spectrum denturism

June 2012 • Vol. 6, No. 3

In This IssueImplant supported bar work

Genios: Spanning the rangefrom combination restorations

to implant restorations

Occlusion and Attachments:The Underlying Scheme for

Successful Overdentures

The Latch Bar System - Part 1

Product Review

Continuing Education Tests

SDen_V6N3_JUN12_Spectrum 6/13/2012 4:07 PM

In this issue Vol. 6 No. 3 – June 2012Publisher:Ettore Palmeri, MBA, AGDM, B.Ed., BA

Palmeri Publishing Inc.Toronto, [email protected]

Associate Publisher:Peter Pontsa, RDT

Editor:Carlo Zanon, DD, LD, FCAD – [email protected]

Associate Editor:Mike Vakalis, CDT, DD

Office Administrators:Sanaz Moori Bakhtiari, B.SC – [email protected] Ellis – [email protected] Palmeri, B.SC – [email protected] Palmeri – [email protected]

Sales/Marketing:Mark Behar Bannelier – [email protected] Palmeri – [email protected]

Editorial Director:Frank Palmeri, H.BA, M.Ed – [email protected]

Production Manager:Samira Sedigh, Design Dip. – [email protected]

Design & Layout:Tim Faller – [email protected] Sophie FallerLindsay Hermsen, B.Des.Hons. – [email protected]

Internet Marketing Director:Ambianz Inc., Rashid Qadri

Event Coordinator:Roya Safari, B.SC – [email protected]

Canadian Office:35-145 Royal Crest Court, Markham, ON L3R 9Z4Tel: 905-489-1970, Fax: 905-489-1971Email: [email protected]

Website: www.palmeripublishing.com

SPECTRUM DENTURISM is published four times a year anddistributed to Denturists across North America. The journal iscommitted to presenting cutting edge education in order tooptimize patient care.

Articles published express the viewpoints of the author(s) anddo not necessarily reflect the views and opinions of the Editorand Advisory Board.

All rights reserved. The contents of this publication may not bereproduced either in part or in full without written consent ofthe copyright owner.

Publication DatesFebruary, March, May, July, September, November

Printed in Canada Canadian Publications Mail Product Sale Agreement40020046

Advisory Board

Daniel Léveillé,DD

Peter Pontsa,RDT

Joe Smith,President, CentralDental Ltd.

Frank McMinniman,CDT, DD

Marc Northover,DBSc (Hons), DD,Dip CDT RCS (Eng)

Paul Levasseur,LD, DD

Austin Carbone,LD, DD, BSc, BEd

Allen Aptekar,DMD, BSc

Mike Vakalis,CDT, DD

Shawn M. Murray,CDT, LD

Vallan Charron,LD

Peter Rotsaert,DD, CDT

Carlo Zanon,Editor-in-Chief

Spectrum Denturism – Vol. 6 No. 3 – June 2012 3

S P E C T R U M

Harold Bergman, DDS,Dipl OS&A, MScD(Path),MRCD(C)

Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Carlo Zanon, DD, LD, FCAD

Implant supported bar work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Hans-Peter Vögtle, MDT

Genios: Spanning the range from combination restorations to implant restorations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Hans-Peter Vögtle, MDT

Occlusion and Attachments: The Underlying Scheme for Successful Overdentures . . . . . . . . . . . . . . . . . . . . 24Dennis Urban, CDT

The Latch Bar System - Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30DT Axel Mühlhäuser

Continuing Education Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Advisors Connect the Dots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Dale Tucci

People and Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48


I n a world that is connected with instant notificationsand news via the internet and media, it would be idealto set up a network that would connect, unify and set

international standards for Denturists.

Denturism is still in its infancy in comparison to manylonger standing professions. Medicine and Dentistry havehad a substantially longer time to evolve and implementnational standards and respective business plans to advancetheir goals and profession. We are still in the evolutionarystages of developing programs and standards for educationand quality in comparison.

Our profession is still not recognized in most states inthe United States and most countries in Europe. It wouldseem elementary for a profession that is recognized and hasbeen accepted and established in many parts of the world tohave the ability to practice anywhere worldwide. Individualshave sacrificed incredible amounts of time and effort andsome have been jailed, in order to achieve what we haveaccomplished this far!

Our efforts should be constructive in determining aworldwide structure that unifies education, examinationstandards and continuous learning in order to strengthenwhat we have achieved. In order to stay strong and gain instrength, we need individuals to step forward to lead and sethigher standards. We must remain independent and unified.This can be achieved by working together and aiding in theeducational process worldwide. Europe presently has openboarders for professionals, Professionals licensed to practicein the own countries have the ability to practice in all othercountries if the country is a member of the EuropeanEconomic Community (EEC). In Canada we still areworking towards a national accreditation that will allowfreedom of movement to practice. Standardized education isthe key as well as a worldwide examination standard.

Although this is an ideal thought, it is a difficult task.Governments are presently moving towards open borders.Let us be leaders in this movement and prepare adequatelyfor what hopefully will be implemented and let’s takecontrol as a group in order to benefit and lead with thischange. It is time to raise the bar once again and setstandards that will be admired by others. n

We want to hear

from you!

[email protected]

Carlo ZanonDD, LD, FCAD

Raising the bar

Editorial

4 Spectrum Denturism – Vol. 6 No. 3 – June 2012

Our efforts should be constructive indetermining a worldwide structure that unifies

education, examination standards andcontinuous learning in order to strengthen

what we have achieved. In order to stay strongand gain in strength, we need individuals to

step forward to lead and set higher standards.



Implant supported bar work Hans-Peter

Vögtle, MDT

Status and planning

• Four Straumann-implants regular neck, 4.8 mm diameter • Bar work with four milled crowns and bars • Three dolder bars • Matrix distal on 35 and 34 • Multicon attachment • Secondary parts individually produced from precious metal

In the above-mentioned planning stage, set-up and wax-upare created, copied and converted to plaster (Figs. 1 to 4). NowI am able to visualize what the reconstruction might look like.

Impression

After the teeth exposure, the denturist sends us a pre-impression (Figs. 5 and 6). Once the model is produced, anindividual impression tray for an open implant impression

(Figs. 7 to 10) in the mandibula is created. It is important thatthe impression posts do not interfere with the functionalimpression to avoid a fitting inaccuracy later on. In the case ofmultiple implants it is advisable to interlock the impressionposts in the patient’s mouth before the impression taking; itensures a considerably higher degree of stability.

We use the individual impression supplied by the denturistto create the master model. This is done with or without thegingiva mask.

Bite-taking

Back in the laboratory the next step is bite-taking (Fig. 11),which is produced with bite registration aids or impressionposts so that a stable fit in the mouth is guaranteed. Thedenturist marks the midline and cuspidline (Fig. 12). Withthis information, the work is transferred to the semi-adjustable articulator.



Set-up

Now we start with the actual work by choosing the properteeth and doing a set-up of the teeth on the adjustable biteplate, which is then placed in the patient’s mouth andcorrected if needed. This step is absolutely necessary toensure proper planning and to reach the desired goal(Figs. 13 to 15).

