For Which Part of the Denture Process Can Digitization Have the Greatest Impact on the Final Outcome?
Christopher Silvoy, DMD; Brian Goodacre, DDS; and David Little, DDS
Christopher Silvoy, DMD: I believe that digitization of the design component of denture fabrication can have the most positive impact on the final product.Why is that? Well, dentists will continue to send cases using diverse methods of record taking. And due to the nature of clinical work, there will likely never be one standardized method of treating patients. However, once the records get to the lab, the design step begins, and this is where all of the advantages are realized. From this step, standardized approaches to anatomic tooth placement, material thickness, and record taking of the setup can be made. During design, the try-in can be easily derived, maintained, or modified within the digital world. Once again, as this relates to clinical work, dentists will likely request the try-in technique that they are most familiar and comfortable with. In the future, given all of the proper information, it is likely that the digital setup will be able to be viewed virtually, eliminating the need for a try-in without compromising quality of care.
Digitizing the design stage opens up various paths to printing, milling, or other methods of fabricating the try-in denture or final prosthetic. In addition, digitization allows for endless changes and reproductions of a denture design. Once the design is finalized, it needs to be produced. It will be a very long time before there is industry standardization of the denture finishing process. Some will still pack, while others will pour. Some will try printing or milling the teeth. And yet others will attempt entirely new methods for assembling the final denture-all with potentially varying rates of success.
Although technicians must decide that they are going digital and acquire the technology to allow them to do so, they can still adhere to some of the tried-and-true and most reliable workflows on either side of the design phase. It is important to remember that the patient is the one who has to deal with the potential failures inherent in this transition to digital denture fabrication. Therefore, not only do I think that digitization of the design has the greatest impact on the final outcome of the case, I also believe it has the potential to create the highest level of predictability for our patients.
Brian Goodacre, DDS: The benefits of digitization can be realized during many of the stages of the denture fabrication process. In fact, depending on the practitioner's preference and comfort level, digital technology can be used at each and every step of the denture fabrication process. The decision of which step(s) to digitize is likely to change as a practitioner progresses in his or her experience with digital technology. However, prior to introducing digital technology in practice, it is important to be experienced and comfortable with the traditional clinical steps involved in the fabrication of complete dentures.
The steps for which digitization can benefit complete denture fabrication include impression taking, designing, trying-in, and processing of the final prosthesis. Although each of these steps can benefit from digital technology, I believe that digitization of the processing step provides the most benefit for clinical dentistry. This is due, in part, to the advantages gained by milling the denture base from a dense block of prepolymerized acrylic resin. This method helps eliminate processing distortions that occur with conventional techniques and creates improved denture base-to-tissue contact. Due to the extremely dense acrylic resin, the milled denture base also reduces the adherence of Candida albicans and the presence of residual monomer. These advantages cannot be obtained without the digitization of denture fabrication. The denture teeth can be milled as part of the denture base (ie, a monolithic denture) or produced separately and bonded into the denture base. When compared with conventional processing techniques, both methods have shown reduced tooth movement. If your records are correct, the precision in the occlusal surfaces of denture teeth results in occlusion that replicates that which was designed. This occlusal accuracy reduces the amount of adjustments needed as well as the total chair time.
Another significant advantage to digitization becomes apparent when patients lose their denture or otherwise require a new denture. Conventional techniques necessitate restarting the clinical procedures from the beginning. But with digital dentures, the records are archived, and a new prosthesis can be made at the push of a button. For those who choose to enter the digital denture world, these advantages are available today.
David Little, DDS: Digitization has a great impact on all aspects of the denture fabrication process, as they all play a role in visualizing the outcome before completing the final prosthesis. Having a digital record available is a huge benefit in itself. It allows for remakes of lost, damaged, or ill-fitting dentures without the need to take new records, which is a significant service to patients in terms of time and cost savings.
Digitizing the record-taking process streamlines office inefficiencies and cuts down the overall chair time as well as the total number of appointments needed to complete the process and produce the final prosthesis. Incorporating digital design along with cone-beam computed tomography (CBCT) facilitates enhanced implant placement because the clinician knows exactly where the restorations need to be in relationship to the teeth for proper form and function. The 3D-printed try-in gives the patient and the doctor a predictable preview of the fit of the final prosthesis. In addition, if changes need to be made during any step of the process, they can be accomplished more easily in a digital workflow than in a traditional, analog workflow.
When fabricating dentures, all of the steps in the process are improved by digitization, and this improvement results in a more predictable outcome for the patient.
Christopher Silvoy, DMD, maintains a private practice in Raleigh, North Carolina.
Brian Goodacre, DDS, is an assistant professor at the Loma Linda University School of Dentistry in Loma Linda, California.
David Little, DDS, maintains a private practice in San Antonio, Texas.