Prosthetics Rehabilitation of a Male Patient with a Unique Looped Metal Palate Denture A Case Report

Transcription

1 CASE REPORT / PRIKAZ IZ PRAKSE Serbian Dental Journal, vol. 59, N o 4, UDC: DOI: /SGS B Prosthetics Rehabilitation of a Male Patient with a Unique Looped Metal Palate Denture A Case Report Vishwas Bhatia, Garima Bhatia Department of Prosthodontics, Crown and Bridge & Oral Implantology, Eklavya Dental College and Hospital, Rajasthan, India SUMMARY Complete denture can improve both function and aesthetics. Even though mastication is highly improved, one of the most common problems for new full upper acrylic denture wearers is lack of feeling sensations such as hot and cold, loss of taste and fracture in the mid palatal region. These patients require a denture that allows them to feel sensations as close to normal as possible. The present case report discusses an alternative way of designing a metal palate for maxillary complete denture that along with fulfilling the above mentioned functions, has specially designed loops incorporated in such manner and directions to improve mechanical interlocking of acrylic within the metal loops and not to interfere with teeth arrangement. Keywords: alternative; hot and cold sensations; mechanical interlocking; metal palate INTRODUCTION Denture is defined as a prosthetic device constructed to replace missing teeth, supported by surrounding soft and hard tissues in the oral cavity. Dentures can help patients in mastication, aesthetics, phonetics, and self esteem improvement. One of the most common problems with new complete upper acrylic denture wearers is lack of feeling sensations to hot and cold and loss of taste. The thickness of denture in the palatal region also adds to the patient s discomfort. Maxillary complete dentures opposing natural dentition are prone to midline fractures due to multiple reasons [1]. Since acrylic is weak material, maxillary acrylic denture base should be three to four times thicker than metal denture base [2]. In order to overcome these problems, there is a need to fabricate maxillary complete denture with unique metal palate. A few designs have been described for the fabrication of metal palate. However, there has not been put much emphasis on metal palate fabrication that: 1) has adequate union with acrylic portion of the denture; 2) does not interfere with artificial teeth during teeth arrangement; and 3) has a smooth acrylic metal joint. The present case report describes a completely edentulous patient, facing the above mentioned problems with his acrylic denture. A unique metal palate design was used for the fabrication of maxillary denture. Such design should help clinicians to overcome drawbacks shown in previous reports. CASE REPORT A 60 year old man reported the chief complaint of inability to feel temperature changes of food, unnatural feeling during food mastication due to the thick palatal portion and repeated fracture of maxillary complete denture. The challenge in this case was to create a maxillary denture with specially designed palate that would: give better temperature sensation and taste perception, be thin palatally, be able to resist fracture, have adequate interlocking of acrylic, not interfere with teeth arrangement and have smooth metal acrylic junction. A maxillary complete denture was fabricated with customised metal palate. It had an innovative style with metal loops in specific directions and positions to enhance interlocking of acrylic portion, and not to interfere with artificial teeth arrangement. Also a butt joint was incorporated for smooth finish at the acrylic metal junction palatally. Fabrication The primary impression was taken with irreversible hydrocolloid (Alginate, Dentsply, Wey Bridge, Surrey, UK). After the custom tray fabrication, the secondary impression was obtained using zinc oxide eugenol (DPI Impression paste, DPI, Mumbai, India). The final cast derived from this impression was duplicated and a refractory cast (Bellasun, Bego, Germany) was formed. The refractory cast was used to fabricate customised metal palate. Address for correspondence: Vishwas BHATIA, Department of Prosthodontics, Crown and Bridge & Oral Implantology, Eklavya Dental College and Hospital, Delhi-Jaipur Highway, Rajasthan , India; drvishprostho@gmail.com; vishwas211@yahoo.co.in

