Evaluation of functional suitable digital complete denture system based on 3D printing technology

Clinical use of digital applications for diagnostic and treatment planning in prosthodontics: A scoping review

AIM

This scoping review aimed to compile and evaluate clinical trials investigating digital applications in prosthetic diagnostics and treatment planning by assessing their clinical relevance and future potential.

METHODS

Following the PCC-framework for scoping reviews and combining the source of analysis (Population/P: "prosthodontics"), the technique of interest (Concept/C: "digital application") and the field of interest (Context/C: "diagnostics"), a three-pronged search strategy was applied in the database PubMed and Web of Science. Clinical trials (≥10 study participants, English/German) were considered until 2023-03-09. Reporting adhered to the PRISMA-ScR statement.

RESULTS

The search identified 520 titles, of which 18 full-texts met the inclusion criteria for data extraction. The trials involved a total of 14,457 study participants and were mapped for prosthetic subdisciplines: fixed (n = 9; 50%) and removable (n = 4; 22%) prosthodontics, reconstructive dentistry in general (n = 3; 17%), and temporo-mandibular joint disorders (n = 2; 11%). Data merging of medical format files, as DICOM+STL, was the dominant digital application (n = 7; 39%); and virtual treatment simulation using digital smile design or digital wax-up represented the most frequent prosthetic diagnostics (n = 6; 33%).

CONCLUSION

This scoping review identified a relatively low number of clinical trials. The future potential of digital diagnostics appears to be mostly related to the subdiscipline of fixed prosthodontics, especially regarding virtual treatment simulation for communication with the patient and among dental professionals. Artificial intelligence emerged as a key technology in many of the identified studies. Further research in this area is needed to explore the capabilities of digital technologies in prosthetic diagnostics and treatment planning.

CAD/CAM versus traditional complete dentures: A systematic review and meta-analysis of patient- and clinician-reported outcomes and costs

STATEMENT OF PROBLEM

Computer-aided design and manufacturing (CAD/CAM) have been increasingly used to enhance the patient and clinician experiences with removable complete dentures (CDs). Yet, evidence from systematic reviews is lacking to validate the clinical significance of these digital prostheses.

PURPOSE

The purpose of this systematic review was to compare CAD/CAM CDs with the traditional ones in terms of patient and clinician-reported outcomes, post-insertion adjustment visits and costs.

MATERIALS AND METHODS

An electronic search of four databases [Medline (Ovid), Embase, Scopus and Cochrane CENTRAL; last update: May 2022] was performed to retrieve clinical studies comparing CAD/CAM and traditional CDs. Two independent reviewers screened the articles, extracted data (methods and outcomes) and assessed risk of bias of the included studies. The following outcomes underwent meta-analysis (random-effects model): overall patient and clinician satisfaction, oral health-related quality of life (OHRQoL), number of post-insertion adjustment visits, as well as laboratory and total costs.

RESULTS

This review included 11 studies. Meta-analysis revealed that CAD/CAM CDs are comparable to the traditional CDs in terms of overall patient satisfaction and OHRQoL. Clinician-reported data depended on the manufacturing technique: whereas milled CDs performed better than traditional CDs in terms of clinician satisfaction and number of adjustments, 3D printed and traditional CDs were similar. Fabrication of CAD/CAM CDs required significantly less laboratory and overall costs than the traditional CDs.

CONCLUSIONS

There is some evidence showing that CAD/CAM CDs are at least comparable to traditional CDs. Further well-designed randomized clinical trials are needed to evaluate the performance of specific CAD/CAM approaches for manufacturing CDs, however.

Fabrication of facially guided CAD-CAM complete dentures: A dental technique

An alternative protocol is presented to design computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures and overdentures using a facially guided digital design. The facially guided design protocol with CAD-CAM facilitated communication between the clinician and dental laboratory technician. A monolithic denture and overdenture were fabricated guided by preliminary dentures with 3-dimensionally (3D) printed denture bases and milled wax teeth.

Which clinical and laboratory procedures should be used to fabricate digital complete dentures? A systematic review

STATEMENT OF PROBLEM

Digital workflows for digital complete denture fabrication have a variety of clinical and laboratory procedures, but their outcomes and associated complications are currently unknown.

PURPOSE

The purpose of this systematic review was to evaluate the clinical and laboratory procedures for digital complete dentures, their outcomes, and associated complications.

MATERIAL AND METHODS

Electronic literature searches were conducted on PubMed/Medline, Embase, and Web of Science for studies published from January 2000 to September 2022 and screened by 2 independent reviewers. Information on digital complete denture procedures, materials, their outcomes, and associated complications was extracted.

