Scott Udell, CDT, CEO

Scott Udell, CDT, CEO
Udell Dental Laboratory, Inc.
Minneapolis, MN

Bob, Ultaire AKP Patient

Bob
Minneapolis

“Ultaire™ AKP frames were ideal for Bob because of his bite sensitivity and concern for having a metal frame. The milling procedure provided an exact, snug fit right off the mill, so the partial will never shift in Bob’s mouth or become loose.”

— Scott Udell, CDT

Lightweight, durable RPDs for a misaligned bite

Case overview

In the lab, the most challenging cases often bring the greatest sense of satisfaction – especially if they have a life-changing effect on the patient. This was the case with Bob, a great-grandfather with a misaligned bite, crooked smile, and a serious stubborn streak. For decades, dentists had offered to fix Bob’s occlusal characteristics, including a bite that came from the side, sliding across and damaging his few remaining lower anterior teeth. Instead, he repeatedly opted for an upper partial that accommodated – rather than repaired – his unique bite.

In 2017, after much encouragement from his wife and family, Bob agreed to work with his dentist, Dr. Gregory J. Kemmitt, and the team at Udell Dental Lab on an upper and lower combination that would give him a proper bite and smile. The team at Udell devised the best solutions to Bob’s significant challenges.

Challenge Solution
Long span area because Bob only has three remaining upper teeth (#2, #13, #14) Selected Ultaire™ AKP for framework because of its strength, comfort, and secure clasp design
Lower front teeth worn and lacking structural integrity (patient insists on keeping these teeth) Designed a five-unit PMMA structure that covers the damaged teeth
Lack of interocclusal space; freeway space for clear speech Created anterior tooth structure to gain clearance for the over-closed bite
Lopsided smile line; different lip line at rest versus smile line Created an overbite to make room for a level tooth line
Did not want “metal” in his mouth; his last restoration was an acrylic upper with wire clasps, he was also biting against the remaining lower teeth Selected Ultaire™ AKP as a lightweight and durable alternative to metal, restoring Bob’s ability to eat comfortably, and speak with improved clarity

 

Design technique

Creating the framework

To design frames from Ultaire™ AKP, Udell Dental Lab technicians completed the Solvay Ultaire™ AKP training and installed Solvay Dental 360™ Material Settings into their 3Shape™ Dental Manager software.

The first design step after importing the digital 3D model was surveying and wax block out for undercuts. When using Ultaire™ AKP, an undercut depth of 0.5 mm is ideal for clasp engagement. Deeper undercuts are possible because of the flexibility of the material. This was especially beneficial for Bob, who had so few remaining teeth.

Direct milling of Ultaire™ frames results in a more accurate fit compared to lost-wax casting techniques. This was an important benefit in the upper partial with only three abutment teeth, as well as in the stabilization of the lower partial, which has no cross arch support.

“It took 20 minutes to design and two hours to mill each partial.”

— Scott Udell, CDT

Deeper undercuts are not the only design differences that are possible when working with Ultaire™ AKP versus metal or other framework materials. Although some of the structural features of the Ultaire™ AKP frame may be a fraction of a millimeter thicker, they are much lighter for the patient. The material has a more natural feel than metal or acrylic in the palate and clasp areas.

The full palate on the upper frame adds stability to a long span of unsupported dentition

The full palate on the upper frame adds stability to a long span of unsupported dentition. With only two teeth for retention in the lower partial and no cross arch stabilization, the lingual portion of the partial is thickened.

Adjusting the anterior tooth structure

Bob’s bite had a distinct lack of space over his existing anterior teeth, which he had worn down to nubs but did not want removed. To compensate for the lack of space, the Udell team created a five-unit PMMA tooth structure that fit directly over the worn teeth. Extra mesh was added to the framework to support this unique structure. All other artificial teeth were placed on the removable partial using the Ivocap® injected acrylic process.

A five-unit PMMA tooth structure fit directly over the worn teeth

A five-unit PMMA tooth structure fit directly over the worn teeth.

Creating the overbite

While intentionally creating an overbite is not ideal, it was the only way to compensate for Bob’s crooked smile line without damaging the jaw joint or causing TMJ disorders.

To accomplish the overbite, the Udell team used a flat-plane occlusion scheme that incorporated the palate areas into the biting surface. Bob’s anterior teeth now rest on the acrylic material of the upper partial when his teeth are clenched.

Clasp designs are shorter and thicker

Clasp designs are shorter and thicker, yet they are still able to encircle a minimum of 200° of their respective tooth to aid in retention.

 

Discussion

Extended try-In period

Because Bob had been so resistant to restoration, the team at Udell was mindful of what Bob could handle and what he was willing to tolerate. To ensure that Bob would not feel pain or pressure of any kind with his new bite, the team scheduled a 30-minute try-in session, which was successful. Bob did not experience any discomfort.

While wearing his new partials, Bob noted that they felt secure, light, and comfortable. He and his wife were thrilled about his new smile. His wife was also happy that he could pass the “Mississippi test,” as it had been years since Bob had been able to say “s-words” with clarity.

Bob wearing his finished Ultaire™ AKP RPDs.

Bob wearing his finished Ultaire AKP RPD
Bob wearing his finished Ultaire AKP RPD

“Bob now has fully functional dentition. With his straight smile and corrected bite, he looks like he’s had a facelift.”

— Scott Udell, CDT