2 206 Bhatia V. and Bhatia G. Prosthetics Rehabilitation of a Male Patient with a Unique Looped Metal Palate Denture A Case Report A sheet of green spacer wax (Ruby Dental Products Inc., Osaka, Japan) was adapted on the palatal portion of the cast covering the crest of the ridge and extending 2 3 mm beyond it. Wax loops of 2 3 mm length (Ruby Dental Products Inc., Osaka, Japan) were attached at the peripheral border of previously adapted palatal spacer wax. These loops were 2 3 mm short of the sulcus as shown by the straight arrow on Figure 1. Their role was to enhance interlocking of acrylic. Tiny loops were placed slightly palatally to the crest as shown by the curved arrow (Figure 1). The height of these loops did not interfere with artificial teeth setting but it was sufficient enough for inflow of acrylic resin. A butt joint was created palatally to the crest at the junction of acrylic and metal. This butt joint had purposes to enhance the strength of metal acrylic junction, and to create smooth joint between acrylic and metal avoiding step formation. For a butt joint, a 2 mm of cylindrical blue wax beading (Ruby Dental Products Inc., Osaka, Japan) was adapted palatally to the crest of the ridge as shown by the straight arrow on Figure 2. Once the palate design was completed, wax sprues were attached and casting was done. When finished the metal palate was placed on the master cast (Figure 3). Modelling wax (Ruby Dental Products Inc., Osaka, Japan) was adapted into the sulcus and on looped region and wax rim was built (Figure 4). The maxillary rim was ready for establishing jaw relations. Thereafter, artificial teeth were arranged. After curing, the maxillary metal denture was finished and polished (Figure 5). Any bead over acrylic surface (Trevalon Heat Cure acrylic resin, Dentsply, Wey Bridge Surrey, UK) or metal acrylic junction was removed. The maxillary denture was tried in and retention was confirmed (Figure 6). Both maxillary and mandibular dentures were inserted and occlusion was checked. The patient's pre treatment (Figure 7) and post treatment (Figure 8) photographs showed marked improvement in esthetics. On a follow up after six months, the patient reported improvement in feeling sensations of hot and cold and taste perception and had almost normal mastication. Figure 2. 2 mm cylindrical blue wax placed palatally to the crest Slika 2. Plavi vosak valjkastog oblika debljine 2 mm postavljen palatinalno uz greben Figure 3. Metal plate with loops placed on the master cast Slika 3. Metalna pločica s petljama postavljena na glavni model Figure 1. Straight arrow showing loops 2-3 mm short of the sulcus. Curved arrow showing loops placed slightly palatally to the crest. Slika 1. Prava strelica pokazuje petlje 2-3 mm udaljene od sulkusa. Zakrivljena strelica pokazuje petlje palatinalno postavljene u odnosu na vrh alveolarnog grebena. Figure 4. Occlusal rim with metal palate finished Slika 4. Završen nagrizni greben s metalnim nepcem

