Digital Way Of Complete Denture

Content

1. Introduction

2. Digital workflow steps and

Current status of Digital
complete Denture

3. Clinical outcomes with digital

way of complete denture

4. Advantages , Disadvantages
and limitations

5. Conclusion
Conclusion

• The integration of CAD/CAM technology into complete denture design and

fabrication helps improve the consistency of complete dentures and improves
the fit when the base is milled from pre-polymerized resin.

• Time-consuming laboratory procedures are reduced or eliminated, allowing the

dental technician to provide reproducible, efficient, and accurate prostheses.

• Dental literature lacks long term clinical trials that are necessary to validate this
technology in complete denture prosthodontics.

• Need evidence based research that addresses treatment and patient- centered
outcomes of digital way of complete denture technology
Introduction
Definition

According to the Glossary of Digital Terms, a digital denture is a complete

denture created by or through automation using CAD (computer-aided
designing), CAM (computer-aided manufacturing), and CAE (computer-aided
engineering) in lieu of traditional processes.
History of Digital Complete Denture

• In 1994, Maeda et al, a group of Japanese researchers published the first English
scientific report on the concept of using computer- aided technology to fabricate
complete dentures.

• In 1997, another Japanese group, Kawahata et al, investigated the concept of

duplicating existing dentures digitally and milling them using a CNC milling machine.

• In 2011, Kanazawa et al evaluated that the resulting CAD/CAM complete denture was
accurate, an average deviation of 0.10 mm for the mucosal surface and 0.50 mm for
the occlusal surface.

• In 2012, Goodacre et al published the first report of clinical patient treatment using
a CAD/CAM denture.
Digital Workflow Steps

• In digital dentistry, there are

• Scanning phase
• Two options - directly scan the tissue with intraoral scanner and indirectly
scan a stone cast, or the impression with a laboratory desktop scanner or an
intraoral scanner

• Designing phase
• Manufacturing phase
•
• Image
• There are numerous paths to achieve an acceptable
treatment with CDs produced through a digital workflow.

• 5 systems are available for the fabrication of CAD/CAM

dentures:

1. AvaDent (Global Dental Science),

2. Baltic Denture System (Merz Dental GmbH),

3. Ceramill Full Denture System (Amann Girrbach AG),

4. DENTCA/Whole You (DENTCA, Inc; Whole You, Inc),

5. Wieland Digital Denture (Ivoclar Vivadent, Inc).

Avadent

• 2 or 3 appointments
• definitive impressions by light body PVS impression material and prefabricated tray
• Use Anatomical Measurement Device (AMD; Global Dental Science) that consists of
maxillary and mandibular partial arch trays, to make Gothic Arch tracing

• Record CR by Gothic arch tracing and shipped to lab

• Superimpose the digital images of scanned AMD and final impression
• Virtual design CD confirmed by Clinician
• Final denture by milling
• Image
Baltic Denture system

• Use functional impressions with the KEY Set Components

Ceramil Full Denture System
• Video
DENTCA/WHOLE YOU

• 2 different methods
• First - 3D printing or rapid prototype , a trial denture is printed and verified
then final denture with traditionally processed using a custom 3 D printed
flask

• Second - denture base is printed by a 3D printer and denture teeth are boned
to the printed base
Weiland Digital
Denture
• Video
Digital workflow of complete • Digital mucostatic scans - slight
denture by intraoral digital under-extended denture flanges, no
scanning of fully endentulous trauma for overextension.
concept
• Slight under-extension of the flange
• based on the mucostatic does not affect denture retention
impression concept, with no
pressure being applied to the • Border molding and palatal seal
recorded areas and no border have been reported not to be
molding. required, and shorter denture
flanges do not impact denture
• The limitation of not recording the retention because of the intimate
vestibular depth and width is tissue contact.
compensated - by this mucostatic
digital scanning - results in • 3 clinical appointments were
maximizing the surface tension scheduled (digital scanning and re-
between the intaglio surface of the cords, printed clinical evaluation,
denture base and the underlying and definitive prosthesis delivery )
tissue.
• Reference denture
• Current status on CAD
• Jaw movement and the relationship
between mandible and maxilla can be
reproduced with Virtual Articulators

• Combination with CBCT images ha

potential to accurately simulate the
mandibualr movements and condyle
trajectories