Figures 1 to 4 — Planning model, set-up and wax-up

Figure 5 — Mandibula with implants

Figure 6 — Impression posts on the mandibula model

Figure 7 — Wax-out with wax

Fig.1

Fig.2

Fig.3

Fig.4



Figure 12 — Bite situation with maxilla

Figure 13 — Teeth set-up

Figures 14 and 15 — Mandibula set-up

Figures 8 to 10 — Individual impression tray from different angles

Figure 11 — Bite-taking

Fig.8

Fig.9

Fig.10

Fig.14

Fig.15

Figure 16 — Lay-out of the mandibula with silicone wall



If the patient and denturist are pleased with the set-upand all functions work properly, a 1/1 silicone precast isprepared in the laboratory. It is used for design, barpositioning, attachment and spacing purposes (Fig. 16).

Primary construction

We are ready to choose the implant elements:synOctasecondary parts 1.5 and the matching attachablegold cap for better fitting results (Figs. 17 to 20). For non-conical implant systems, we usually suggest a sealant like

Gebsil for our clients. We begin with the modellation of thebar and the milled posts.

We then place the attachments (Figs. 21 and 22) andinvest the cast piece. These pieces are created in wax in two-parts or multi-parts. After the casting, the work is fitted,secured with a laser and soldered (Figs. 23 and 24).

Secondary construction

Once the bar fits tension-free the structure is milled, polished(Figs. 25 to 29) and the secondary construction is modeled.

Figures 17 and 18 — Secondary parts milled in wax

Figures 19 and 20 — Adding of the attachment

Figures 21 and 22 — Attachment of the bars

Fig.17 Fig.18

Fig.19 Fig.20

Fig.21 Fig.22



Figures 23 and 24 — Casted gold bar

Figures 25 and 26 — Lasered bar

Figures 27 and 28 — Finishing of the bar

Figure 29 — Finished bar with rider Figure 30 — Manufacture of the secondary part

Fig.23 Fig.24

Fig.25 Fig.26

Fig.27 Fig.28



The prefabricated bar matrices dolder macro are integratedtension-free and polymerized into the acrylic later on. It isimportant that the bar riders can be activated and deactivatedfreely and are not covered with acrylic. We polymerize insteadof soldering; this way we eliminate the tempering of the riders.The modellation should offer sufficient retention for the teethand the acrylic and yet be delicate enough. We model metalocclusal surfaces over the attachment boxes due to space andstability requirements (Figs. 30 to 33).

After casting the secondary parts, (please note: a good castresult is very important) we finish the secondary structure andprepare it for the set-up (Figs. 34 and 35). The transfer is easy

Figure 31 — Space verification with precast

Figures 32 and 33 — Modellation

Figures 34 and 35 — Cast result

Figures 36 and 37 — Set-up

Fig.32 Fig.33

Fig.34 Fig.35

Fig.36 Fig.37



because we work with a precast and the metal occlusal surfacesintegrate well into the prosthesis. We insert a thin gold strip toour work on the lingual side, which adds a delicate touch(Fig. 36). Once more function and aesthetic are verified in thearticulator (Fig. 37), followed with a complete wax-up,embedding and boiling process.

Finishing

Finally the work is prepared for the finishing process. Theframeworks are opaquered and the structure is waxed-out in

Figure 38 — Preparation for the finishing Figure 39 — Precast with acrylic teeth

Figures 40 and 41 — Work unprocessed

Fig.40 Fig.41

Fig.42 Fig.43

Fig.44



all undercut areas (Figs. 38 and 39). It is importantthat a thin wax layer is applied in the smallopening between the prefabricated matrix and castpiece. It ensures an easy activation anddeactivation of the bar in the future. With theacrylic finishing the final stage of our work isreached. For the finishing we use the cuvettetechnique by Candulor. We opt for a cast acrylic byMerz Dental (Figs. 40 and 41). It flows well andhas minimal shrinkage. After the acrylic work isdone we attach a composite veneer on tooth 34and 45 followed by polishing and functional tests.The very last step is the polishing of the preciousmetal parts and the implant pieces, which is a time-consuming process that has to be done verymeticulously (Figs. 42 to 49).

Conclusion

This type of removable prosthesis is a solid and aboveall durable solution and is manageable for an elderlyperson as well. It can be activated easily and thespecific adjustment of friction, which is matched tothe patient individually, is easily obtained.

With regard to price, it is a reasonable andcontemporary solution compared to a fixedrestoration consisting of six to eight implants. Theaesthetic’s compromise compared to a fixed option isdefinitely acceptable mainly because we are dealingwith a technique that has proven itself for years. n

Acknowledgement

Special thanks to MDT Volker Weber who inspired me as ahighly competent course instructor and as a person.

Fig.45 Fig.46

Fig.47

Fig.48

Fig.49

Figures 42 to 49—The finished workfrom different angles



Discussions about healthcare have a way of focusing almost exclusively on rising costs and associated problems.Yet, experiences have shown that restorations fabricated by pros in dental laboratories at a fair price generallycontinue to be in great demand. Most patients will opt for restorations in the upper-medium price range whenpresented with different options. Treatments commonly opted for as a result include combination restorations ortelescoping bridges that include the use of denture teeth. The quality and economic aspects of a restoration willtherefore greatly depend on the selection of an appropriate tooth line. This article discusses aspects to be consideredin the selection process and reflects the experience by the author’s medium-sized laboratory with a staff of 12.

Genios: Spanning the rangefrom combination restorations

to implant restorationsOne tooth line instead of three: Same performance, lower inventory cost

T he Vögtle dental laboratory has traditionally focused oncombination restorations. Recently, this existing focushas been expanded to cover more and more implant

restorations. Needless to say, our top priority is to offerconsistently high quality in terms of function, occlusal designand aesthetics. However, the upper-medium price range ofdental restorations requires an aggressive approach to costcalculation. A novel and very economical strategy employed atour laboratory concerns our use of denture teeth to finishcombination restorations, telescoping bridges and bar-supported suprastructures.

The Objective: One tooth line for all indications

A few years ago we were still using three different toothlines side by side. But given the time-consuming and costlyinventory requirements, we decided to streamline our

workflow by standardizing on a single tooth line. A well-deviser product was therefore needed that could be bothuniversally applied and conveniently processed. In otherwords, compatibility was required both with all indicationsand with the personal preferences of all staff members.This search criteria eventually led us to the Genios system(Dentsply, Canada).

A number of cases will be presented below to illustrate someof the important aspects of this decision in greater detail.

Comparative aesthetics

A natural aesthetic appearance is a vital goal when restoringteeth in the anterior segment. We evaluated the aestheticoutcomes of the Genios system in comparison with othertooth lines. It turned out that interdental closures just did notget any nicer than with the Genios A (anterior) tooth line.

Hans-PeterVögtle, MDT



Figures 1 to 5 — Situation on the cast: Nice relation between the Genios A anteriors with themandibular ceramic bridge.

Figures 6 to 8 — Intraoral try-in: Thanks to their favourable surface structure, the Genios Aanteriors self-adjust to the mandibular restorations, which still require treatment.

Fig.1 Fig.2

Fig.3

Fig.4

Fig.5

Fig.6

Fig.7 Fig.8

Fig.8



The lively arrangement of the layering, especially in theincisal areas, were convincing. If trimming adjustments werenecessary at all, they could usually be kept to a minimum,promoting fast and economical workflows.

The competing product required placing the papillae at ahigher level, such that a larger percentage of the tooth surfacewas covered with denture resin. The human eye willimmediately notice the artificial nature of such teeth. Not sowith Genios.If desired, Genios teeth can be perfectly customized byminimal abrasive adjustments, or by the addition of resinmaterial. For example, translucent incisal edges could beimplemented in this fashion (Figures 14 to 16). Mamelonscan be designed without a problem. Genios teeth also differfrom competing products by retaining their surface textureeven after polishing.

