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Figure 1. Upper first molar had been extracted.
Figure 2. Missing first molar was visible in the patient’s smile, causing her to be self-conscious.
Figure 3. The milled acetal resin removable prosthesis (Snap-On Smile [DenMat]) on the lab model.
Figure 4. The appliance was ready for delivery.
Figure 5. This retentive tooth-borne appliance was easy to insert and comfortable for the patient.
Figure 6. The patient was able to smile confidently and to function well while preparing financially for the future implant-restorative work.

For many people, having a missing tooth in the aesthetic zone when they smile can make them self-conscious and can affect their social interactions. The reality is that many people cannot afford the preferred permanent tooth replacement options such as implants or fixed bridges. However, just because their economic situation does not allow for the ideal solution does not mean that we cannot provide these patients with a solution that will allow them to look better and feel better about themselves.1

In the past, the most common low-cost option was an acrylic “flipper”-style removable appliance. Although these provide a limited aesthetic replacement for missing teeth, they are traditionally difficult to keep in place and can be challenging for phonetics and eating.

This article will demonstrate the use of the Snap-On Smile (DenMat) removable prosthetic as an alternative to the traditional flipper appliance as a temporary aesthetic solution until the patient can afford a definitive implant-retained restoration.

CASE REPORT
A 40-year-old female patient presented with a missing upper first molar (tooth No. 14) that had been previously extracted (Figure 1). Due to her current financial situation, she was unable to immediately have the single-tooth implant and restoration that she desired. However, a treatment plan was created for an implant and definitive restoration so she could make budget plans that would allow us to do the work within a couple of years.

In the meantime, her missing tooth was very noticeable when she smiled, making her self-conscious (Figure 2). She desired an affordable temporary aesthetic option until the definitive implant restoration could be started.

A 3-unit Snap-On Smile appliance was recommended. Different from a traditional removable prosthesis, the Snap-On Smile option is a tooth-borne, milled prosthesis. These acetal resin appliances are more durable and stain resistant than acrylic, yet they are strong, flexible, stable, and functional.2 This stable and retentive appliance would provide the patient with the function and aesthetics that she desired while waiting for the definitive work.3 If required, the patient would have years of service from this solution until she was able to proceed with the implant. In the future, it would also be able to serve its aesthetic and functional purpose during the surgical healing phase after implant placement.

Clinical and Laboratory Work
Upper and lower full-arch impressions were taken using a vinyl polysiloxane impression material (Splash! [DenMat]). In addition, an accurate centric occlusion bite registration was taken (Vanilla Bite [DenMat]). On the laboratory prescription form, we noted the desired design and specified a request for a digital preview of the prosthesis so that we could approve the design before the appliance was actually made.

A hybrid design was created, incorporating 360° coverage of the second molar and a lingual wing on the second premolar. On the occlusal aspect of the second molar, a hole was fabricated so that there would be no change in the patient’s occlusion. A lingual wing was created on the second premolar to provide retention, but the buccal aspect was not covered to maximize the aesthetic results. The strong yet flexible nature of the Snap-On Smile acetal resin would allow for this type of design to function well (Figures 3 and 4).

Delivery of the Tooth-Borne Prosthesis
Upon delivery, we tried in the prosthesis to ensure that the fit was comfortable for the patient (Figure 5). Next, the occlusion was checked and a few minor adjustments were made to the appliance using a 16-fluted football-shaped carbide bur (Komet). Some areas of adjustment were repolished with a polishing wheel (Abrasive Buff [Komet]). Finally, the patient was instructed on how to insert and remove the appliance, and we also provided her with home care instructions.

The final restoration provided the patient with the desired aesthetics (Figure 6). It also provided full function as she later reported that she had no problems eating with the Snap-On Smile appliance in place.

In the year after the patient had her Snap-On Smile delivered, she saved enough money to begin her im­plant restoration. She recently made her appointment for her implant surgery and will begin the final stage of replacing her first molar. Upon implant placement, she will continue to use her Snap-On Smile appliance during the healing as well as the restorative stage of her treatment.

CLOSING COMMENTS
Tooth loss can be psychologically traumatic for many people. Having the ability to provide an economical option to help the patient through the restorative phase of recreating his or her smile is a tremendous service that we can provide our patients.

Snap-On Smile is a viable tool to provide patients with aesthetic and functional replacement of missing teeth. When used as part of implant therapy, it can provide patients with both a temporary replacement of their teeth and allow them the opportunity to get their financial planning in order so that the definitive replacement of a tooth does not cause an economic burden.


References

  1. Liechtung M. The Snap-On Smile removable appliance. Inside Dentistry. 2010;6:96-97.
  2. Rosenberg J. The immediate smile makeover. Oral Health. 2011;101:26-34.
  3. Arda T, Arikan A. An in vitro comparison of retentive force and deformation of acetal resin and cobalt-chromium clasps. J Prosthet Dent. 2005;94:267-274.

Dr. Radz is a graduate of the University of North Carolina School of Dentistry. His private practice is located in downtown Denver, Colo. He is an associate clinical professor at the University of Colorado School of Dentistry. He serves on the editorial board of 7 dental journals and has published more than 100 articles related to the materials and techniques used in cosmetic dentistry. Additionally, he lectures internationally on subjects related to aesthetic dentistry and the development of cosmetic-based dental practices. He can be reached via e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it. or via the Web site downtowndenverdentist.com.

Disclosure: Dr. Radz was paid an honorarium by DenMat for writing this article.



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