Wallace Workshop 6490 Wednesdy AM

tHE LARGEST DENTAL MEETING/EXHIBITION/CONGRESS IN THE UNITED STATES
Full Dentures In A Single One Hour Visit: No Dental

Laboratory Needed
Lawrence N. Wallace, D.D.S.
Wednesday
December 4, 2013
Welcome to the Greater New York Dental Meeting

6 Days of Education Seminars,
Hands-on Workshops & Essays
Friday - Wednesday
2013
Celebrity Luncheon Speaker
General Registration Hours
Friday, November 29th

12:00 Noon - 4:30 P.M.
Saturday, November 30th
8:00 A.M. - 4:30 P.M.
Sunday, December 1st - Tuesday, December 3rd

8:00 A.M. - 5:30 P.M.
Wednesday, December 4th
8:00 A.M. - 4:30 P.M.
4 Days of Exhibits
Exhibit Hall Hours
Sunday - Wednesday
Sunday, December 1st - Tuesday, December 3rd

9:30 A.M. - 5:30 P.M.
Wednesday, December 4th
9:30 A.M. - 5:00 P.M.
Sunday
Scientific Poster Sessions
Special Events
Sixth Annual
INVISALIGN- GNYDM EXPO
4 Days of Programming:
Sunday - Wednesday
Over 1,500 Exhibit Booths
Dinner Dance - November 30th - Ticket 2010

Wednesday Night Happening - December 4th
New York Marriott Marquis Hotel
Doris Kearns Goodwin

Monday, December 1st
12:00 - 2:00 - Ticket 4010
$85.00
Tickets
Tickets for all functions can be purchased at

all general registration booths located in the
Registration Area on the Upper Level in the Crystal
Palace and online.
Botox and Facial Fillers

Seminar & Workshop
Educational Audio Recordings
Recordings of selected programs may be purchased

at the Strategic Events Plus booth outside
Classroom 1E18
New Programs
FREE Live Patient Dental
Treatment on the Exhibit Floor
CAD/CAM
CONE-BEAM
LASER
Technology Pavilions
FREE Live Dentistry Hi-Tech 430 Seat Arena

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SUNDAY
10:00 - 12:30
VOCO America, Inc.

Dr. Robert A. Lowe
Restorative
2:30 - 5:00
Philips Sonicare &

Zoom Whitening
Dr. Gerard Kugel
Whitening
MONDAY
TUESDAY
10:00 - 12:30
10:00 - 12:30
VOCO America, Inc.
Millennium Dental
Technology, Inc.
Dr. Robert A. Lowe

Fixed Prosthetics
2:30 - 5:00
OcoBioMedical, Inc.
Dr. Charles D. Schlesinger

Implants
Dr. Charles Braga

Lasers
2:30 - 5:00
Millennium Dental
Technology, Inc.
Dr. Alex Touchstone
Restorative
WEDNESDAY
Watch us
10:00 - 12:30
Bisco & Shofu
Dr. Jack D. Griffin, Jr.

Esthetics
Blog with us
2:00 - 4:30
Hiossen, 3D Diagnostix &

Planmeca
Dr. Aeklavya Panjali
Implants
Connect with us

www.larelldentures.com
Greater New York Dental Meeting

The Larell One Step Denture: The Alternative Denture
Lecture Notes:
Introduction
Speaker background
History of dentures
Denture demographics and usage
Scientific background
Classic Prosthodontic Literature
Principles of Successful Dentures
The Larell One Step Denture
Indications for usage
Denture technique
Case Studies
Complete Denture Upper/Lower
Immediate Denture
Implant Overdenture
All on Four provisional denture
Summary
Q and A
The Larell One Step Denture Technique the Fabrication Process

Pocket Guide
1. Choose the proper template size from the preliminary model
2. Modify template on model and in mouth
3. Functional In mouth reline process
4. Finish, Polish and Deliver
The Larell One Step Denture Complete Dentures in an Hour GNYDM 2013 Presentation
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Slide 1
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CompleteDenturesinAnHour
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1
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Slide 2
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Speaker Lawrence N Wallace DDS
DDS University of Illinois College of Dentistry 1970
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Oral Surgery Residency Long Island Jewish Medical Center 1973

Board Certified Oral and Maxillofacial Surgery 1978
Private Practice 1973-1995
VP Dental utilization review firm 1997-1999
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President and CEO, Larell Surgical Consultants 1999-present