3 Stomatološki glasnik Srbije. 2012;59(4): Figure 5. Acrylic denture with looped metal plate finished and polished Slika 5. Završena i ispolirana akrilatna proteza s metalnim nepcem i petljama Figure 6. Maxillary denture inserted and checked for retention Slika 6. Isprobavanje retencije gornje totalne proteze Figure 7. Pre-treatment photograph Slika 7. Izgled pacijenta pre terapije Figure 8. Post-treatment photograph Slika 8. Izgled pacijenta posle terapije DISCUSSION Most frequent complaints of patients with maxillary acrylic dentures include chewing discomfort, inability to feel variations in temperature of food, fracture near the midline, thick palatal portion and objectionable phonetics. Determining patient expectations and their influence on patient satisfaction with treatment is critical [3]. The present case report describes a completely edentulous male patient with acrylic dentures complaining about the loss of feeling temperature changes and food taste. Also his upper denture was prone to repeated fracture. In order to overcome these problems, a maxillary complete denture with an innovative metal palate design with loops was fabricated. Few earlier reports demonstrated the use of reinforcing Ni Cr plates or carbon cloth within acrylic

4 208 Bhatia V. and Bhatia G. Prosthetics Rehabilitation of a Male Patient with a Unique Looped Metal Palate Denture A Case Report in order to strengthen the denture but these methods had no effect on improving patient perception to temperature changes [2, 4]. Earlier studies have also reported the alteration of taste perception after the insertion of a maxillary complete denture. It is generally accepted that changes in temperature and texture perception of food caused by a complete maxillary denture are consequences of covered hard palate with acrylic [5]. Studies that investigated taste sensation in elderly have also shown the association between acrylic dentures covering the entire hard palate and dissatisfaction with taste ability [6]. Looped metal palate not only improves temperature sensations, prevent fractures of mid line region but also provides adequate interlocking of acrylic within metal and does not interfere with teeth arrangement. Also, a thin metal plate at palatal portion adds to patient comfort. As metal is stronger, the upper metal denture base can be three to four times thinner than acrylic denture base [2]. Patient comfort has a positive effect on patient s psychology. On the other hand, different psychological profiles play an important role in patient s satisfaction with complete denture treatment [7]. There have not been many reports regarding the metal palate design emphasising possible ways to enhance bond between metal and acrylic and not to interfere with teeth arrangement, as well as to meet requirements such as improved feeling of temperature changes in mouth and prevention of mid line fractures. Such metal palate design may improve quality of life of edentulous patients as metal base is known to prevent fungal growth typically present in complete denture wearers [8]. Studies have also demonstrated that complete dentures with metal palate are perceived more comfortable than acrylic dentures [9, 10]. This case report introduced an innovative metal palate design in addition to few previously mentioned reports about metal base dentures. Looped metal design improved temperature sensitivity and prevented fractures. It also enhanced metal acrylic bond and allowed adequate space for teeth arrangement. Researchers, educators and clinicians should focus on innovative methods to improve conventional management of edentulous patients for their better satisfaction. REFERENCES 1. Schneider RL, Stokes JL, LaDuke D. Design and fabrication technique for metal palates in maxillary complete dentures. J Dent Technol. 2000; 17: Miyairi H, Nagai M, Takayama Y. Application of carbon fiber (CF) cloth reinforcement to upper complete denture base. Bull Tokyo Med Dent Univ. 1983; 30: Roumanas ED. The social solution-denture esthetics, phonetics, and function. J Prosthodont. 2009; 18: Kawano F, Miyamoto M, Tada N, Matsumoto N. Reinforcing effect of a Ni-Cr alloy plate on an acrylic resin denture base. Int J Prosthodont. 1991; 4: Jüch PW, Kalk W. Influence of a maxillary complete denture on taste perception Patients regularly report an alteration in taste perception after the insertion. Ned Tijdschr Tandheelkd. 