Combination restorations:Preserving a traditional strength

We have been able to capitalize on all these Genios advantagesfor combination works too. Restorations of this type have been atraditional focus of our laboratory. Perfect compatibility with thisapplication was therefore a major requirement in selecting thisnew tooth line.

Figures 9 and 10 illustrate a telescopic restoration. Perfectharmony of the gypsum teeth, telescope and denture teeth isevident from the sizes without any cut backs. Functionallyexcellent occlusal relations are almost invariably obtained in allclinical situations. Due to the translucency offered by Geniosteeth, more refined shades can normally be obtained usingstandard layering techniques for composite resins (Figure 11) –all conductive to a swift, and hence economical, workflow.

Implant restorations: Broadening the laboratory focus

Implant-supported restorations have become another focus ofour laboratory. One important requirement was therefore thatour denture teeth should be universally suited for implant-supported restorations. The Genios system is perfectlyserviceable in this respect, for example by ensuring that theresultant papillae have nice outlines that can be visualized onthe model ahead of time (Figures 1 to 5). Teeth 11 and 12were optimized in size and position by axial and longitudinaladjustment to balance out an asymmetrical lip line. We didnot have to wait for customization with veneering resin butwere able to appreciate the overall harmony in appearance asearly as during the wax try-in (Figures 6 to 8). Note the correctocclusal relationships with the mandibular dentition, whichhad been restored with a ceramic bridge.

The lower anterior segment had yet to be restored at the time.Nevertheless, the patient expressed a desire for younger, brighterteeth. This goal could be readily achieved, given the late juvenilemorphology of the Genios teeth. Unpleasant contrasts with thenon-restored mandibular dentition were safely avoided by thenatural surface texture of the denture teeth.

Implant restorations: Accelerating the workflow

With appropriate denture teeth, more straightforward routes canbe selected on the roadmap to success. Time can be saved bycircumventing any lengthy wax-up and modelling procedureswith verification in the articulator. The case presented hererequired the design of a four-unit partial denture supported bytwo implants (sites 11 and 21). Our initial thought was tocombine a substructure with a mesostructure and a tertiary

Figures 9 to 11 — Combination restoration, standard telescopic design: The Genios toothblends in very naturally into the overall situation with regards to both shape and size.

Fig.9

Fig.10

Fig.11


structure. However, on performing a simple set-up with the helpof an occlusion rim, it became evident that casting a fullyanatomical one-piece framework was a much better solution.The screw abutments were placed far lingually and wereeventually bonded without tension in the patient’s mouth.

A laborious wax-up was not needed in this case, thanks to theanatomical form and size of the Genios A tooth used. Instead,the set-up could be tried in directly (Figures 12 and 13).Experience has shown that this approach will yield good resultseven in the hands of less experienced technicians.

Complete dentures:Convincing quality and cost-effectiveness

Complete dentures – which unfortunately are not alwaysgiven as much attention as other dental restorations – can alsobe fabricated to the standards expected in the upper-mediumprice range by using Genios teeth within economicallyreasonable limits. After all, the occlusal surface design ofGenios P (posterior) teeth features an intercuspation patternthat is inherently correct for all practical purposes. A fullybalanced occlusion with group function could be obtainedwithout major effort (Figures 17 to 20).

Overall evaluation and conclusions

Committing to the Genios tooth line has allowed us to reduceour denture teeth inventory by more than half, minimizing

inventory cost. Nevertheless, we still have a complete range ofteeth for universal indications available. Even those stafftechnicians who initially preferred working with other teethhave quickly become familiar with the new system. In fact,they ended up reconsidering their previous option, realizingthat this streamlining of laboratory routines has simplifiedthings rather than narrowed down options.

The convenient processing of Genios teeth has certainlycontributed greatly to this positive feeling. Also, we have noticedthat long-term bond with the denture resin is guaranteed evenwithout the use of any specific retention aids or primers. Geniosteeth are not prone to fracture, and their overall design ensuresthat natural colour effects will be present at all times, even in thesporadic cases where major subtractive adjustments are required.

The Genios posterior moulds with a reduced basalsegment allow even faster and more efficient workflows insituations characterized by limited space. Beyond improvingthe cost-effectiveness of our workflows, the tooth line iscontinuously being improved further, yielding products thatreally make our daily laboratory work more efficient.

Personally, I like these Genios teeth better than any of theother tooth lines we have used. Their occlusal surface design has


Figures 14 to 16 — Natural papillary design and beautiful interdental closures: Comparisonof Genios A (teeth 21 to 23) with a competitor product (teeth 11 to 13).

Fig.14

Figures 12 to 13 — No complex wax-up required: The set-up is directly used as the base forthe first firing of a mandibular implant-supported restoration.

Fig.12

Fig.13 Fig.15

Fig.16



suited me very well. Their translucency including the mamelonstructure and multiple layering correspond with the desire ofmany patients for having relatively brighter teeth with significantlyenhanced aesthetics. Genios teeth can, if desired, be perfectlyveneered and offer a final appearance similar to ceramic teeth. n

Fig.18

Fig.20

Figures 17 to 20 — Even complete dentures can be fabricated in a highly economicalmanner thanks to the anatomic shape of the Genios teeth.

Fig.17

Fig.19

Ropak Kompaktopaker UV (pink coloured) and Kompaktopaker UV

(tooth coloured) are perfect for improving aesthetics by masking out the greyness from the underlying cast

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Call us today at 1-800-250-5111 to order the Ropak Kompaktopaker and

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Tel. 519-942-9315e-mail: [email protected]



Occlusion and Attachments:The Underlying Scheme for Successful Overdentures

Dennis Urban, CDT

I n the ever-changing world of dental technology, the onesegment that seems to be a mainstay in growthconsistency is removables. Whether it is full dentures,

partials, implant overdentures, or attachment overdentures,the potential for continued laboratory business growth inthese areas is substantial. While growth opportunity is amajor factor, the success factor for removable cases includedin the areas mentioned includes many variables.

We are faced today with the demand of creating a denturethat by far surpasses the esthetics and function of denturesthat were made twenty years ago. Denture wearers want tolook as if aesthetic natural dentition is taking up the oralcavity as opposed to the old mediocre look of denture teethand acrylic or as I have heard it called “The Pink Smoothie”.

The good news is now the patient can get what he or shewants when it comes to function and high-end aesthetics.Successful high-end cosmetic dentures all start with goodcommunication with the denturist and the patient and thenit is combined with knowledge, technical expertise, andquality materials. But all of the above mentioned cannot be

achieved without the appropriate occlusal scheme and theright attachment system.

