or individual production as was the case here. As proximal surfaces of the front and side teeth are very much parallel, it is also easy to model the artificial gums. The entire palatal surface of teeth is continuous from gums to the incisal edge without any slots that would lend an impression of false teeth. This makes it straightforward for a dental technician to individually determine the form and dimension of the gingival margin (Image 6a). With the individual setup presented here, the front teeth were once placed closely side by side and once in a partly overlapping manner. In both cases, the area looks natural and hygienic both during setup as well as gum modelation (Images 6b, c). The same applies to the lower jaw area. Particularly striking is the palatal shape of the front teeth. These are designed in a very functional and aesthetic manner which is extremely patient-friendly. The palatal surfaces are not too heavily curved, they are smooth and not blemished by tooth type coding. In addition, the arrangement of layers gives teeth a very natural interplay of colours (see Images 3a, b). The vestibular area can be given both a smooth or anatomic appearance, whichever better corresponds to the patients' requirements. In gum sculpting/modelling, we generally follow our clients' wishes. 6 Rübeling+Klar Dental Labor GmbH 6a 6b 6a, 6b, 6c: Palatally, the front teeth are designed in a very functional, aesthetic and patient-friendly manner. The palatal surfaces are not too heavily curved, they are smooth and not blemished by tooth type coding. The proximal areas are in close contact and the design of layers affords the teeth a very natural appearance. 6c End well, all is better Polident's front and side teeth have been included in our portfolio not long ago. Their setup is exceptionally simple and safe. Even our apprentices are soon able to achieve good results with their use. The colours of teeth correspond to the Vita Classic colour guide. The design of layers affords the teeth a natural appearance and despite a high share of enamel colour, teeth do not look gray. The tooth neck is sufficiently long, therefore these teeth can also be used for partial dentures. The feedback from our clients is altogether positive, both in terms of the aesthetic appearance and the pleasant characteristics of the material, as Polident's REF-LINE teeth do not consist of usual composite materials, but rather use a more complex pre-cross-linked polymer reinforced with inorganic micro- and nano-fillers. ZT Erik Lauter Rübeling+Klar Dental Labor GmbH ZT Christiane Poppitz 7