2011; 118: Yoshinaka M, Yoshinaka MF, Ikebe K, Shimanuki Y, Nokubi T. Factors associated with taste dissatisfaction in the elderly. J Oral Rehabil. 2007; 34: Hantash RO, Al-Omiri MK, Yunis MA, Dar-Odeh N, Lynch E. Relationship between impacts of complete denture treatment on daily living, satisfaction and personality profiles. J Contemp Dent Pract. 2011; 12: Perezous LF, Stevenson GC, Flaitz CM, Goldschmidt ME, Engelmeier RL, Nichols CM. The effect of complete dentures with a metal palate on candida species growth in HIV-infected patients. J Prosthodont. 2006; 15: Hummel SK, Marker VA, Buschang P, DeVengencie J. A pilot study to evaluate different palate materials for maxillary complete dentures with xerostomic patients. J Prosthodont. 1999; 8: Carlsson GE, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Oral Rehabil. 2010; 37: Received: 15/08/2012 Accepted: 17/10/2012

5 Stomatološki glasnik Srbije. 2012;59(4): Totalna proteza s metalnim nepcem i posebno dizajniranim petljama u protetičkoj rehabilitaciji pacijenta prikaz slučaja Višvas Batia, Garima Batia Klinika za stomatološku protetiku, fiksnu protetiku i oralnu implantologiju, Stomatološki fakultet i bolnica Eklavja, Radžastan, Indija KRATAK SADRŽAJ Iz ra da to tal ne pro te ze mo že po bolj ša ti i funk ci ju usne du plje i estet ski iz gled pa ci jen ta. Iako je funk ci ja žva ka nja po bolj ša na, je dan od naj če šćih pro ble ma ko ji se ja vlja kod oso ba s to tal nim gor njim akri lat nim pro te za ma je po re me ćen ose ćaj to plog i hlad nog, gu bi tak uku sa i pre lom pro te ze na sre di ni nep ca. Ovi pa ci jen ti zah te va ju pro te zu ko ja im omo gu ća va što nor mal ni ji ose ćaj u usnoj du plji. U ovom pri ka zu pred sta vljen je al ter na tiv ni na čin iz ra de gor nje to tal ne pro te ze s me tal nim nep cem ko ja, uz is pu nje nje nave de nih funk ci ja, ima ugra đe ne po seb no di zaj ni ra ne pe tlje ko je po bolj ša va ju me ha nič ku re ten ci ju akri la ta unu tar me tal ne pe tlje i ne ome ta ju po sta vlja nje ve štač kih zu ba. Ključ ne re či: al ter na tiv ni na čin iz ra de; ose ćaj to plog i hlad nog; me ha nič ka ad he zi ja; me tal no nep ce UVOD Zub na pro te za je pro te tič ka na dok na da ko ja tre ba da za me ni zu be ko ji ne do sta ju, s oslon cem na okol no me ko i ko šta no tki vo u usnoj du plji. Pro te ze mo gu po mo ći pa ci jen ti ma pri žva ka nju, go vo ru, u estet skom iz gle du i po ve ća ti sa mo po što va nje. Je dan od naj če šćih pro ble ma s no vim to tal nim gor njim akrilat nim pro te za ma je ste po re me ćen ose ćaj to plog i hlad nog i gubi tak uku sa. De blji na pro te ze u pre de lu nep ca ta ko đe mo že da uti če lo še na kom for pa ci jen ta. Gor nje to tal ne akri lat ne pro te ze ko je su u kon tak tu s pri rod nim zu bi ma u do njoj vi li ci sklo ne su pre lo mi ma u pre de lu sred nje li ni je iz ne ko li ko raz lo ga [1]. Budu ći da akri lat ni je čvrst ma te ri jal, ba za gor nje to tal ne akri lat ne pro te ze bi tre ba lo da bu de tri če ti ri pu ta de blja ne go ba za pro teze od me ta la [2]. Ra di pre va zi la že nja tih pro ble ma, po treb no je iz ra di ti gor nju to tal nu akri lat nu pro te zu s je din stve nim nep cem od me ta la. Ne ko li ko raz li či tih di zaj na je opi sa no u li te ra tu ri za iz ra du me tal nog nep ca kod gor njih to tal nih akri lat nih pro te za. Me đu tim, ni u jed nom slu ča ju ni je bi lo fo ku si ra nja na di zajn pro te ze ko ji bi omo gu ća vao da me tal no nep ce: 1) ima od go va raju ću ve zu s akri lat nim de lom pro te ze; 2) ne ome ta po sta vlja nje ve štač kih zu ba, i 3) ima ra van pre laz iz me đu me ta la i akri la ta. Auto ri pri ka zu ju pa ci jen ta sa svim go re po me nu tim pro blemi ma s gor njom to tal nom akri lat nom pro te zom. Kon stru i sa no je nep ce od me ta la je din stve nog di zaj na u iz ra di ova kve pro te ze. Ta kav di zajn bi tre ba lo da po mog ne kli nič kim sto ma to lo zi ma da pre vla da ju ne do stat