Developer and Founder, The Larell One Step Denture 2005
Winner, Monterey Bay Region Business Plan Competition 2010
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2
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Slide 3
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Discussion Points
Introduction
Scientific background
Indications for use
Case Studies
Summary
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3
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Slide 4
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The History of Dentures
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4
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Slide 5
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Why Wear Dentures
Nutrition
Health
QualityofLife
SelfEsteem
No
dentures
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Higher
healthcare
costs
Increased
chronic
disease
Poor
nutrition
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Slide 6
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Denture Demographics
DenturePatientMarketSize(Millions)
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210
180
160
140
Millions
120
102
100
80
60
40
42
38
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20
2010
USMarket
2020
GlobalMarket
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Slide 7
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Denture Usage
33-37 Million edentulous currently in the US

Only 90% of the edentulous wear dentures
The percentage decline in edentulism will be more
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than offset by the 79% increase in the adult

population over 55.
Dentists will find a sizeable minority of the patient
___________________________________
population will continue to need complete denture

services.
Will there be a need for complete dentures in the United States in

2020?
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Douglass CW Shih A Ostry L J Prosthetic Dentistry 2002 Jan;87(1):5-8
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Slide 8
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Denture Demographics
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38.5 million over the age of 65 with an

edentulous rate of 22.9% or 8.86 million
Income: < $10k = 18%
$10-29k = 12%
$30-50k = 6%
> $50k = 4%
Men > Women
Rural > Urban
Less Educated > College Education
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Slide 9
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What Makes A Successful Denture
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Principles of Denture Fabrication
Fit
Form
Function
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Slide 10
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Scientific Principles of Complete Dentures
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Critical Clinical Definitions:

Support The quality of a denture to
resist displacement by functional
stresses.
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Retention- The resistance of a

denture to removal in a direction
opposite that of its insertion.
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10
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Slide 11
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Boucher CO Prosthodontic Treatment for Edentulous Patients
11th Edition 1997
a definitive impression is one of the most critical stepsin the
fabrication of complete dentures
Frank RP DCNA 1970
the key to obtaining a good final impressioncorrectly
extended and properly relieved tray
El Khodary et al JPD 1985
1.3mm relief of denture for material
Russell A JPD 1959
second molarsometimes must be eliminated
Kapur KK et al JPD 1965
number of posterior teeth didnt affect chewing efficiency
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11
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Slide 12
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Wright CR JPD 1966

ability to wear a lower denturea normal tongue position
the occlusal plane is 2 mm below the retromolar pad
Schiesser FJ JPD 1966
The shape of the polished surface contributes more to the
stabilization of a denture than the border of the denture
the artificial teeth must occupy a position so that the tongue
is pressed inward with just as much force as the cheek is
pressed outward
Trapozanno V JPD 1959
there is little difference between 20 degree vs non anatomical
teethlittle less efficient but felt better
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Slide 13
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Jones PM JADA 1972

monoplane teeth suffer less of a derangement of occlusal
relations
Anatomic teeth will suffer heavier forces on the forward facing
inclines of the lower teeth against the distal inclines of the upper
teeth. This results in a sliding of the weaker denture base on the
mucosa causing inflammation, pain, bone destruction, and
tissue hyperplasia
set maxillary posterior teeth first
maxillary teeth are arranged with regard to appearance
Felton DA Texas Dental Journal Apr 2010
complete edentulism continues to represent a tremendous
global health care burden, and will for the foreseeable future.
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13
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Slide 14
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Standard of Care The Larell Denture
Adherence to Scientific Principles and

classic prosthodontic literature
Professionally accepted materials
Patient satisfaction results
Fit
Form
Function
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14
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Slide 15
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Dental Marketing 101
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15
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Slide 16
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Patient Expectations
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It isnt all about the
occlusion
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16
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Slide 17
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I hope you can do better than the last dentist I

had!
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I cant chew lettuce, apples or corn on the

cob!
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The lower ones moves when I eat!

My food tastes different!
My speech has changed some!
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17
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Slide 18
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Slide 19
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Slide 20
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Slide 21
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Slide 22
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Dentures are not a
replacement for teethThey
are a replacement for NO
teeth
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22
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Slide 23
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Dentures in an Hour
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Do they meet
Standard of Care ?
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23
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Slide 24
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Standard of Care
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STANDARD n. that which is

established by authority, custom,
or general acceptance as a model;
criterion.
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*guides
practice and may be used to evaluate

performance
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24
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Slide 25
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Innovative method of denture fabrication

Lower-cost, one-visit solution
Opens unserved and underserved
markets due to its:
Portability
One visit fabrication
Intuitive, easy to learn technique
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25
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Slide 26
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Indications for Use
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Complete Dentures Upper/Lower

