A Scoping Review on the Accuracy of Fit of Removable Partial Dentures in a Developing Digital Context

A technical and clinical digital approach to the altered cast technique with an intraoral scanner and polyvinyl siloxane impression material

This technique digitalizes the clinical and laboratory steps of fabricating removable partial dentures (RPDs) with the altered cast technique. An intraoral scanner was used to capture the mandibular Kennedy class II partially edentulous arch. An RPD framework was fabricated digitally and then combined with a custom tray with a wax occlusal rim. A conventional polyvinyl siloxane altered cast impression was made and then digitalized both intraorally and extraorally, followed by a digital interocclusal record. The resulting scan was modified to produce an additively manufactured cast. The teeth and gingival components were then designed and fabricated with a combination of additive and subtractive manufacturing, followed by the conventional acrylic resin pour technique. The definitive prosthesis was completed with minimal conventional techniques and without the use of gypsum, prefabricated teeth, or a physical articulator. The technique reduces the number of appointments and achieves the functional extension of the prosthesis through border molding, which is not possible with intraoral scanning.

Trueness of 3D-printed cobalt chromium versus titanium removable partial denture clasps

PURPOSE

The purpose of this in vitro study was to evaluate the trueness of removable partial denture clasps fabricated with titanium (Ti) through the selective laser melting (SLM) technique compared to cobalt-chromium alloys (CoCr).

MATERIALS AND METHODS

A virtual Aker clasp was designed on a scanned tooth, and SLM printers were used to print 20 claps using cobalt chromium (n = 10) and titanium alloy (n = 10). The deviation between the printed clasps and reference design was measured using the surface matching software (Geomagic control x) at rest, retentive tip, reciprocal tip, retentive shoulder, and reciprocal shoulder. An Independent t-test was used to determine the influence of 3D-printed material on the trueness (a = 0.05).

RESULTS

The gap distance in mm between the reference design and printed in titanium showed an average of 0.0001 ±0.0544, 0.0256 ±0.1309, 0.0230 ±0.1028, 0.0701 ±0.1234, and 0.0013 ±0.0735 mm in rest, reciprocal arm tip, retentive arm tip, retentive arm shoulder, and reciprocal arm shoulder, respectively. The gap distance in mm between the reference design and printed clasps in CoCr alloy showed an average of 0.0316 ±0.0692, 0.2783 ±0.1678, 0.1446 ±0.1528, 0.0315 ±0.0906, and 0.0419 ±0.1088 mm in rest, reciprocal arm tip, retentive arm tip, retentive arm shoulder, and reciprocal arm shoulder, respectively. The difference between titanium and CoCr alloys at each observation site was significant.

CONCLUSION

Clasps fabricated from titanium with SLM printing have the least deviation and better trueness compared to those fabricated from cobalt chromium.

Fit of removable partial denture frameworks fabricated from 3D printed patterns versus the conventional method: An in vitro comparison

STATEMENT OF PROBLEM

The conventional method of fabricating removable partial denture (RPD) patterns is a time-consuming, expensive, and complex process, and the success of the treatment depends on the fit of the framework. Questions still remain as to whether the 3D-printing method is an acceptable procedure compared with the conventional method.

PURPOSE

The purpose of this in vitro study was to compare the fit of RPDs cast from 3D printed frameworks and conventionally fabricated RPDs according to the gaps between the framework and the reference model.

MATERIAL AND METHODS

A metal reference model was made from a Kennedy class III modification 1 maxillary typodont. For the conventional group (n=9), impressions were made from the metal cast. Cobalt chromium frameworks were cast with the conventional method. For the digital group (n=9), the metal cast was scanned with a laboratory scanner, and the RPD was designed in the 3Shape platform. The standard tessellation language (STL) file of the design was downloaded to a 3D printer (Hunter DLP), and 9 resin frameworks were printed. These frameworks were invested and cast in the same dental laboratory as the first group. Gap measurement was assessed vertically with a superimposition software program (Geomagic Control X), and additional measurements were assessed under rests, reciprocal arms, and a 2.2-mm box under the major connector. The independent t test was used for determining the results and statistical analysis between groups. The paired t test was used for statistical analysis within groups (α=.05 for all tests).

RESULTS

No significant differences (P>.05) were observed in the mean ±standard deviation in overall fit according to the gaps in the conventional group (103 ±18 μm) and those in the digital group (109 ±21 μm). The biggest gap (poorest fit) was observed in the 2.2-mm box under the major connector (115 ±6 μm).

CONCLUSIONS

Both conventional and 3D-printing methods showed clinically acceptable fits. Further clinical studies with a larger sample size and long-term follow-up are needed.

Evaluation of two printing techniques for maxillary removable partial denture frameworks

STATEMENT OF PROBLEM

Three-dimensional (3D) printing technology has gained popularity in producing removable partial denture (RPD) frameworks, including direct 3D printing of the metal framework and framework printing using castable resin, subsequently cast and processed. However, whether the technology is sufficiently accurate and precise to supersede traditional methods is unclear.

PURPOSE

The purpose of this in vitro study was to determine the accuracy and precision of 2 different methods in the fabrication of RPD frameworks, including 3D printing by selective laser melting (SLM) and digital light processing (DLP).