ke uoče ne u ra ni jim ra do vi ma. PRIKAZ SLUČAJA Še zde se to go di šnji mu ška rac sa to tal nom pro te zom gor nje vi li ce ja vio se na pre gled zbog te go ba u vi du iz o stan ka ose ća ja tem pera tur ne pro me ne pri je de nju (to plo hlad no), zbog ne pri rod nog ose ća ja to kom žva ka nja usled de blji ne pro te ze na nep cu, kao i zbog po nov nih pre lo ma pro te ze. Kod ovog pa ci jen ta je bio pra vi iza zov di zaj ni ra ti gor nju to tal nu pro te zu s po seb nim ob li kom nep ca ko ja bi: da la bo lji ose ćaj tem pe ra tu re i uku sa, ima la tan ko nep ce, bi la ot por na na pre lo me i ima la do bru re ten ci ju akri la ta, bez ome ta nja po stav ke ve štač kih zu ba i s rav nim pre la zom meta la i akri la ta. Iz ra đe na je gor nja to tal na pro te za s pri la go đe nim me tal nim nep cem ino va tiv nog sti la, s me tal nim pe tlja ma u odre đe nim po lo ža ji ma i sme ro vi ma zbog bo lje re ten ci ja akri la ta, a da pri to me ne do đe do ome ta nja po stav ke ve štač kih zu ba. Ta ko đe, je dan do dat ni deo je omo gu ća vao ra van pre laz na spo ju me ta la i akri la ta. Izrada proteze Pre li mi nar ni oti sak je uzet ire ver zi bil nim hi dro ko lo i dom (Al gina te, Dentsply, Wey Brid ge, Sur rey, UK). Na kon iz ra de in di vi dual ne ka ši ke, ko nač ni oti sak je uzet cink ok sid euge nol pa stom (DPI Im pres sion pa ste, DPI, Mum bai, In dia). Ko nač ni mo del je iz li ven, a po tom i du pli ran. Du pli ra ni mo del bio je od va tro stalne ma se (Bel la sun, Be go, Ger many), da bi se omo gu ći lo iz li va nje nep ča nog de la pro te ze od me ta la. Ze le ni vo sak (Ruby Den tal Pro ducts Inc., Osa ka, Ja pan) adapti ran je na nep ce mo de la po kri va ju ći al ve o lar ni gre ben kao i 2 3 mm iz van nje ga. Vo šta ne pe tlje (Ruby Den tal Pro ducts Inc., Osa ka, Ja pan) ve li či ne 2 3 mm po sta vlje ne su po obo du ze le nog vo ska. Ove pe tlje su bi le 2 3 mm da le ko od ve sti bu lar nog sul kusa, ka ko je pri ka za no pra vom stre li com na sli ci 1. Nji ho va ulo ga je bi la u re ten ci ji akri la ta. Tan ke pe tlje su po sta vlje ne i pa la tinal no od vr ha gre be na, ka ko je po ka za no po vi je nom stre li com (Sli ka 1). Vi si na ovih pe tlji ni je ome ta la po sta vlja nje ve štač kih zu ba, ali je omo gu ća va la uliv akri lat ne smo le. Pra vo u gli spoj je for mi ran pa la ti nal no od vr ha al ve o lar nog gre be na na spo ju akri la ta i me ta la. On je imao ulo gu da po bolj ša spoj me ta la i akri la ta i da po mog ne pri for mi ra nju rav nog pre la za iz me đu akri la ta i me ta la, ka ko ne bi do šlo do stva ra nja ste pe ni ka. Za for mi ra nje pra vo u glog pre la za pla vi vo sak valj ka stog obli ka (Ruby Den tal Pro ducts Inc., Osa ka, Ja pan) de blji ne 2 mm adap ti ran je pa la ti nal no u od no su na vrh al ve o lar nog gre be na, ka ko je to na zna če no pra vom stre li com na sli ci 2. Ka da je dizaj ni ra nje nep ča nog de la za vr še no, po sta vlje ni su uliv ni ko či ći. Na kon iz li va nja nep ča ni deo od me ta la je po sta vljen na glav ni mo del (Sli ka 3). Po mo ću ro ze vo ska (Ruby Den tal Pro ducts Inc., Osa ka, Japan) for mi ran je na gri zni gre ben (Sli ka 4). Na kon to ga od ređe ni su me đu vi lič ni od no si, a po tom po sta vlje ni ve štač ki zu bi. Na kon ki ve ti ra nja, gor nja to tal na pro te za je za vr šno ob ra đe na i