Also, the following points listed are a must for asuccessful case:

• Case planning• Accurate impressions• Correctly contoured bite rims and accurate bite

registrations• A semi-adjustable or fully-adjustable articulator to mimic

jaw function• Precise denture processing

Let’s start with case planning. Keep in mind that themost important objective here is patient satisfaction.Without patient satisfaction the denturist loses businessand the patient suffers with an inadequate restoration.That is why it is so important to have qualitycommunication between the denturist, the patient, and thelaboratory technician. When it comes to case planning for

Figure 1 — Equator attachmentsfor implants

Figure 2 — Equator attachmentsfor castable sphere

Figure 3 — Low profile Equatorvs. Locator

Figure 4 — Equator profile



implant cases, the ideal situation is to have the OralSurgeon and if possible the Periodontist involved in thecommunication loop.Unfortunately, many dental schools still do not train in

depth about implant-supported overdentures. Numerousdenturists still rely on condensed courses presented by implant

companies. This is why knowledge, material science, and theexpertise of the denturist are so important. A few of the factors for prescribing an implant overdenture

for a patient are inadequate bone support, loss of alveolar ridge,and instability with fit and function on a tissue supporteddenture base. After a radiograph is done and the evaluation of

Figure 7 — Prepared denture for processing attachments Figure 8 — Finished denture with equator attachments

Figure 5 — After implants have been placed Figure 6 — Equator caps placed on implants



bone quantity is determined, then the treatment for the patientis ready to begin. Let’s utilize an attachment system that willallow us size options, retention choice, and quality. An excellentattachment of choice is Rhein 83. Rhein 83 offers a completesystem of prefabricated components for planning and fabricatinga successful and personalized case. The new OT Equator offers alow profile and is compatible with all implant brands. Inaddition, the Equator offers optional castable components forthe indirect system. (Figs. 1-8) The low profile feature enables the technician to utilize more

space for an enhanced esthetic denture set-up. The additionalspace also provides more room for denture acrylic, which will inturn strengthen the denture.When planning a case for a simple overdenture with single

spheres, the OT cap is the perfect choice and they are available in2.5 mm and 1.8mm (Normal and Micro). The caps also come ina variety of retentive values (Figs. 9, 10). In an overdenture, the use of a sphere with a leveled head in

conjunction with an elastic cap results in case stability with aminimum amount of trauma. Keep in mind that an overdenturemade entirely from resin will be exposed to possible fracture. Irecommend using a castable reinforcement bar called the OTBox. Any type of alloy can be used for the casting (Figs. 11-14).Let’s assume that you are ready to go to the denture tooth set

up stage and all the prerequisites for a successful case have beenmet up until this point. You have received an accurate biteregistration and are ready to proceed with the next step. Thearticulation system that I find the most user friendly and themost accurate is the ARTEX System by Jensen. A separatemounting articulator can be used to keep dust and debris fromgetting into places on the main Artex units used throughout thelab. The mounting units are calibrated and models can beaccurately transferred to the working articulator.The semi-adjustable Artex CR has an adjustable condylar

inclination of -20˚and +60˚, a radius of 19mm, and adjustableBennett angle from 0 - 30˚ including side shift functions andprotrusion functions. It is designed to mimic realistic jawmovement and that is precisely what you want when creatingfull mouth reconstruction and overdentures. After the case is mounted and you have determined the

mould of the anteriors, the most important part of thedenture set up is going to come into play and that is theocclusal scheme. The scheme that works the best with implant

Figure 9 — Castable spheres with housings for soldering or curing in acrylic

Figure 10 — Various retentive values

Figure 11 — OT Box placed on relieved model Figure 12 — Sprued OT Box



Figure 13 — Finished OT Box casting Figure 14 — Finished OT Box processed into denture

overdentures is lingualized occlusion. What is lingualizedocclusion? It is when the lingual cusps of the upper posteriorteeth come in contact with the central fossa of the lowerposteriors. Why is lingualized occlusion so important? Becausethe objective is to get the patient in the most ideal occlusalfunction while relieving the off axis stress on the alveolar andon an implant or attachment. The minimizing of lateral forceson implants and attachments lead to a denture withfunctional stability. All occlusal forces are directed to the crestof the ridge.

Years ago a higher degree of tooth was used on the upperposteriors such as 20˚, while a lesser degree tooth was used onthe lower such as 10˚ or 0˚. The object was to still have thelingual cusp of the upper occlude with the central fossa of thelower. Today tooth companies sell specially designedlingualized teeth. Some are effective and some are not.Lingoform teeth by Vita satisfy both esthetics and functionwhen utilizing lingualized occlusion. They are extremely easy

to set and come in 3D shades (Figs. 15, 16, 17). Also keep inmind that the patient is spending a large amount of money onan overdenture case. We want to use a tooth that will wear likenatural dentition and the wear factor on Vita teeth isphenomenal. They wear almost like natural dentition.

If all the steps required for a successful overdenture case havebeen followed correctly and the denturist and patient aresatisfied with the overdenture try-in, then we are ready to processand finish the case. Be sure to use a high impact acrylic with anaccurate processing method such as the injection method ofpacking. To complete this high-end aesthetic overdenture, adenture base stain may be added for natural effects.

Obviously, there are some other factors that come into playfor a successful overdenture case. We have covered some of themost important ones. Keep in mind; the patient is the one wehave to please. Utilizing the best materials available, applyingour expertise, and proper communication will inevitably yieldto a successful case. n

About the authorDennis Urban, CDT has worked in the dental technology field for 35 years. He owned and operated a full service lab on Long Island,New York for many years. He has lectured worldwide since 1985 and his technical articles have been published in many dental publicationsin the U.S. and Canada. Dennis Urban has been Vice President of both the Long Island Dental Laboratory Association and the DentalLaboratory Association of the State of New York. He was a Cal Lab board member and a delegate for the NADL. He was the recipient ofthe 2007 NADL Excellence in Education award. Dennis has been a Technical and Sales Director for various dental manufacturers and isnow the Technical Consultant and Removable Manager for Drake Precision Dental Laboratory in Charlotte, NC.

Figures 15, 16 and 17 — When setting Lingoform, make sure that the lower teeth are set first and that you maintain a Curve of Spee, but not a Curve of Wilson

Fig.15 Fig.16 Fig.17



The use of latch bars in restorations has declined steadily in the past years. The cost factor playsan important role, no doubt. In addition, the latch bar approach requires a bar or telescopedesign, which by itself provides enough stability for the prosthesis and considering the price ofalloy these days, creates substantial costs for the patient. Two additional individual turn-type,pivoting or push latches are too costly for this kind of project. In the following article AxelMühlhäuser will demonstrate when it is advisable to integrate a latch bar system and how, with aready-made latch bar, the costs are manageable without compromising function.

The Latch Bar System – Part 1

DT AxelMühlhäuser

Anamnesis and design

Patient: 65 years with an old, insufficient telescope restorationin the maxilla and a clasp prosthesis in the mandibula (Figure1). The remaining teeth were severely damaged and were notworth preserving (Figure 2). Full dentures seemed to be theonly option in this case. Since the patient did not like the idea

of a covered palatal region we agreed on a restoration withimplants. We informed the patient that a fixed restorationwas not possible in this particular case, which she acceptedbut she strongly insisted on a restoration that would notpurely rely on friction bonding, fearing instability andpossible loosening of the restoration. Therefore our onlychoice was the latch bar technique. In order to keep the costsdown yet create a design with high-gold content, we inserted

Figure 1 — The initial situation Figure 2 — The remaining teeth are not worth preserving



bar stubs instead of creating a full bar structure. The use ofready-made latch bars enabled us to stay even more within theestimated budget. We opted for the Si-tec latch system with acontinuous inner and external stop activation mechanismplus an exchangeable retention element. In terms of theaesthetic aspect the patient had specific requests: A light andpleasant colour, more visible anterior teeth, stronger lipsupport and an even idealized set-up.