MATERIAL AND METHODS

Maxillary casts were digitized to design RPD frameworks. Thereby, 8 frameworks were produced for each group. The SLM group underwent a thermal finishing process after printing. In the DLP group, castable resin was printed but not cast. All frameworks were scanned to generate digital files, which were then compared with the original design using a metrology software program and manual measurements. Statistical analysis was executed using the t-test for independent specimens (α=.05) and by comparing heatmaps of the overlaid meshes.

RESULTS

The analysis of the frameworks indicated minor deviations across all specimens. Regarding accuracy, there were no significant differences between the groups (P=.986). The SLM frameworks demonstrated greater precision, with absolute deviation values of 0.13 mm compared with 0.17 mm in the DLP group (P<.001).

CONCLUSIONS

The findings underscored a high consistency between the 2 printing techniques, demonstrating a sufficiently advanced production process to yield predictable results. While the accuracy of both techniques was at a comparably high level and did not differ significantly, the SLM technique delivered RPDs with higher precision.

Research on the Quality of Partially Removable Skeletal Prostheses Made Using Classical Versus Modern Sintering Techniques

Conventional partially removable skeletal dentures are one of the most common therapeutic solutions offered to edentulous patients worldwide. The present study aims to compare the skeleton of removable dentures realized via classical techniques to that realized via modern techniques, represented by the laser sintering technique, with the comparative aspects being realized through the evaluation of atomic force microscopy (AFM). A total of 20 metal frameworks made of Co-Cr were sectioned, representing the infrastructure of partially removable skeletal dentures, developed using the classical technique versus the laser sintering technique. The infrastructures of partially removable skeletal dentures were designed for both the maxilla and the mandible, with the design of each type of denture being identical, and were developed using both techniques. The roughness values are different depending on the technological method used; for the conventional casting technique, we have higher roughness for the component elements of the partially removable skeletal denture that have more stretch, e.g., the major connector, and for the 3D laser sintering technique, lower roughness is obtained for the component elements that have a lower stretch, e.g., the clasp arms, the minor connector, or the junction between the saddles and the major connector. The clinical implications of the presence of roughness at the level of the active arms or at the level of the connector saddle junction are represented by the risk of fracture, which confers real discomfort to the patient.

Effect of Palatal Vault Depth on the Trueness of Metal Laser-Sintered and Cast Cobalt-Chromium Removable Partial Denture Frameworks

PURPOSE

This in vitro study compares the trueness of removable partial denture cobalt-chromium (Co-Cr) frameworks fabricated by 3D-printed pattern casting and those fabricated by selective laser sintering (SLS) of different palate vault depths.

MATERIALS AND METHODS

A partially edentulous Kennedy class II mod.1 maxillary model with a deep palatal vault was used, which was modified and duplicated to produce another model with medium palatal vault depth. After model scanning, the partial denture framework was designed using CAD software to fabricate 20 removable partial denture (RPD) frameworks. For each model, two types of frameworks were fabricated. For the 1^st type, the 3D-printed resin patterns were formed using a 3D printer, and then casting was performed (AM-cast framework). For the 2^nd type, a direct metal laser sintering machine was used for the RPD frameworks fabrication (SLS framework). 3D scanning of fabricated frameworks was performed, and the standard tessellation language (STL) file was superimposed over the STL file from the original design, and the average deviation was recorded. Data were statistically analyzed.

RESULTS

Two-way ANOVA test was used, followed by the least significant difference (LSD) for pair-wise comparisons to estimate any significant differences between groups. The RPD frameworks with high palatal vault depth represent larger discrepancies mean value than that with the medium palatal vault depth with a highly significant statistical difference. SLS shows less deviation than AM-cast CO-Cr frameworks with highly significant statistical differences whatever palatal vault depth.

CONCLUSION

RPD metal frameworks fabricated with SLS have better accuracy compared to those fabricated by AM-cast, regardless of the depth of the palatal vault. This article is protected by copyright. All rights reserved.

Influence of molding angle on the trueness and defects of removable partial denture frameworks fabricated by selective laser melting

PURPOSE

To examine the effect of molding angle on the trueness and defects associated with removable partial denture (RPD) frameworks fabricated by selective laser melting (SLM).

METHODS

A plaster model of a partially edentulous mandibular arch classified as Kennedy class II modification 1 was used. After obtaining the 3D data of the model (design data), a framework was designed using CAD software. Based on the design data, three different molding angle conditions (0°, 45°, and -45°) were set in the CAM software. The frameworks were fabricated by SLM under each condition, and 3D data were captured (fabrication data). The design and fabrication data were superimposed using 3D inspection software to verify the shape errors. The number of support structures was then measured. To examine the internal defects, micro-computed tomography (µCT) was performed for void analysis. Surface roughness was measured using a laser microscope.

RESULTS

The overall shape errors of the RPD framework were smaller under the 0° condition compared with the others, and the largest number of support structures was observed at 0°. Many internal defects were observed in the large components of the framework at 45° and -45°. The surface roughness was the smallest at -45°.

CONCLUSION

The trueness and defects associated with the RPD frameworks were affected by the difference in the SLM molding angle.