Duplicating Porc denture teeth with Milled/Pressed Teeth?

[JMN]

Hey all,
Please help me with this:

Got a request to duplicate a denture that is a big mess waiting to happen. The patient *insists greatly* that he wants a perfect duplicate of his current denture that he's been wearing for over a decade. The Porcelain teeth have worn in to exactly how he wants it to be and he will not take "it can't be done with Porcelain teeth" for an answer. He demands porcelain teeth.

So, anyone try to scan and mill/press a 14 unit set on a bar, or individual teeth (with diatorics like for valplast?) and then pack acrylic to them? That's what I'm thinking is the only option that will result in what the patient requires. I'm unable to scan/mill/press currently, so I'd have to partner with someone to do that end, and I'm not sure what needs they would have as my hand on cad/cam background is limited to Procera Forte.

Is this even possible, I think it is, but I don't know if I know what I'm talking about either.

Thank you all, for any helpful comment, I'm a bit at loose ends on this one.

 

[2thm8kr]

Are you going to disassemble the current denture and duplicate every tooth individually? Perfectly duplicating a denture is a pretty tall order. We've had some serious think tank sessions on using CAD for this and haven't been able to come up with a solution that is realistic or affordable yet. It is something that may be a possibility in the not so distant future.

I recently saw a photo of a denture using emax teeth. They mentioned that diatorics were used. I'm interested to hear what the removable guys have to say when they finally get out of bed around noon.

 

[rkm rdt]

Did they stop making porcelain denture teeth?

 

[XxJamesAxX]

Perfect duplicate isn't going to happen IMO... Atleast not at this time. Real close is a possibility, but IMO even if you could duplicate it exactly it still won't feel the same to the patient and they won't think it's an exact duplicate. I like a challenge but everyone has to be realistic....

 

[Car 54]

JMN, I know I may be considered a woos for saying this, or for not stepping up to the challenge, but, could you say to the Dr that it is out of your comfort zone, beyond where you're at right now, and to send it elsewhere? I know we all need the work and there is a dental technicians fear of saying no, that we'll lose the work from the Dr, but it sounds like one of those nightmare cases you may either regret doing, or....possibly could learn a lot from in doing it?

I like rkm's question, is someone out there still making porcelain denture teeth?

edit:sp

 

[JTG]

I agree with Car. This would have to be a case I pass on, been there done that (not with porcelain teeth, but the same basics),not worth the headache. Like James said, pt has to be realistic, nothing will ever compare to the denture he currently has. Do you think it would be a possibility that you can meet the pt with the dr at the office and discuss your concerns? That's what I do in these situations anymore, and it always works when I explain the issues that will arise, problems that will happen. FWIW. Good luck!

 

[cdtwade]

You can buy porcelain teeth and you can replicate the wear in the anteriors. But to replicate the wear in posterior function is a whole different matter. This patient has expectations that are unrealistic. Is the doctor a prosthodontist? There are some patients no one can satisfy, not even an experienced prosthodontist. These patients have issues that go way beyond the realm of what the restorative team is capable of, ie. they have state of mind problems that require different kind of doctor, you know what mean? I am a removable tech and I do get out bed before noon LOL!!! I have worked in full service labs and always wondered why the denture department is always up and running so early and and the ceramists are meandering in after 9:00 a.m.?

 

[Doris A]

Your only option would be is to use porcelain teeth and measure from the neck of the tooth to the incisal edge and then custom grind every tooth. Even then it's not going to be exactly the same. Charge for labor for each individual tooth, and I would make the labor charge so high that the patient will want acrylic teeth.

 

[Car 54]

You can buy porcelain teeth and you can replicate the wear..... ----------
----------
I have worked in full service labs and always wondered why the denture department is always up and running so early and and the ceramists are meandering in after 9:00 a.m.?

lol, because we've been there working until 3:00 A.M.

 

[rkm rdt]

First of all, the porcelain teeth have not worn to the patient's natural teeth.

It's the other way around.

You can easily set up new posts to the occlusion.
I'd tale a putty matrix of the original ants and replicate the incisals to the new porcelain ants.

That's it.
Charge like Doris said.

 

[JTG]

Your only option would be is to use porcelain teeth and measure from the neck of the tooth to the incisal edge and then custom grind every tooth. Even then it's not going to be exactly the same. Charge for labor for each individual tooth, and I would make the labor charge so high that the patient will want acrylic teeth.

What stinks is the pt will agree, you'll go through all that work, the denture fits great and dr is happy with that, pt thinks you've done a great job on reproducing the wear patterns, and then you'll hear "You know what, I think the shade is a little off. Could we go a little lighter?"

 

[Car 54]

Can also happen with cosmetic ceramic cases..."could we go a little lighter" than this toilet bowl white

 

[sidesh0wb0b]

there should be no promise of an exact duplicate, since its not possible lol
and it should be in writing with signatures.
than charge, charge, and charge more. do the best you can.

 

[cdtwade]

Your only option would be is to use porcelain teeth and measure from the neck of the tooth to the incisal edge and then custom grind every tooth. Even then it's not going to be exactly the same. Charge for labor for each individual tooth, and I would make the labor charge so high that the patient will want acrylic teeth.

Never thought of that. Punish the patient that isn't well to begin with.

 

[MasterCeramist]

If he likes the teeth so much couldn't you just rebase the existing denture ? Same old looks and function with new acrylic.

 

[JKraver]

Why is the pt getting a new denture? Shade change? You could silicone dupe the gingival contours, and tooth shape fill with stone scan mill teeth to those contours. Place teeth in silicone dupe and pour method acrylic.

 

[XxJamesAxX]

If he likes the teeth so much couldn't you just rebase the existing denture ? Same old looks and function with new acrylic.

This is what would be best but do so with this is mind. Your not going to be able to duplicate the acrylic base to "feel" just like the denture did before and the patient is probably going to bawk about it if there that picky.

On one hand it's a good thing because it forces the patient to deal with the new denture and not revert back to there old denture, because IMO if you make them a new one this is what's going to happen and the patient is going to want a refund.

On the other hand you no longer have that old denture for them to go back to and your stuck trying to make them happy, vs. making them a new one there comes a point where you/doc can say we've done all we can and they can go back to there old denture.

Either way I'd stay away from this case. 99% chance it's not going to end well. I don't like the odds...

 

[JTG]

If he likes the teeth so much couldn't you just rebase the existing denture ? Same old looks and function with new acrylic.

pt may be looking to use old denture as spare. If they're already this demanding, my fear would be if I did that and then pt came back saying it doesn't fit like it used to, then you have a whole new problem. I'm not saying it isn't a good idea, but I would only do it as a last resort. Been there, done that, didn't go well for me (though dr was cool). Now I suggest not to do it.

 

[JTG]

This is what would be best but do so with this is mind. Your not going to be able to duplicate the acrylic base to "feel" just like the denture did before and the patient is probably going to bawk about it if there that picky.

On one hand it's a good thing because it forces the patient to deal with the new denture and not revert back to there old denture, because IMO if you make them a new one this is what's going to happen and the patient is going to want a refund.

On the other hand you no longer have that old denture for them to go back to and your stuck trying to make them happy, vs. making them a new one there comes a point where you/doc can say we've done all we can and they can go back to there old denture.

Either way I'd stay away from this case. 99% chance it's not going to end well. I don't like the odds...

Beat me to the punch!

 

[Doris A]

Never thought of that. Punish the patient that isn't well to begin with.

Oh, so you would do it for free?!?!?