Model and bite

We are and have always been supporters of the openimpression technique. Based on the anatomic impression withhealing caps, we extend a thick wax wire over the plannedimpression tray base axial to the healing cap plateau. On themodel we wax-out the area around the implants for theimpression posts (Figures 3 and 4) we then create the

impression tray using C-Plast material for the maxilla and themandibula (Figure 6). Since it might be necessary to eitherenlarge or reposition the openings later on, the tray handleshould not be too close to the openings or, as seen in themandibula, needs to be recessed accordingly at the base.Once the impression posts are inserted (Figure 7) and fit,positioning and opening size have all been verified by thedenturist, we take the open impression.

Model fabrication

The impression does not show signs of imperfections ordistortions in the maxilla (Figure 8) or the mandibula (Figure 9),the impression posts are firmly fixed. Before we insert thelaboratory analogs, the implant position needs to bemeticulously checked for possible imperfections or impurities.During the placement of the laboratory analogs it is important

Figure 3 — The model is waxed-out for the individualimpression tray

Figure 4 — Wax wires markthe openings

Figure 5 — The impression traymade of C-Plast inthe maxilla for theopen impression

Figure 6 — In the mandibula thebase of the tray handlehas been widely recessed

Figure 7 — The impression posts have been placed

Figures 8 and 9 — Open impression in the maxilla and mandibula

Fig.8 Fig.9



Figures 10 and 11 — The model analogs are in place

Figures 12 and 13 — Master casts with gingival mask

Figures 14 and 15 — For a more stable fixation temporary abutments are incorporated

that the locating screw is tightened onlyby hand to prevent over-tightening(Figures 10 and 11). Once the gingivalmask material has been placed andhardened, the mesial and distal seals arecut in a right angle to ensure a better fiton the model. We then proceed with thefabrication of the model with split cast.The atrophy between 11/14 and 21/24 isquite noticeable on the completed mastermodel of the maxilla (Figure 12). We donot detect any problem areas in themandibula at first glance (Figure 13). Formore stability in the mouth we integratea temporary abutment into the C-Plastbite base (Figures 14 and 15). Theremaining implant areas need to begenerously waxed-out analogous to thehealing caps. Idealized wax walls thatpredetermine the tooth arch as well asthe bite height complete the bite plates(Figure 16).

Bite-taking

For the bite-taking, reference lines likesmile line and midline are very helpfuland essential for the further workflow.To facilitate the denturist’s work with thefacebow we load a bite fork withPlatinum 85 material and take animpression of the maxilla. Once it hashardened we cut back the impression.The denturist has the option to relinethis base if necessary. With the transfer

Figure 16 — Idealized wax walls facilitate bite registration

Figure 17 — The mandatory marking of the reference lines

stand we adjust the relation of the maxilla to thecranium (Figure 18). Afterwards with the help of thebite plate the counterbite is articulated (Figure 19).

Set-up

Since we want to gain important informationduring the first aesthetic try-in regarding aestheticsand phonetics yet be able to easily verify theocclusion, we do the set-up just up to tooth numberfour (Figure 20). The teeth need to be adjusted fartowards the labial side. According to therequirements a light, neat colour is selected andmisalignment of the teeth is kept to a minimum(Figure 21). Contrary to the initial situation theanterior teeth have to be longer and more

Fig.10 Fig.11

Fig.12 Fig.13

Fig.14 Fig.15


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dominant. To check the bite we use an acrylic wall for theposterior region of the maxilla (Figure 22) and in themandibula simply a wax wall with bite impressions. The try-inreveals insignificant bite adjustments and from an aestheticpoint of view the teeth number three need to be reducedslightly and both teeth number two need to be shorteneddistally to achieve a more pleasant smile line. Since we do notwant to go beyond the scope of this work description, we aresumming further processes up as follows: completing of theposterior set-up, modeling and a final try-in.

Individual abutments

If no additional adjustments are needed during the set-upwe start the fabrication of the individual abutments. As apreliminary step we need to ensure that we have all therequired information for the different applications. For thefabrication of the abutments we start by creating a working

matrix made of Platinum material (by Zhermack, Marl) fromthe palatal/lingual and buccal/labial side and simultaneouslya two-part matrix for the actual fabrication. The cast-onabutments are inserted and the direction of insertion isadjusted. In order to eliminate unnecessary milling andavoid wasting high-gold material we premill with a H364RGEcutter (by Gebr. Brasseler. Lemgo) (Figure 23). Analogous tothe working matrices made of Platinum material the plastictubes are shortened to the desired length in the mandibula(Figure 24) and the maxilla (Figure 25). We solve any spaceissue with the creation of chamfers and complete the primaryform with milling wax followed by the premilling of thecommon direction of insertion.

Bar stubs

We then use the paralleling mandrel from the latch bar kit (Si-tec, Gevelsberg) to fix the bar stub with Pattern material to the

Figure 18 — The relation of the maxilla to the cranium is adjusted in the articulator Figure 19 — The mandibula has been adjusted



Figure 20 — First cosmetic set-up with wax walls in theposterior region of the mandibula

Figure 21 — As desired: neat without major misalignments Figure 22 — Fixed with screws and acrylic walls in the maxilla

Figure 23 — Premilling with the H364RGE cutter Figure 24 — A matrix made of Platinum putty material creates needed space lingually…

Figure 25 — …and buccally Figure 26 — Fixation of the bar stub with a paralleling mandrel

Figures 27 and 28 — Verification of the latch bar position with the Platinum-matrix

Fig.27 Fig.28



appropriate spot (Figure 26). Since this is an important step wewill describe it in more details subsequently.

The latch top has to integrate harmoniously into theprosthesis after completion and it should neither be in the areaof the prosthesis teeth nor too close to the rim of the prosthesis.The base angle may deviate slightly from the jaw line (up to amaximum of 15˚), which means it should be lowered minimallytowards the distal direction to facilitate the opening from themesial side for the patient and to allow smooth gliding of thetongue. We are also aiming for a positioning in the interdentalspaces where possible. With the help of the working matriceswith integrated abutments, the final position is determined with

reference to the expansion of the prosthesis and thealignment of the teeth in the maxilla (Figure 27) andthe mandibula (Figure 28). Markings on the modelfacilitate the correct positioning additionally (Figure 29).Should insufficient space be an issue, the bar stubs arereducible or may be aligned (Figure 30). From thebuccal view it is evident that the bar stubs do notnecessarily need to be positioned in the center of thejaw ridge. In fact a repositioning towards the oraldirection or, in this case towards the buccal direction, ispossible at any time (Figure 31). The bar stub is alsoextendable basally with wax, should additional supportbe desired or needed (Figure 32). Note: Of course the

bar stub is extendable so it can also be used as a bar. In the finalstep the edges are thoroughly checked under the stereomicroscope for possible imperfections. There should be no signsof overcontouring towards the implant or gaps. Finally thecomponents are thoroughly cleaned to remove excess wax andgreasy residue and then sprued (Figure 33). The screw channelshould always be placed almost vertically in the muffle to avoidbubble formation and subsequently casting beads. The actualholding time in the furnace has to be extended by at least 15 to30 minutes, depending on the number of individual abutments,and the final temperature needs to be raised by 50 to 70 degreesto ensure a successful initial casting. The divesting is done with

Figure 29 — The correct positioning does not always coincide with the jaw ridge center of the mandibula…

Figure 30 — …or of the maxilla

Figures 31 and 32 — The bar stubs are completed with wax from the basal side

Figure 33 — Sprued in the “open casting ring”

Fig.31 Fig.32



polishing beads and minimal pressure to prevent damage to theimplant. This attention to detail and meticulous approachpromises a perfect cast (Figure 34) using the high-gold alloyBiolight (by Argen, Düsseldorf). The rich yellow golden colourand surface quality speak for themselves.

