.png)
Candulor Case Study
CANDULOR KunstZahnWerk competition 2025
By Rudy Concina.
The successful outcomes that can be achieved with denture prosthetics are a result of taking accurate records and adequate communication with the patient during the course of treatment. These include accurate clinical chair-side records and the technical records and processes undertaken in the laboratory.
The clinical records include noting a patient’s medical conditions and general health and well-being. Discussing the patient’s expectations, in relation to what is a measured predictable outcome will assist in gaining patient acceptance of the prosthesis. The physiological limits and psychology of expectations are important factors that need to be discussed and emphasized at the consultation visit, and, or during early parts of treatment. Assessment of the old dentures and measured comparative records will reduce the risk of the patient rejecting the prosthesis. This may entail provisional treatment using the old dentures. For example, a tissue conditioner and occlusal pivots placed on the old dentures to open the occlusal vertical dimension over a period of time may gradually adjust the patient to changes until an ideal mandibular posture is established. Other important records include photographs of the patient with the old dentures, and or using computer software or photographs as a guide to the aesthetic possibilities. Accurate functional impressions
that are appropriate to the patient’s anatomy will provide retention, stability and comfort for speech and mastication. Maxilla – Mandibular relationship record will guide the tooth position and jaw relationship when setting the teeth for a tryin. The phonetics with “f, v and s” sounds should be tested for the desired vertical dimension and freeway space.
This journal focuses on the technical laboratory aspects of denture prosthetic treatment. Emphasis will be placed on model analysis, tooth setting and processing the final dentures. In the laboratory the teeth setup should follow the bite index, both anteriorly and posteriorly. The anterior region must provide for the correct amount of lip support and anterior teeth relationship. Posteriorly the teeth should correct the buccal corridor. The ideal goal is for the restoration of aesthetics, masticatory function, occlusal vertical dimension, phonetics, fit of the denture, patient confidence and acceptance of the outcomes.
Candulor has provided the following information about the patient to be treated: Patient name: Mrs Martin.
Age: 68 years old.
Photographs of the patient and their old dentures demonstrate the over-closure of vertical dimension.
Figure A. Photo of Maxillary – Mandibular relationship demonstrating the required lip support and occlusal plane.
The photo below of the patient smiling indicating the occlusal plane, also highlights other elements that need to be considered when setting the teeth. The patient’s right side of the face is more dominant than the left. This is highlighted by the ala of the nose being further from the midline on the right side when compared to the left. There is also a more visible buccal corridor on the right side when the patient smiles. The corners of the mouth are higher on the left side than the right. In order to respect the clinical records teeth will need to be arranged aesthetically to suit the face rather than a symmetrical straight smile appearance.
Figure B. Photo planning of aesthetics and occlusal plane.
Other information to not include:
Patient has no disease relevant to treatment.
The existing dentures are 15 years old and were immediate dentures at the time. There is pronounced atrophy of the alveolar ridges, particularly the mandible.
There is significant loss of vertical dimension due to the age and wear of the prosthesis. The teeth have a poor occlusal relationship and is over-closed giving the appearance of a Class III relationship.
The dentures are only possible to wear with the use of adhesive. There is pain in mandibular movements. The lower ridge is sensitive to compression in the mentalis foramen region on both sides of the mandible.
The patient feels her teeth are not visible enough. There is a lack of lip support. She deplores the sunken appearance of her lower lip.
The patient wants a better fitting denture that will enable her to chew comfortably. She would like an improvement to her smile, with better lip support. The shape, position and colour of teeth are to look natural corresponding with age. The patient would like a little irregularity in the teeth setting. The aim is to bring the patient back to a Class I. However, the anterior tooth setup is closer to a Class II.
The laboratory procedures will entail using the records provided with a detailed model analysis to achieve the outcome desired. The teeth are to be set using Gerber’s tooth to tooth setup concept. The articulator used is a Candulor 3.0 and the condylar guidance angle is set to an inclination of 28 degrees on the right side and 30 degrees on the left. The models are to be articulated using average values accordingly, whereby the occlusal plane is equal to Campers plane. The denture teeth shade and moulds chosen are PhysioStar NFC+ shade A2, mould 770 (upper anteriors), mould 994 (lower anteriors), and Condyloform II NFC+ in mould 34 for upper and lower posteriors.
The occlusal rims indicate the exact form of lip support and occlusal plane. A silicone key is used to guide the lower teeth setup. The upper occlusal rim indicates the correct aesthetic and phonetic parameters. Therefore it is imperative to keep the over-jet recorded in the MMR.
The lower ridge is sensitive to compression in the mentalis foramen region on both sides. The denture will require relief foil to be applied on the model prior to processing to avoid compression in this region (figure 23). The mentalis foramens are terminal openings that form part of the mandibular canal. This transmits terminal branches of the inferior alveolar nerve and mentalis vessels. The terminal opening is usually located between the lower first and second premolar.
However, clinical examination should be used as an accurate reference locator with the use of radiographic exam and palpation of the tissue. Variations in position may exist according to sex, age and racial ethnicity. The loss of teeth and bone causes the mentalis foramen to move upwards towards the alveolar border, or alveolar margin. As a result, relief foil of 0.3mm will be applied between the lower 1st and 2nd premolar over the alveolar ridge crest and terminating in the buccal sulcus prior to processing (figure 23).
The upper model requires the post-dam to be carved into the model. This should be marked in the clinic at the vibrating line where the junction of hard and soft palate exists. The “aah” sound expresses the movement of the soft palate. The degree of compression will vary and should be tested by compression and indicated in the clinic records. The post-dam usually passes just anterior to the line of flexure of the soft palate and close to the fovea palatinae (Keng and Ow, 1983). The post-dam should be round and smooth. It crosses the mucosa covering the pterygomaxillary notches in the distal part of the buccal sulcus becoming part of the buccal seal. It should be narrower and deeper in the lateral, softer parts of the palate. Where it crosses the midline of the fovea it is usually shallower as the tissue is less compressible. An additional line should be scribed on the cast anteriorly to capture the mucous glands found in this area. The area between the two lines blended slightly towards each other to restrict the thick mucus from escaping posteriorly past the denture border.
The model is soaked in water and ready for duplication using a class A silicone (Figure 1 & 2).
Figure 1 &2 Duplication of master models.
The bases of the models are then modified for a split cast technique using magnetic bases with retention elements (figures 3 & 4). This aids accurate reseating of models on the articulator.
