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Digital Removable Complete Denture—an Overview

  • Dental Restorative Materials (M Özcan and PF Cesar, Section Editors)
  • Published:
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Abstract

Purpose of Review

During the last few years, the interest in fabrication of computer-engineered removable complete dentures has grown intensively. Innovative clinical and technological advances are driving forces. They allow (i) the creation of new and more efficient workflows, (ii) an emergence of modified and easier procedures, and (iii) the use of alternative biomaterials with improved properties. The results are a better fit and retention of the digital complete dentures, as well as a generally high satisfaction of patient and clinician, while reducing the number of appointments and the technical input. The purpose of this narrative review is to present the historical, clinical, and technological developments in the field of digital removable complete dentures and to evaluate the future potential of this technology.

Recent Findings

The fabrication of a digital complete denture either by milling separately the base and the denture teeth set-up or by milling a monolithic denture is well investigated. Concurrently the trend for fabricating complete denture bases by using the 3D print technology is growing. There is plenty of research showing that milling dentures from standardized pre-polymerized polymethyl methacrylate pucks guarantee the fabrication of homogenous objects with excellent biomaterial properties. The results indicate a better base adaptation, a higher flexural strength, an improved resistance to denture staining, and no polymerization distortion while milling. Furthermore, a sophisticated milling strategy allows to obtain a detailed and accurate intaglio and cameo surface, which is even exceeded when 3D printing. The clinical and technological freedom, to either combine selectively analog and digital steps or to take a totally digital workflow ending with milling or 3D printing, opens countless opportunities in the field of removable complete dentures. Whatever steps are taken, whatever sophisticated technology is chosen, still only the professional and individual know-how of the dentist in combination with the manual skills and the experience of the dental technologist—including especially the finish of the final product—will lead to a superior teamwork result. Limitations inherent to the milling process are the waste of raw material, the wear of milling tools, and the challenge to access undercut areas; the reasons are the milling bur size, the number of milling axes, and the limited movements of the machining axes. The advantages of additive manufacturing lay in a high resolution of complex geometries and a reduced waste of the biomaterial. As a limitation, the accuracy of the object, i.e. deformation, may be affected by several fabrication parameters, such as the polymerization light intensity, the build direction and angle, the layer thickness and numbers, the amount of supporting structures, and the post-processing procedures. However, with improved materials and techniques, printing may also become a primary method for fabricating digital complete dentures.

Summary

The available clinical and technical information and multiple research demonstrate that the integration of digital steps into the workflow for fabricating removable complete dentures opens countless options, leading to the achievement of an esthetically, functionally, biologically, and technically high-quality end product. However, a longer learning curve must be considered. To simplify the fabrication methods of complete dentures in specific clinical situations, with the aim to increase efficiency and to save resources, is indicated. However, the use of conventional step-by-step approaches may still be valid for complex clinical situations. It is foreseeable that for treating edentulous patients, the evolution of new biomaterials, the introduction of sophisticated digital methods, and the development of improved software will follow attractive workflows with more standardized, easier, achievable, and predictable results. It challenges the clinician to have a more direct impact on denture construction and to provide the patient with the opportunity to participate in the esthetic designing. A generally higher efficiency and satisfaction for all partners involved in the fabrication process of removable complete dentures—patient, dental technologist, and dentist/prosthodontist—is the result. For a dental technologist, it is a great challenge to set up esthetic and functional denture teeth in an edentulous 3D space defined by the maxilla, the mandible, and the oral soft tissues. It is a question of time and partly already existing that machine learning—a branch of artificial intelligence—has the capacity to recognize specific intramaxillary and intermaxillary situations and to deliver an acceptable functional and esthetic denture teeth set-up, at least as a working base. Furthermore, with the introduction of a face scanner, the patient becomes virtually present anytime. Transferring the virtual situation in a physical articulator makes judgments and changes possible in both worlds simultaneously. Innovations such as robot technology still are in their infancy; however, there are aspirations to automatically place denture teeth into a dental arch. There is a great responsibility for a dentist and a dental technologist for fabricating high-quality removable complete dentures. Factors, such as a meticulous diagnosis and treatment planning, a personal communication between the involved persons, and a profound knowledge of the clinical and technical possibilities, should lead to an easy, simple, cost-effective, and highly satisfying denture fabrication workflow. The digitalization in this field already has and will even more activate research and clinical opportunities in the near future. The globally existing many edentulous patients will highly appreciate the excellent results.

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Acknowledgements

The authors especially acknowledge the continuous support of Mr. E. Steger for this project.

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  1. Voltastr. 33, Zurich, 8044 CH, Switzerland

    Carlo P. Marinello

  2. An der Ahr 7, Gais, 39030 BZ, Italy

    Rudolf Brugger

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Marinello, C.P., Brugger, R. Digital Removable Complete Denture—an Overview. Curr Oral Health Rep 8, 117–131 (2021). https://doi.org/10.1007/s40496-021-00299-1

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