Casting and working-up

After cutting off we eliminate possible imperfections or castingbeads and work on the edges. In order to prevent damage to theimplant we always use a polishing aid. The blue polishing wheelenables us to quickly and efficiently create a low gloss shine inthe subgingival or basal areas (Figure 35). The high glosspolishing is done with brushes, polishing paste and for the finishwith a buffing wheel – again only with a polishing aid. Themirror image displays an all over neat result (Figure 36) andfuture milling work will be almost eliminated. The rough millingis performed with the H364RXE cutter (Figure 37) and it isimportant that the gingival mask is not touched during theprocess. The spacing between implant regio 24 and 25 is a reasonfor concern. We use cutters from the H364RGE series atapproximately 12,000 rpm for the precision milling (Figure 38)and at approximately 2,000 rpm for smoothing until we achieve

Figure 34 — A perfect cast with Biolight Figure 35 — Finishing with polishing aid and blue silicone polisher

Figure 36 — The basal regions are finished and polished

Figure 37— Rough premilling with a H364RXE cutter Figure 38 — Precision-milling with a H364RGE cutter



a satin finish. Finally the occlusal parts need to be worked-upand polished, during which time a constant verification of thespacing with the matrices is essential. The aim is to have enoughspace for the actual telescopic coping as well as the non-ferroussecondary structure. After a thorough cleaning and steaming-off,the abutments are placed on the model.In the mandibula from the buccal side at implant regio 43

the neat finish is noticeable, which we created by doing a wax-up basally on the bar stub (Figure 39). From the lingual sidethe shift of the bar stubs towards the buccal direction isapparent (Figure 40). From the occlusal, lingual side theinsufficient spacing at implant regio 36 and especially at regio46 is evident (Figure 41). In the maxilla from the buccal sidethe limited space between implant regio 24 and the bar stub isclearly noticeable (Figure 42). From the palatal side the shift of

the bar stubs towards the buccal direction is again quite visible(Figure 43). From the occlusal side the beautiful shoulderform of the telescope crowns is apparent (Figure 44).

Telescopic coping and latch bar system

The latch bar set includes two kinds of spacers for varioustechniques and fabrication methods: Spacer D (short) for thedoubling method, spacer F (long) for the lifting technique.Detailed and user-friendly instructions are included in the set.In this particular case we use the lifting technique analogousto the telescope method. For this, spacer F is fully insertedinto the corresponding hole of the bar stub and fixed with a

Figure 39 — A perfect finish on the bar stubs due to the wax-up from the basal side Figure 40 — From the lingual view the shifting of the bar stubs towards the buccal direction is clearly visible

Figure 41— Limited space in the region of abutments 36 and 46 from the lingual side Figure 42 — Insufficient spacing between abutment and bar stub

Figure 43 — Also in the maxilla the bar stubs shift towards the buccal direction Figure 44 — The shoulder is shaped according to the soft tissue line



small amount of thick Pattern material (Figure 45). To beginwith, the screw channels need to be closed completely withwax followed by the piece by piece completion with Patternmaterial and over extending a little around the spacer(Figure 46). Once the material has hardened, we proceed withthe reducing to the minimal thickness and removing the spacerwith a rotary motion (Figure 47). Minor Pattern imperfectionsbetween spacer and bar stub can be removed at this point.

After the placing of the abutments and the Pattern capsonto the master model we attach a seal in the mandibula(Figure 48) and in the maxilla (Figure 49). It supplies not only

Figure 45 — The spacer is attached with Pattern resin Figure 46 — The remaining surface areas are covered

Figure 47 — Reduced to the minimum thickness

Figures 48 and 49 — Circular seals are attached

Figure 50 — Perfect Biolight outer surfaces Figure 51 — Perfect on the inside as well Figure 52 — The remaining sprued abutments

Fig.48 Fig.49



extra stability but also a neatly defined transition from acrylicto gold. The open ring cast displays a perfect result alreadyafter divesting due to the Biolight alloy (Figure 50). Theelements are also without any defects, casting beads or castinglugs (Figure 51). Elaborate and time-consuming fitting worklater on will not be necessary with such a casting result.Simultaneously the remaining telescopic crowns are fabricatedand sprued (Figure 52). Here too we achieved a perfect castingresult of impeccable quality and appearance (Figure 53).

With this kind of approach practically all major fittingwork is eliminated, the marginal seal is perfect withoutelaborate rework (Figure 54) and the same applies to the inner

surface of the latch bar system (Figure 55). During the fittingwith latch bars it is important to avoid friction yet a slightsuction fit is acceptable. Now the basal parts are ready to beworked-up and polished. These areas should always be slightlyhollowed out to prevent pressure points in the mouth. Theend result with inserted abutments after polishing speaks foritself, even in the bar stub area no significant gap shows(Figure 56). Finally the circumferential telescopic seals arereduced to the required width making sure that they have aright-angled finish. We clean the inner copings and theabutments and position them in the mandibula (Figure 57)and the maxilla (Figure 58). n

Figure 53 — A clean cast with an impeccable surface Figure 54 — The fitting is no problemeven without any rework

Figure 55 — Inner surface of the latch systemwith bar stub

Figure 56— After finishing and polishing of the basal parts the transitions are barely visible

Figure 57 — The circular seals are shortened in a right angle… Figure 58 — …contact surfaces have to be avoided


Each clinical article in Spectrum Denturism is part of a continuing education series. The answers to the questions can be found within the body of the article.

Circle the correct answers to the questions below. Then simply complete the form and submit it to Palmeri Publishing Inc. You will receive your corrected test which you can save for your Continuing Education Records.

Continuing Education Test for Spectrum Denturism Vol.6 No.3

Once you have completed the questionnaire, fill out the information below. You can photocopy this form. Then simply complete the formand submit to Spectrum Denturism by mail to 35-145 Royal Crest Court, Markham, ON L3R 9Z4 or by fax to 905-489-1971. It’s that easy!

Subscriber Name: ________________________________________ Phone: _________________________ Fax: _________________________

Address: ___________________________________________________________________________________________________________

Email: ___________________________________ CDT or RDT #: _______________________ Signature: _______________________________

S P E C T R U M

Questions for:

Genios: Spanning the range from combination restorations to implant restorations

Hans-Peter Vögtle

1. In a standard telescopic design, the Genios tooth blends in verynaturally into the overall situation with regards to...A: shapeB: texture and shapeC: size and textureD: shape and size

2. Genios teeth can be perfectly customized...A: by minimal abrasive adjustmentsB: by the addition of resin materialC: A and BD: none of the above

3. Genios teeth differ from competing products because...A: they can only be used in particular restorationsB: they retain their surface texture even after polishingC: they cannot be perfectly veneeredD: of their poor compatibility with other applications

4. Which of these statements is true?A: Genios teeth are not prone to fractureB: Genios teeth look artificial in natureC: need wax-upsD: can be very costly

5. In this particular lab it is felt that...A: Genios has minimized inventory costB: Genios has simplified things for staff techniciansC: Genios teeth are better than any of the other tooth lines they

have usedD: all of the above

Questions for:

Implant supported bar work — Part IHans-Peter Vögtle, MDT

1. During the finishing stage...A: the frameworks are opaquered.B: the structure is waxed out in all undercut areas.C: a thin wax layer is applied between the prefabricated matrix

and cast piece.D: all of the above

2. To finish why does the author opt for a cast acrylic by Merz Dental?A: it is of high quality yet economicalB: it is extremely durable.C: it flows well and has minimal shrinkage.D: though it does not flow well it has minimal shrinkage.