RESULTS

Of 266 screened studies, 39 studies were included. While 26 assessed definitive complete dentures, 7 studies assessed denture bases, 2 assessed trial dentures, and 4 assessed the digital images only. Twenty-four studies used border molded impression technique, 3 studies used a facebow record, and 7 studies used gothic arch tracing. Only 13 studies performed trial denture placement. Twenty-one studies used milling, and 17 studies used 3D printing for denture fabrication. One study reported that the retention of maxillary denture bases fabricated from a border-molded impression (14.5 to 16.1 N) was statistically higher than the retention of those fabricated from intraoral scanning (6.2 to 6.6 N). The maximum occlusal force of digital complete denture wearers was similar across different fabrication procedures. When compared with the conventional workflow, digital complete dentures required statistically shorter clinical time with 205 to 233 minutes saved. Up to 37.5% of participants reported loss of retention and up to 31.3% required a denture remake. In general, ≥1 extra visit and 1 to 4 unscheduled follow-up visits were needed. The outcomes for patient satisfaction and oral health-related quality of life were similar between conventional, milled, and 3D-printed complete dentures.

CONCLUSIONS

Making a border-molded impression is still preferred for better retention, and trial denture placement is still recommended to optimize the fabrication of definitive digital complete dentures.

Digitally printed custom trays assembled with occlusion rims and gothic arch tracing devices attached with tenon-and-mortise joints for biofunctional complete dentures: A dental technique

A novel technique of digitally printed custom trays assembled with occlusion rims and gothic arch tracing devices attached with tenon-and-mortise joints for biofunctional complete dentures that could be delivered in 2 visits is presented. This technique takes advantage of closed-mouth impressions and objective jaw relation records by following the biofunctional prosthetic system concept with high efficiency and reduced labor.

Digital fabrication of complete dentures using a combination of additive and subtractive manufacturing technologies

Fabrication of complete dentures in the traditional way is a labor-intensive and time-consuming method. This article reports a series of novel digital methods for impression making, design and fabrication processes for complete dentures. It is highly anticipated that this novel method could improve the efficiency and accuracy of the design and fabrication of complete dentures.

Comparison of treatment outcomes and time efficiency between a digital complete denture and conventional complete denture: A pilot study

BACKGROUND

The authors of this study aimed to compare the treatment outcomes and time efficiency between digital and conventional complete denture restorations and propose suggestions for clinical use.

METHODS

The authors used digital (functionally suitable digital complete denture [FSD]) and conventional complete denture restorations to make 2 dentures each for 10 edentulous patients. All the operations of both techniques before denture delivery were completed in the first 4 visits, and then 2 dentures were delivered successively for the patients. The clinical and laboratory times were recorded to evaluate the time efficiency; treatment outcomes were evaluated via scoring the denture satisfaction of the dentist and patients in a double-blind manner.

RESULTS

The satisfaction scores of FSDs (7.6-9.6 [dentist's scores], 8.4-10 [patients' scores]) were higher than those of conventional dentures (7.2-9.7 [dentist's score], 7.4-9.8 [patients' scores]), but there were no significant differences. The clinical and laboratory operation times of the FSD group were less than those of the conventional group, saving an average of 28.0 minutes and 64.3 minutes in the clinic and laboratory, respectively.

CONCLUSIONS

FSD technology can improve the efficiency of clinical and laboratory operations and shorten the manufacturing cycle of dentures. The occlusion stability of FSDs was statistically better than that of traditional dentures, but there was no statistical difference in other clinical indicators.

PRACTICAL IMPLICATIONS

FSD technology is low cost and easy to operate and has several applications. Compared with conventional complete denture restoration technology, FSDs can save time and have a comparable clinical effect. This clinical trial was registered at the Chinese Clinical Trial Registry. The registration number is ChiCTR1900021722.

A digital workflow for single complete denture using a multi-functional diagnostic denture

Creating a single complete denture against natural dentition can be challenging. To facilitate the clinical procedure and promote balanced occlusion, we developed a digital workflow of a single complete denture using a multi-functional diagnostic denture (DD). The DD was digitally designed and fabricated using a three-dimensional printing process to create a guide for tooth grinding in opposing dentition and a final impression that allows the jaw relationship and dynamic articulation to be recorded by an intraoral scanner. The definitive complete denture was combined with a milled artificial dentition and titanium-plated denture base. Within three clinical visits, this digital workflow provided better efficiency and easy implementation for a single complete denture.