Immediate Dentures
Implant Overdentures
Immediate
final
Additional uses
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26
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Slide 27
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Market Sectors
Private Practice
Skilled Nursing Facilities
Assisted Living Residences
Working population without insurance benefits
Mobile Dental Clinics
Safety Net Clinics
Mission of Mercy dental clinics
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27
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Slide 28
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Larell Dentures utilize Classic Prosthodontic

Principles
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There are three posterior teeth

The teeth are over the ridge
The impression is most accurate, done direct
Lingual flange concave for better retention
Maxillary occlusal plane set first for
appearance
Monoplane teeth for maximum comfort and
least tissue damage
Adapted template allows for proper thickness
of reline material
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28
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Slide 29
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Factors associated with Successful Dentures
Roberta L.Diehl, Ulrich Foerster, Venitta Sposetti, and Teresa
Dolan Journal of Prosthodontics, Vol 5, No2 (June), 1996, 84-90
___________________________________
76.7% satisfied with their dentures

74.6% expectations had been meet
67% said they adjusted easily at 6 month
78% said they adjusted easily at 18 months
Age, gender, race, income level, education,
marital status and maxillary and mandibular
anatomy were not significantly associated with
denture success within this study
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29
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Slide 30
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Survey of Larell Denture Patients
69 patients surveyed: 61 responding

Telephone interview and post-op evaluation
11% previous denture wearers
83.6% overall satisfaction with their dentures
98.4% pleased with appearance
80.3% chew comfortably
83.3% reported feeling healthier
Patient demographics consistent with previous
study
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Mastication difficulty reported with apples and corn on the cob
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Treated by Dr Alouf and Dr Miller in Bristol VA DPH project
30
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Slide 31
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Conventional Denture vs. Larell Denture
Conventional denture
Larell One-Step Denture
Made in dental office

Made in 4-5 visits
Can be made anywhere
Total time 3-4 hours
Total time about 1 hour
$200 - 400 lab cost
No lab cost
Retail $3000-5000 per set
Sugg Fee $1,200 per set
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Made in 1 visit
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31
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Slide 32
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Larell Results
RAM/MOM VA Clinic August 2011
100 dentures
VA Dept of Health clinic August 2011
92 dentures
Sacramento CA CDA clinic Sep 2012
86 dentures
VA Dept of Health clinic Feb 2012
70 dentures
Roanoke VA MOM Clinic Apr 2012
78 dentures
San Jose CA CDA Clinic May 2013
104 dentures
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All done in 1 - 2 day clinics
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All completed to patient satisfaction
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Slide 33
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Our Patients
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33
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Slide 34
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The Larell One-Step Denture System
Multiple size pre-formed patented dental templates
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Available in shades B65, B1
Accommodates 99% of edentulous population
Templates made in the US from all US made materials
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34
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Slide 35
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Denture Placement Technique
Check vertical dimension in standing relaxed position
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Final vertical to be 2 mm less than initial measurement
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35
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Slide 36
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Start with quick set stone model

Choose closest template size
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36
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Slide 37
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Trim flanges to allow 2-3 mm of space between the edge of

flange and height of mucobuccal fold
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Frenum attachments and other impingements on the

template are relieved at this time
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37
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Slide 38
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Palate is adapted to close fit
Reduce posterior border to vibrating line
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38
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Slide 39
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Position upper template in mouth
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Anterior/posterior (ala tragal line): Occlusal plane

Occlusal cant: Occlusal plane
Tooth Show: Visual
Lip Support: Visual
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39
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Slide 40
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Templates-Before and After
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Slide 41
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Complete Larell One Step Denture
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Slide 42
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Slide 45
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Slide 46
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Template Customization
Teeth not over ridge Heat template and move teeth

slightly. If more movement is needed then cut notch in
template and move segment over ridge.
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Occlusal plane canted on template try in Place stops

inside upper template to level occlusion prior to reline.
46
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Slide 47
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Template Modification
Unable to achieve ideal class I occlusion Not all

circumstances will allow an ideal class I occlusion. There
may be a posterior crossbite or edge to edge occlusion.
This is not an issue with monoplane teeth
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47
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Slide 48
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Modifications
Poor retention of lower template Use soft reline material,