• the most resent specialized CAD software

allows tooth selection, arrangement of
the artificial teeth in the three
dimensions and fine-tuning of the
occlusion with the virtual articulator
• CAM - addictive method or • Printed teeth are bonded to the
substractive method denture bases with liquid material
from the printer tank
• Addictive method - printing of the
denture base in pink material, • light-cured for complete
polymerization.
• the teeth individually or in complete
arches in tooth shade material • Not all of printing system are
suitable for CD due to lack of
• Use ultrasonic baths in alcohol to appropriate compatible material
remove excess unpolymeralized and lack of avaliable building
resin volume
The most commonly used 3D printer technologies in dentistry for CD
production are briefly described in Table
• The subtractive method - milling the denture base from a red pigmented industrially produced resin disk
• The artificial teeth are either milled or selected from a prefabricated series and bonded to the denture base
Additive Manufacturing (3D Printing): Subtractive Manufacturing (Milling):
• Cost Efficiency: more affordable than milling • Established Technology: being in the market
machines, accessible for smaller labs and longer, and users are more familiar with the
practices. available machines and their capabilities.
• Material Utilization: minimal material waste • Material Properties: superior mechanical
and suitable to create complex shapes and properties, greater toughness, surface
design smoothness, and color stability of the final
product.
• Range of Applications: highly versatile,
enabling the production of various dental • Accuracy and Consistency: consistent and
models, parts, and complete restorations. precise results with less variance compared to
additive manufacturing.
• Customization and Design Flexibility: allows for
intricate designs that might be challenging with • Material Waste: more material waste as it
subtractive method involves cutting away material from a larger
block to create the final product.
• Potential Issues:higher variance in the final
product’s quality and the orientation of the • Limitations in Design: less flexible in producing
printed object can affect accuracy. complex geometries compared to 3D printing.
• Selection Criteria: depends on the type of dental restoration, desired
material properties, equipment availability, and budget constraints.
• Clinical Outcomes: While 3D printing shows promising results in many
areas, long-term studies are needed to fully assess its clinical efficacy,
especially regarding wear resistance and bond strength of denture
teeth.
• Future Prospects: As 3D printing technology continues to evolve, it is
likely to close the gap in areas where subtractive methods currently
have an advantage.
Clinical outcomes

• favorable patient-centered outcomes at the 1-year evaluation for phonetics (93%), lip support (94.3%),
mastication efficiency (91.5%), esthetics (94.8%), and overall denture satisfaction (92.8%) , Bidra et al ,
2016

• Retention - milled complete denture bases from prepolymerized poly(methyl methacrylate) resin was
significantly higher than that offered by conventional heat polymerized denture bases.

• Adaptation - no significant difference in the adaptation of maxillary milled versus maxillary injection-molded
dentures, but superior for milled mandibular dentures.

• Vertical dimension - slightly superior with injection molded over milled denture bases.
• Number of clinical visits - with the 2-visit protocol significantly reduced clinic time , 205 minutes less for
digital dentures.

• Accuracy - higher overall accuracy of the denture base for the milled, over the 3D printed, and over the
conventionally fabricated denture base for both maxillary and mandibular arches was recently reported.
Advantages of digital method
1. reduced number of clinical visits, as few as 2 appointments

2. superior strength and better fit as the denture base is milled from a prepolymerized block of acrylic
resin;

3. minimal porosity - reduced potential for dentures to harbor microorganisms such as Candida
albicans and consequently reduced infections;

4. stored digital data makes creation of duplicate dentures (reproducibility) easier;

5. Reduction of residual monomer

6. better denture base adaptation and reproducibility (superimposition of STL files) for CAD/CAM
milled dentures compared to conventional.

7. increased ability for better quality control and improved potential for standardization in clinical
research on complete dentures as well as implant-retained overdentures.

8. If CAD/CAM denture failed to satisfy the patient or clinician’s requirements, the clinician is capable of
reverting to the conventional denture fabrication method, or removing the artificial teeth from the
CAD/CAM denture
Disadvantages of digital method
1. very challenging to optimally evaluate vertical dimension of occlusion,
maxillomandibular relationship, lip support, and maxillary incisal edge
position

2. Presence of initial learning curve

3. Certain manual steps are still essential

4. Impressions of edentulous arches - still using conventional techniques and

materials >> digital impression require registration with a dynamic movement
of the muscles and jaw

5. bonding of artificial teeth into the recesses of the denture base in the lab

6. current material cost and laboratory expenses are relatively higher