6 210 Bhatia V. and Bhatia G. Prosthetics Rehabilitation of a Male Patient with a Unique Looped Metal Palate Denture A Case Report is po li ra na (Sli ka 5). Sva ka per la na akri lat noj po vr ši ni (Tre va lon He at Cu re acrylic re sin, Dentsply, Wey Brid ge Sur rey, UK) ili na spo ju akri la ta i me ta la je uklo nje na. Ura đe na je pro ba pro te ze na pa ci jen tu i po tvr đe na do bra re ten ci ja (Sli ka 6). Po sta vlje ne su obe pro te ze u usta pa ci jen ta i pro ve re na oklu zi ja. Sli ke pa cijen ta pre te ra pi je (Sli ka 7) i na kon te ra pi je (Sli ka 8) po ka zu ju zna čaj no po bolj ša nje nje go vog iz gle da. Na kon trol nom pre gle du na kon šest me se ci pa ci jent je nagla sio po bolj šan ose ćaj to plog i hlad nog i bo lji efe kat ču la uku sa, kao i sko ro pot pu no nor mal nu funk ci ju žva ka nja. DISKUSIJA Naj če šće pri tu žbe pa ci je na ta sa gor njom to tal nom akri lat nom pro te zom su po re me će no žva ka nje, ne mo guć nost ose ća ja tempe ra tur nih va ri ja ci ja hra ne, pre lom pro te ze u sre di šnjoj li ni ji, de blji na nep ca i ne pri ro dan go vor. Utvr đi va nje pa ci jen to vih oče ki va nja i nji hov uti caj na za do volj stvo pa ci jen ta te ra pi jom je ve o ma zna ča jan [3]. Ovaj rad je pri ka zao mu škar ca bez zu ba, s to tal nim pro teza ma i te go ba ma, kao što su gu bi tak ose ća ja to plog i hlad nog i sma njen ose ćaj ču la uku sa. Ta ko đe, nje go va gor nja pro te za bi la je sklo na lo mlje nju. Da bi se ot klo ni li po sto je ći pro ble mi, kon stru i sa na je no va gor nja to tal na pro te za s ino va tiv nim dizaj nom ko ji uklju ču je me tal no nep ce s pe tlja ma. Ne ko li ko rani jih ra do va uka zu ju na ko ri šće nje po ja ča nih Ni Cr plo ča ili kar bon skih vla ka na ra di oja ča nja pro te ze, ali ove me to de ni su ima le ni ka kav uti caj na po bolj ša nje pa ci jen to ve per cep ci je o pro me na ma tem pe ra tu re [2, 4]. Ra ni je stu di je su ta ko đe po tvrdi le pro me nje no ču lo uku sa na kon po sta vlja nja gor nje to tal ne pro te ze. Op šte je pri hva će no da su pro me ne u ose ća ju tem pe ratu re i uku sa hra ne uzro ko va ne pot pu nim pre kri va njem nep ca gor njom to tal nom pro te zom [5]. Stu di je ko je su is pi ti va le osećaj uku sa kod sta ri jih oso ba ta ko đe su po ka za le ve zu iz me đu akri lat nih pro te za ko je po kri va ju či ta vo nep ce i ne za do volj stvo funkcijom ču la uku sa [6]. Me tal no nep ce s pe tlja ma ne sa mo da po bolj ša va ose ćaj prome na tem pe ra tu re i spre ča va pre lo me pro te ze u sred njoj li ni ji, već i omo gu ća va bo lju re ten ci ju akri la ta i ne ome ta po sta vlja nje ve štač kih zu ba. Ta ko đe, tan ka me tal na plo ča na nep cu je da leko kom for ni ja za pa ci jen ta. S ob zi rom na to da je me tal ja či, gor nja me tal na ba za pro te ze mo že bi ti tri če ti ri pu ta ta nja od akri lat ne ba ze pro te ze [2]. Udob nost pri no še nju ova kve pro te ze ima, psi ho lo ški gle da no, po zi ti van uči nak na pa ci jen ta. S dru ge stra ne, raz li či ti psi ho lo ški pro fi li igra ju va žnu ulo gu u ukup nom za do volj stvu pa ci jen ta te ra pi jom [7]. Ne ma mno go stu di ja ko je se ba ve di zaj nom me tal nog nep ca na gla ša va ju ći mo gu će na či ne za bo lju ve zu me ta la i akri la ta, kao i neo me ta no po sta vlja nje ve štač kih zu ba, a ko ji ujed no is pu nja va ju zah te ve kao što su po bolj ša ni ose ćaj tem pe ra tur nih pro me na u usti ma i spre ča va nje pre lo ma pro te ze u sre di šnjoj li ni ji. Ta kav di zajn nep ca od me ta la mo že po bolj ša ti kva li tet ži vo ta oso ba ko je ne ma ju zu be. Po zna to je i da je me tal na ba za ma nje po god na za rast glji vi ca, ko je se obič no ja vlja ju kod akri lat nih pro te za [8]. Is tra ži va nja su ta ko đe po ka za la da su to tal ne pro te ze s me tal nim nep cem da le ko kom for ni je od akri lat nih pro te za [9, 10]. Ovaj pri kaz slu ča ja pred sta vlja ino va tiv ni di zajn me tal nog nep ca uz ne ko li ko pret hod no ob ja vlje nih ra do va na tu te mu. Me tal ni di zajn s pe tlja ma po bolj šao je ose tlji vost na pro me ne tem pe ra tu re i spre čio pre lo me pro te ze. Ta ko đe je po bolj šao ve zu me ta la i akri la ta i omo gu ćio neo me ta no po sta vlja nje ve štač kih zu ba. Is tra ži va či, na stav ni ci i kli nič ki sto ma to lo zi tre ba lo bi da se fo ku si ra ju na ino va tiv ne me to de iz ra de to tal nih pro te za, ka ko bi omo gu ći li ve će za do volj stvo pa ci jen ta pru že nom te ra pi jom.