add mylohyoid flange extensions, consider the use of
mini implants.
Gingival color too light Add ink to reline liquid before
mixing
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48
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Slide 49
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Cosmetic Dentures
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49
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Slide 50
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Case Study
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Maxillary Immediate
Denture
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50
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Slide 51
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Placement Technique Immediate Denture
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Vertical already established
Lower occlusion to be balanced to upper
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51
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Slide 52
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Slide 53
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Slide 54
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54
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Slide 55
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Case Study
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Maxillary Immediate
Denture
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55
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Slide 56
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Case Study Immediate Interim Denture
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56
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Slide 57
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Slide 58
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Slide 59
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Slide 60
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Case Study
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Maxillary Immediate
Denture With Template
Modifications
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60
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Slide 61
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Case Study Immediate Denture
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Slide 62
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Slide 66
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Slide 67
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Case Study
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Maxillary Implant
Supported Denture
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Slide 68
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Case Study Maxillary Implant Case
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Slide 69
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Slide 70
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Case Study Maxillary Implant case
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Slide 71
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Slide 74
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Case Study
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Mandibular Implant
Supported Denture
With Reinforcement
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74
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Slide 75
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Case Study Mandibular Implant Case
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Slide 76
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Slide 78
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Slide 79
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Slide 80
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Case Study
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All on Four
Implant Reconstruction
Temporary Denture
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Slide 81
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Case Study All on Four Implants
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Slide 82
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Slide 87
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Slide 88
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Slide 89
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The Real Economics
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One Set of Larell Dentures
One hour of time

Cost of templates and reline material
Suggested fee to patient
$ 355.00
$1200.00
___________________________________
Profit: $ 845.00/hour*
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*Fixed Expenses not included
89
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Slide 90
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Grow Your Practice
Add patients you would not have seen

Brings in family members and friends
Promotes your practice as innovative
___________________________________
Sample increased gross income at $1200.00/set

Sets per week
hours/week
Additional Gross Income/Yr
1.5
3.0
4.5
$187,000.00
6.0
$249,000.00
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$ 62,400.00
$124,800.00
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Slide 91
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The Larell Difference
Addresses major barriers to care of:
ACCESS AND COST
Innovative one hour technique
Intuitive, efficient easy to learn technique
Affordable for patient
Profitable for the dentist
Improvesnutrition
Improveshealth&qualityoflife
Raisesselfesteem
Lowershealthcarecosts
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Slide 92
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Contact Information
___________________________________
___________________________________
Dr Lawrence Wallace
Phone 831.659.9300
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Info@larell.com
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___________________________________

Wallace Workshop 6490 Wednesdy AM

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tHE LARGEST DENTAL MEETING/EXHIBITION/CONGRESS IN THE UNITED STATES

Full Dentures In A Single One Hour Visit: No Dental

Welcome to the Greater New York Dental Meeting

General Registration Hours

Friday, November 29th

Exhibit Hall Hours

Sunday, December 1st - Tuesday, December 3rd

Scientific Poster Sessions

Over 1,500 Exhibit Booths

Dinner Dance - November 30th - Ticket 2010

Doris Kearns Goodwin

Tickets for all functions can be purchased at

Botox and Facial Fillers

Educational Audio Recordings

Recordings of selected programs may be purchased

FREE Live Patient Dental

Treatment on the Exhibit Floor

FREE Live Dentistry Hi-Tech 430 Seat Arena

VOCO America, Inc.

Philips Sonicare &

VOCO America, Inc.

Dr. Robert A. Lowe

Dr. Charles D. Schlesinger

Dr. Charles Braga

Dr. Jack D. Griffin, Jr.

Hiossen, 3D Diagnostix &

Greater New York Dental Meeting

The Larell One Step Denture Technique the Fabrication Process

2. Modify template on model and in mouth

3. Functional In mouth reline process

4. Finish, Polish and Deliver

DDS University of Illinois College of Dentistry 1970

Oral Surgery Residency Long Island Jewish Medical Center 1973

President and CEO, Larell Surgical Consultants 1999-present

33-37 Million edentulous currently in the US

than offset by the 79% increase in the adult

Dentists will find a sizeable minority of the patient

population will continue to need complete denture

Will there be a need for complete dentures in the United States in

Douglass CW Shih A Ostry L J Prosthetic Dentistry 2002 Jan;87(1):5-8

38.5 million over the age of 65 with an

Critical Clinical Definitions:

Retention- The resistance of a

Wright CR JPD 1966

Jones PM JADA 1972

Adherence to Scientific Principles and

I hope you can do better than the last dentist I

I cant chew lettuce, apples or corn on the

The lower ones moves when I eat!

STANDARD n. that which is

practice and may be used to evaluate

Innovative method of denture fabrication

Complete Dentures Upper/Lower

Larell Dentures utilize Classic Prosthodontic

There are three posterior teeth

76.7% satisfied with their dentures

69 patients surveyed: 61 responding

Mastication difficulty reported with apples and corn on the cob

Treated by Dr Alouf and Dr Miller in Bristol VA DPH project

Larell One-Step Denture

Made in dental office

Can be made anywhere

Total time 3-4 hours

Total time about 1 hour