Dennis Urban, CDT

Dennis Urban, CDT
Jason J. Kim
Dental Aesthetics
Port Washington,
Long Island, NY

Zitta, Ultaire AKP patient

Zitta
New York

“The team created a horseshoe design for Zitta, which maximized comfort and provided maximum use of her taste buds.”

— Dennis Urban, CDT

Polymer RPD allows for deep undercut engagement and smooth, stationary clasps

Case overview

The inside of Zitta’s cheeks looked like a road map. Years of cuts and scrapes from the metal clasps on her upper partial had left a trail of scars. Not only that, the poorly-fitted partial had torqued her remaining teeth, atrophied her natural dentition, and ruined her smile. Fortunately her new dentist, Gerald Grossman, DDS knew there were other options for her and collaborated with the team at Jason J. Kim Dental Aesthetics to find the best solution.

Challenge Solution
Achieve excellent retention with only four remaining maxillary teeth Designed frame with Ultaire™ AKP, a rigid high-performance polymer that allows for deep undercut engagement and smooth, stationary clasps
Provide gentle stability to significantly atrophied areas Ultaire™ AKP is a biocompatible, bone-like material that will not damage the remaining dentition
Improve chewing mechanics, which were hampered by an edge-to-edge bite The Ultaire™ AKP frame has plenty of space for an anterior build-up of 8 mm to 10 mm along the gingiva
Create a metal-free smile that shows the patient’s front teeth Used a custom impression tray and VPS impression material to ensure CAD captured all anatomical landmarks for setting the front teeth back to a more natural look

 

Design technique

Creating the framework

With only four remaining teeth available, #1, #3, #12, and #14, the frame design needed to capitalize on every possible undercut. Ultaire™ AKP allows for an undercut depth of 0.5 mm, which is ideal for clasp engagement. The unique design of the Ultaire™ AKP clasp achieves retention without encircling the full tooth, which improves the aesthetics of the partial.

Although the clasps appear slightly thicker than metal clasps, they are smooth and practically weightless, which improves patient comfort. Zitta’s framework was designed in less than 30 minutes. Special Ultaire™ AKP material settings work with the CAD software to help ensure the milled frame snaps perfectly onto the model without needing adjustments.

The Ultaire AKP frame provides retention without having to fully encircle the left bicuspid

The Ultaire™ AKP frame provides retention without having to fully encircle the left bicuspid.

The frame snapped right onto the model upon release from the milling disc. No adjustments were needed

The frame snapped right onto the model upon release from the milling disc. No adjustments were needed.

Improving the bite and smile

Zitta’s old partial gave her a bite that was edge-to-edge and nearly a Class III. Her top lip had a sunken appearance and her teeth did not show when she smiled. To provide Zitta with a more natural bite and smile line, the team created a build-out of the vestibule area. The Ultaire™ AKP frame provided ample space for the build-out.

Anatomical landmarks captured in the custom tray impression guided the placement of the VITAPAN® PLUS acrylic teeth. To achieve a more natural appearance, the team used the papilla as a starting point, coming out an average of 8 mm to 10 mm anteriorly and toward the buccal side.

A horseshoe design maximizes comfort and provides maximum use of Zitta's taste buds

A horseshoe design maximizes comfort and provides maximum use of Zitta’s taste buds.

Zitta's bite and smile were restored by setting the front teeth out to a more natural appearance

Zitta’s bite and smile were restored by setting the front teeth out to a more natural appearance.

To ensure the lateral excursions have full function, it is a best practice
to use fully adjustable articulator mounting to mimic the occlusion of the new partial

To ensure the lateral excursions have full function, it is a best practice to use fully adjustable articulator mounting to mimic the occlusion of the new partial.

Matching and fitting

Working from photos supplied by the dentist, the team used a special colorizing system to mimic Zitta’s gingiva. This is a critical step because ethnicity can greatly influence gingival coloring. During the wax try-in stage, the team assessed how close they had come to accurate colorization, and adjusted as needed. With Zitta, the team determined they would need to darken the gingiva before processing the partial.

 

Discussion

Patient feedback

Because Zitta’s lower partial was also problematic, she asked her dentist to prescribe her a new lower partial made from Ultaire™ AKP.

At the final try-in appointment, Zitta surprised everyone by dancing with joy about the fit and feel of her new Ultaire™ AKP partial. “Ultaire filled out my mouth better. It transformed my whole face,” said Zitta.

With no metal in the design, Zitta feels confident that people won’t know she’s wearing a partial when she’s smiling. “Ultaire is great. It’s fantastic. I love it,” she said.

The Ultaire™ AKP frame didn’t need adjusting because it snapped perfectly into place during the final try-in. The team proceeded to the final waxing, investing, press pack, microwave processing, and finishing steps. They accomplished all of this in one day.

Zitta holding her new, metal-free Ultaire™ AKP RPD.

Zitta holding her new, metal-free Ultaire AKP RPD

 

“Ultaire filled out my mouth better. It transformed my whole face.”

— Zitta,
Ultaire™ AKP Patient