3. When is a 1/1 silicone precast prepared?A: After the patient and denturist are pleased with the set-up.B: After all functions work properly.C: A and BD: none of the above

4. The 1/1 silicone precast is used by the denturist...A: for design.B: for bar positioning.C: for attachment and spacing purposes.D: All of the above

5. Why are bite registration aids or impression posts used?A: To guarantee a stable fit in the mouth.B: To assist with the modellation of the bar.C: To facilitate the activation and deactivation of the bar.D: none of the above.


SDen_V6N3_JUN12_Spectrum 6/18/2012 11:25 AM


Each clinical article in Spectrum Denturism is part of a continuing education series. The answers to the questions can be found within the body of the article.

Circle the correct answers to the questions below. Then simply complete the form and submit it to Palmeri Publishing Inc. You will receive your corrected test which you can save for your Continuing Education Records.

Continuing Education Test for Spectrum Denturism Vol.6 No.3

Once you have completed the questionnaire, fill out the information below. You can photocopy this form. Then simply complete the formand submit to Spectrum Denturism by mail to 35-145 Royal Crest Court, Markham, ON L3R 9Z4 or by fax to 905-489-1971. It’s that easy!

Subscriber Name: ________________________________________ Phone: _________________________ Fax: _________________________

Address: ___________________________________________________________________________________________________________

Email: ___________________________________ CDT or RDT #: _______________________ Signature: _______________________________

S P E C T R U M

Questions for:

The Latch Bar System — Part IDT Axel Mühlhäuser

1. Latch bar designs have steadily declined over the past years due to:A: Clinicians not being trained in this techniqueB: Degree of difficulty in impression takingC: Lack of laboratories qualified to produce themD: Costs involved in producing themE: Poor patient acceptance of the appliance

2. Once the final impression is taken the laboratory analogs are:A: Placed in position and tightened by hand to ensure proper seatingB: Placed in position and tightened using the appropriate screw driver

to ensure proper seatingC: Used only if necessary as the retentive clips can be cold cured in

the denture at insertionD: Not needed in this techniqueE: Placed in position and tightened using a torque wrench to ensure

proper seating

3. During the first aesthetic try in the: A: Anterior and posterior teeth are set and waxed upB: Teeth are only set to the fourth (4) tooth in each quadrantC: Posterior sections of the maxillary & mandibular bases are wax onlyD: Anterior teeth are not positioned E: None of the above are true

4. The bar studs are:A: Always positioned on the buccal side B: Always positioned on the lingual side C: Positioned on buccal or lingual side as position doesn’t matterD: Always positioned depending on the position of the anterior teethE: Optional in this case design

5. The telescopic copings and latch bar system are constructed using:A: TitaniumB: Chromium C: Titanium and goldD: GoldE: Palladium

Questions for:

Occlusion and Attachments The Underlying Scheme for Successful Overdentures

Dennis Urban, CDT

1. The field of Dentistry that has seen consistent growth over the years is:A: FixedB: OrthodonticsC: PerioD: RemovablesE: None of the above

2. Factors used in deciding as to recommend an implant retaineddenture are:A: Inadequate bone supportB: Loss of alveolar ridgeC: InstabilityD: Poor FitE: All of the above are true

3. Equator abutments are smaller then Locator abutments:A: TrueB: False

4. The author recommends an “OT BOX” which is:A: A method of placing the Equator abutmentsB: A method of balancing the pressure over an implantC: A technique used to add retention when cementing the Equator

retentive caps to the dentureD: A technique of pouring the final impressionE: A castable reinforcement bar

5. 5. According to the author the posterior teeth that work best withimplant overdentures are:A: Zero degree Rational posterior teethB: Lingualized occlusionC: Twenty degree semi-anatomical teethD: Thirty degree fully-anatomical teethE: Does not matter providing that balancing and working contacts

are incorporated into the set up



Advisors Connect the Dots

M ore often than I can tell you, denturists share withme their frustration and confusion over guidancerendered by their trusted advisors. Of course each

advisor, be it lawyers, accountants, wealth planners, bankersor consultants is acting in the best interest of their client,attempting to offer valuable input. The frustration andconfusion comes when the denturist is left on their ownstruggling to translate the information and connect it totheir business plan.I’ve determined that there are two classifications of

advisors; disconnected and like-minded each with their ownset of characteristics and tendencies. Although they areexperts in their own field, disconnected advisorsautomatically increase the denturist’s stress level. Whatensues is an increase in time spent gathering and processinginformation in relationship to the business and unnecessaryconfusion for the denturist. If the denturist then attemptsto link the advisors further costs are likely, as each advisorattempts to educate the other as the denturist seeksclarification. This scenario virtually guarantees that time,energy and finances will be stretched.Like-minded advisors are quickly identified in the onset

of the business relationship. They advise clients with acommon approach, speaking the same language and clearlycommunicating, thus reducing confusion. Since they arefamiliar with acting in unison on behalf of the client, theyconsider their advice in the context of the entire group ofservices. Even better, advisors who have worked specificallywith dental professionals bring their collective experience toimprove client outcomes. Denturists who are starting a practice, associating, solo or

group practitioners, general or specialists or successionplanning, will discover sooner or later, that the combinedexperience of their circle of advisors will have a profoundeffect on their business.Our firm has worked in tandem with lawyers, wealth

planners and accountants on behalf of dental professionalswho are buying a practice, starting a practice, expandingand or transitioning their practices. In my experience clientstruly benefit from advisors who work in concert. Some ofthe advantages are: reduced client stress and expenses dueto smoother transactions executed by like-mindedprofessionals who have experience transacting together.Advisors who share common approaches to business and

clients tend to “speak the same language”. As the natureof successful business transactions transpire throughcommunication, the ability of an advisory group tounderstand the other is a significant benefit.Top athletes know that to ensure their success in the

sports arena they need to rely on coaches. Not just anycoach, but individuals who truly know their game, versusjust know about it. The proof of this comes through thecoach’s proven history of experience with the particularsport, shared relatable experiences of success and failure, aproven track record and a sincere desire to devote theirskills, time and energy in order to see the athlete or teamdevelop to full potential.Coaches with limited exposure to the field can result in a great

deal of wheel-spinning, frustration and set-back for the team. They reveal their inadequacy by the “part-time” approach they

apply to their work, a lack of specific experience and fullunderstanding of the field, an inability to provide clear andprompt insight and direction, and a poor or vague track record.It’s no different in the dental industry - experienced and

proven coaching is valued as an integral part of a team and itssuccess. The right skilled advisors will be able to offer a levelof trusted expertise in their methods of analysis, problemsolving, and forecasting. As in the athletic arena, they will“study behavior in the field” and strategize how the team can“play a better game”. This client scenario should help drive mypoint home, illustrating how like-minded advisors workingtogether ensure fluidity and ease of transition.Our firm was approached by a denturist interested in

buying a practice from one of our clients. We began theprocess by facilitating communication between both partiesuntil all indicators were clear that the practice could be sold tothe interested denturist. After verbal agreement on buy/selland transition requirements of seller and buyer, practice valueand timelines, both parties then met to discuss. All the while,our firm continued to focus on and hammer out the details ofthis transaction in the practice’s core areas.Positive, forward momentum and communication

continued to build because it became clear that buyer, sellerand our firm shared a common approach to the process.Even further, the seller happened to be an existing client ofMiller/Canfield; a law firm who is part of the advisorygroup we work and lecture with. To round it out, we learnedthat the purchaser’s lawyer had previously represented other

