Reinventing the Digital Denture Workflow
Fabricate predictable, reproducible dentures in half the time
Andrew C. Johnson, DDS, MDS, CDT
Despite being more than 20 years into the new millennium, the overwhelming majority of dental practitioners are still making dentures using the traditional progression of rudimentary steps. Even many contemporary digital denture protocols are still beholden to this standardized order of events. Regardless of the year, decade, or century in which a clinician completed his or her training, many are likely still working from impressions to bite records to try-ins to finals-give or take a step or two. For many, following this conventional, linear workflow (Figure 1) still makes a lot of sense, especially from a perspective of professional familiarity and public acceptance.
Although the technology used in the production of dentures has advanced (eg, milling, 3D printing, scanning, etc), this has had relatively little impact on the clinical workflow. Even with the fanciest gadgets, we acquire impressions, then we make bite registrations, then we validate our work at a try-in appointment, but the contemporary digital denture try-in (when not skipped entirely) is usually both monolithic and monochromatic, which hardly provides an opportunity to preview and then verify or modify the final results (Figure 2). However advantageous the digital denture product, the digital denture process is often more complicated, more time consuming, and more unpredictable in terms of acquiring, transmitting, interpreting, processing, and actualizing all of the case data in a way that meets or exceeds patient expectations.
A reinvention of the traditional approach to denture fabrication can be implemented to increase the efficiency and predictability of this basic dental service. At the initial patient consultation, the clinician acquires digital scans of the existing dentures (Figure 3) and digital smile photos for 3D alignment and design (Figure 4). These are submitted to the laboratory for the digital design and production of 3D printed modifiable, lifelike wax try-ins and custom impression trays (Figure 5).
Complete master impressions and bite registrations (Figure 6) as well as patient approval of the esthetic try-in (Figure. 7) are all accomplished during the first clinical appointment. Then, the try-ins and any secondary impressions (Figure 8) are scanned and/or shipped to the dental laboratory and all of the data is sent for the digital design (Figure 9) and fabrication (Figure 10) of the final dentures. When the patient returns for the second clinical appointment, the final digital dentures are inserted following standard denture delivery protocols (Figure 11 and Figure 12).
Using this method, the efficient production of attractive and reproducible dentures can finally be a reality. No longer is the value of the denture service embodied solely in the final product-the process itself creates value and retains it indefinitely because the data to remake that denture lives on in the digital database.
This process takes a fraction of the clinical time typically required for the fabrication of complete dentures, and because it does not skip any critical steps and is visually guided from start to finish, neither the clinician nor the technician need worry about the problems that can be encountered with faster, more profitable workflows, such as esthetic deficiencies, functional misalignments, phonetic disturbances, and other complications related to compromising or omitting the traditional wax try-in. In addition, the laboratory, clinic, and patient all benefit from the value of a reproducible denture product that also fits better, looks better, and lasts longer than many of those fabricated using traditional materials and methods. Ultimately, this process can save time for all parties while ensuring better short- and long-term results.
About the Author
Andrew C. Johnson, DDS, MDS, CDT
American Board of Prosthodontics
American College of Prosthodontists
Adjunct Clinical Professor
University of Tennessee
Health Science Center
College of Dentistry