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Progressive Dentist Innovates with Digital Dentures
Ever-evolving system allows for different workflows depending on each case
Digital dentures are one of the most rapidly developing segments of dentistry, as manufacturers continue to develop new hardware, software, materials, and processes. Recognizing a need for clinicians themselves to take on an active role in the evolution of digital dentures as well, a group of dentists has created a think tank whereby they exchange ideas and observations. For example, the group recently has extensively explored the use of intraoral scanning and the integration of intraoral scans with desktop scans to create prosthodontically viable data sets.
"We communicate primarily through email and group chats," says Christopher Silvoy, DMD, a private practitioner in Raleigh, North Carolina, who has an in-house laboratory. "The beauty of the collaboration is that we each use different workflows, so we are able to test and try different methods for assembly and different materials for assembly, and we get to clinically validate the processes and determine which ones turn out best."
The other instrumental members, Silvoy says, are Valerie Cooper, DDS, MS; Nate Farley, DDS, MS, FACP; and Kent Howell, DMD, MS. The four came together at a conference 2 years ago when a consensus developed that a conventionally processed denture was still the best option for in-house fabrication, but disagreement persisted as to the future options.
"Many dental professionals believe 3D printing will be the best method to fabricate a final denture eventually," Silvoy says. "Others think we will develop and sustain superior strength and outcomes using milling. The key is the balance between cost, durability, and practicality. I cannot just paint myself into a box and work with one particular workflow, but we can encourage manufacturers to invest in and develop new strategies to help fulfill greater patient outcomes."
Silvoy has been using Amann Girrbach's Ceramill FDS (Full Denture System) for several years because of its exceptional results and user-friendly workflow, and he says the company's progressive approach has opened new avenues to utilize different workflows with the same system. For example, he relies increasingly on the reference denture technique.
"If the patient comes into the office with an existing denture, whether it is adequate or not, we utilize that to create a border molded impression," he says. "Then we scan the entire denture, and we put that through the conventional FDS process. I can bypass the complicated model pour and articulation setup. I can use the intraoral scanner for the soft tissue, borders, reference denture, and bite. That goes directly into the software, saving me significant time and material. With the model-based process, I cannot work faster than the plaster. Without needing to pour a model, the patient can get the denture back, and we can complete the appointment approximately 30 minutes faster."
Silvoy employs different methods for the try-in stage depending on the case, which the Amann Girrbach software and workflow make possible. Approximately half the time, he now 3D-prints the try-in before milling the wax puck and setting the teeth for a conventional wax try-in.
"I started doing that because it is difficult to change the teeth once we do the wax setup, so if the patient does not like any fundamental component of the wax try-in, then changing out the teeth is difficult and expensive," he says. "When we 3D-print the try-in, the patient validates the bite, the esthetic setup, and the shape and size of the teeth. Once we get validation there, we can mill the wax puck, mill the teeth, set them, and either do a second try-in or send that to process and finish. It is a hybrid approach that saves us time and material costs."
Another development that is upcoming is the integration of the Baltic Denture System from Merz Dental with Amann Girrbach's FDS.
"The Baltic Denture System will give us a more direct route to the full denture product through the milling of a pre-polymerized puck with a preset arch of teeth," Silvoy says. "This is just another element of what Amann Girrbach is doing to stay competitive—integrating another part of a different workflow. Now, in addition to the conventionally processed workflows, they have allowed us to utilize 3D-printed try-ins as well as to move directly to a milled acrylic product if that is best for a particular case."
Like Silvoy and the other dentists in his think tank, Amann Girrbach continues to advance the profession through its forward thinking and innovation.
"If any one word describes what that company has done over the past 2 years," Silvoy says, "it is progressive."
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