Dale Tucci



dental clients on transactions with Mrs. Jennifer Shilsonand Mr. Marco Dolfi of Miller/Canfield.Both seller and buyer could only benefit from the legal

professionals working relationship. The lawyers hadexperience working with one another, and knew they weredealing with like-minds with whom they had completedtransactions in the past. Not only were they familiar witheach other’s approach and personality, but they wereconfident of their shared history and understanding ofdental transitions. The clients then continued to experiencethis synchronicity of like-minded professionals comingtogether in yet another area. Again, both buyer and seller happened to be clients of

accounting firms who had extensive experience workingwith dental professionals during the buy/sell process. Aswas the case with the legal team, the accountants spoke thesame language and were familiar with each other’sexpectations in developing and implementing the rightstructure for the practice acquisition. Finally, consideringthe approach to the deal and to ensure that the structureand buy/sell could be incorporated into his overall financialplan, the buyer consulted with Mr. Timothy Leonard ofLifecycle Wealth Planning and Ms. Laura Fitzsimmons ofWealth Preservation Consulting Inc.Our role as consultants to this acquisition was to fuse the

initial connection and communication between practice

owner and interested buyer. We continued to beinstrumental after the practice sale. With the newlandscape, we were retained to implement business growthstrategies as well as to manage the practice through thetransition phase.This case scenario is a realistic example of how a collection

of essential advisors and professionals who share commonphilosophy and approach, can connect to work so efficientlyand effectively. Keep the above picture in mind if and whenyou embark on transactions related to your practice thatpractically guarantee a more positive experience all around.In an ever changing and challenging business environment

the connectivity of your business advisors can be a competitiveadvantage. If your advisors are not singing from the same songsheet, it may be time for you to connect the dots! n

About the authorDale Tucci is owner and president of TucciManagement Consultants Inc. Dale and her team offer a wide variety of custom practicemanagement services, transition planning,business coaching, associate recruiting, and

marketing and human resource services. You can reach Dale Tuccidirectly at 416.450.8769 or via email at: [email protected] or www.tuccimgmt.ca



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appliances and helps prevent irritation to gum tissue. Will not corrode stainless steel.Available in 6 oz., 1 lb., 2lb., 25 lb., or 12 pre-measured packets for 3 month supply.For more information, visit our website at www.americandentalsupply.net or contact usat 610-252-1464 or Toll Free in U.S. 800-558-5925.

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NOVUS™ Definitive Resilient Denture LinerDenture wearers will appreciate the long-term benefits ofimproved fit, function and comfort when Novus™,‘Definitive Resilient Denture Liner’ is applied to theirdenture. It has permanent resiliency over extended time; itabsorbs shock while chewing; resistant to fungal growth;

low water absorption; easy adjustments and polishing; bonds chemically to acrylicdenture base resins; bonds chemically to acrylic denture base resins; processed, packedand cured using conventional lab processing procedures; can be trial-packed; can bemolded around implant, bar and overdenture abutments; resistant to fungal growth. Formore information, please call Central Dental, Ltd. at 1-800-268-4442.

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The UltraSuction™ SystemOnCore Dental Inc. is proud to introduce theUltraSuction™ System, by offering the denture patient analternative to implants for improved retention of an upperor lower denture. The system is a painless, cost effectivealternative to implants and over dentures. Clinical results

and studies have shown the UltraSuction™ system will increase suction for stability, asthe patient continues to use their denture and maintain their maintenance programs.For more information visit www.oncore-dental.com or call 1-360-841-8426.

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Fit!Synca introduces Fit!® Made in Germany, Fit!® Putty andLight body material offer best in class hydrophilic andsetting properties at a savings of as much as 50% overleading brands. For more information call 1-800-667-9622or visit www.synca.com (not available in the U.S.)

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Synca — Fiber Force Synca Direct Inc. introduces the Fiber Force® fiber reinforcementsystem. Pre-impregnated, light-curable e-glass fibers are easy to use.Create light, thin, comfortable and aesthetic dentures and other

removable or temporary appliances with this versatile range of materials. Fiber Force®is ideally suited as a strengthener for new appliances as well as a repair material forexisting ones, providing a level of reinforcement that is superior to metallic options. Formore information call 1-888-582-8115 or visit www.fiberforcedental.com.



Ad LinkAluwax Dental Products ..........................................www.aluwaxdental.com ...............................................1.616.895.4385....................................................50

American Dental Supply ............................................................................................................................................................................................................47

Baluke Dental Studios.............................................www.baluke.com .........................................................1.800.263.3099 ......................................................9

Central Dental Supplies...........................................www.centraldentalltd.com............................................1.800.268.4442 ......................................................2

CM..........................................................................www.cmsa.ch/dental ...................................................1.800.554.5504....................................................46

Dent-line of Canada Inc. ........................................www.dent-line.com.....................................................1.800.250.5111....................................................23

Dentsply Canada.....................................................www.dentsply.ca..........................................................1.800.263.1437....................................................21

Estrabillo Dental Group ................................................................................................................................1.905.841.2332....................................................34

Flexite.....................................................................www.flexitecompany.com ............................................1.516.746.2622....................................................17

Henry Schein / Zahn Canada...................................www.henryschein.ca....................................................1.800.496.9500 ......................................................5

Juna Imports................................................................................................................................................1.877.818.3681....................................................29

Keystone Industries.................................................www.keystoneind.com.................................................1.800.333.3131....................................................11

OnCore ...................................................................www.oncore-dental.com.............................................1.360.841.8426....................................................49

Perfecting Your Practice..........................................www.denturistassociation.ca........................................1.800.461.4393....................................................37

Rhein 83. ................................................................www.rhein83.com........................................................1.877.778.8383....................................................25

Specialty Tooth Supply Ltd......................................www.specialtytoothsupply.com ....................................1.800.661.2044....................................................27

Swiss NF Metals, Inc...............................................www.swissnf.com........................................................1.800.387.5031....................................................15

Synca .....................................................................www.synca.com...........................................................1.800.667.9622....................................................51

Tucci Management Consultants Inc. .......................www.tuccimgmt.com ...................................................1.888.454.1373....................................................45

Unique Dental Supply..............................................www.uniquedentalsupply.com .....................................1.888.532.0554....................................................15

Vident .....................................................................www.vident.com ..........................................................1.800.263.4778....................................................52

www.SpectrumDenturism.com

S P E C T R U M


BOLD NEW DENTURE TEETH FROM VITABecause failure is not an option, choose denture teeth from the brand you rely on.

VITAPAN® Plus anterior denture teeth are the result of two years of intensive research with dental technicians around the world. VITAPAN Plus offer true-to-nature tooth anatomy and a well-proportioned design, insuring coverage for any indication. And VITAPAN Plus are made with high-quality Microfiller Reinforced Polyacrylic for superior

plaque resistance and wear as well as strength values that satisfy even the highest patient demands. Available in a compact assortment of popular moulds in VITA Classical and 3D-Master® shades, VITAPAN PLUS are perfect for use with all VITA posterior denture teeth.

800-828-3839 www.vident.com

© Vident 2011. Vitapan is a registered trademark of VITA Zahnfabrik.


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