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"complete dentures"
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Assessment of Conventionally and Digitally Fabricated Complete Dentures: A Comprehensive Review
CAD/CAM technology is gaining popularity and replacing archaic conventional procedures for fabricating dentures. CAD/CAM supports using a digital workflow reduce the number of visits, chair time, and laboratory time, making it attractive to patients. This study aimed to provide a comparative review of complete dentures manufactured using CAD/CAM and conventional methods. The PubMed/Medline, Science Direct, Cochrane, and Google Scholar databases were searched for studies published in English within the last 11 years (from 2011 to 2021). The keywords used were “computer-engineered complete dentures”, “CAD/CAM complete dentures”, “computer-aided engineering complete dentures”, and “digital complete dentures”. The search yielded 102 articles. Eighteen relevant articles were included in this review. Overall, computer-engineered complete dentures have several advantages over conventional dentures. Patients reported greater satisfaction with computer-engineered complete dentures (CECDs) due to better fit, reduced chair time, shorter appointments, and fewer post-insertion visits. CAD/CAM allows for precision and reproducibility with fewer procedures compared to conventional dentures. Polymethyl methacrylate is used as the denture base material for conventional dentures. For CECDs, the resin can be modified and cross-linked to improve its mechanical properties. The advantages of CECDs include a reduced number of appointments, saving chairside time, a digital workflow allowing easy reproducibility and greater patient satisfaction with a better fit.
Journal Article
Patient satisfaction and oral health-related quality of life for prefabricated teeth versus CAD-CAM milled acrylic resin denture teeth. A crossover clinical trial
Background
Artificial teeth replicate the appearance of natural teeth and restore proper alignment, oral function, and speech. Over the years, dental materials and prosthetic design advancements have transformed the creation and effectiveness of complete denture teeth. This evolution showcases a continued commitment to developing materials and methods that enhance the comfort, functionality, and visual appeal for patients without teeth. This study evaluated and compared patient satisfaction and oral health-related quality of life (OHRQL) between prefabricated and computer-aided design and computer-aided manufacturing (CAD-CAM) milled acrylic resin denture teeth.
Materials and methods
This crossover clinical study included 10 completely edentulous patients rehabilitated with complete dentures (CDs). Two types of acrylic resin teeth were used: prefabricated and CAD-CAM-milled artificial teeth. Crossover design is a research method that minimizes variability among participants by assessing the impact of various treatments on the same individual. This methodological approach facilitates the identification and measurement of the treatment effects. Following six months of complete denture wear, patient satisfaction and oral health-related quality of life were evaluated using the Visual Analogue Scale (VAS) and the Oral Health Impact Profile (OHIP-EDENT-19). Statistical analysis was conducted using the Wilcoxon signed-rank test in SPSS software, with statistical significance established at
P
< 0.05.
Results
There was no statistical difference between the groups in the total VAS scores and items, except for chewing efficiency, with a
P-value
of 0.035, where CAD-CAM milled resin teeth had statistically higher scores. In contrast, prefabricated teeth had a statistically higher aesthetic score (
p
= 0.033). Regarding OHIP-EDENT-19, many items showed no statistical differences between the two groups, except for functional limitations and difficulty chewing, which had a
P-value
of 0.05 and were statistically higher in prefabricated teeth. In contrast, psychological discomfort (
P
= 0.034) and social disability (
P
= 0.046) had significantly higher scores for the CAD-CAM milled teeth.
Conclusion
This study suggests that prefabricated and CAD-CAM milled resin teeth are viable treatment options for complete dentures. Prefabricated teeth are advisable when aesthetics is the patient’s primary concern. Conversely, CAD-CAM milled teeth are preferable when chewing efficiency is the primary concern.
Clinical trial registration
Registered at
www.clinicaltrials.gov
:
(
NCT06179615) (11-12-2023).
Journal Article
Intraoral scanning to fabricate complete dentures with functional borders: a proof-of-concept case report
Background
The utilization of intraoral scanning for manufacturing of complete dentures (CD) has been reported recently. However, functional border molding still cannot be supported digitally. A proof-of-concept trial shows two possible pathways to overcome this limitation by integrating a relining procedure into the digital workflow for CD manufacturing.
Case presentation
Intraoral scans and additional facial scans were performed with two various scanning systems for the rehabilitation of an edentulous male patient. The obtained raw data was aligned and used for the computer aided design (CAD) of the CD. The virtually constructed dentures were materialized in two various ways, considering rapid manufacturing and digital relining approaches in order to apply functionally molded borders.
Conclusion
The use of intraoral edentulous jaws scans in combination with the digital relining procedure may allow for fabrication of CD with functional borders within a fully digital workflow.
Journal Article
3D printed complete removable dental prostheses: a narrative review
Background
The purpose of this paper is to review the available literature on three-dimensionally printed complete dentures in terms of novel biomaterials, fabrication techniques and workflow, clinical performance and patient satisfaction.
Methods
The methodology included applying a search strategy, defining inclusion and exclusion criteria, selecting studies and forming tables to summarize the results. Searches of PubMed, Scopus, and Embase databases were performed independently by two reviewers to gather literature published between 2010 and 2020.
Results
A total of 126 titles were obtained from the electronic database, and the application of exclusion criteria resulted in the identification of 21 articles pertaining to printed technology for complete dentures. Current innovations and developments in digital dentistry have successfully led to the fabrication of removable dental prostheses using CAD/CAM technologies. Milled dentures have been studied more than 3D printed ones in the currently available literature. The limited number of clinical studies, mainly case reports, suggest current indications of 3D printing in denture fabrication process to be custom tray, record bases, trial, interim or immediate dentures but not definitive prostheses fabrication. Limitations include poor esthetics and retention, inability to balance occlusion and low printer resolution.
Conclusions
Initial studies on digital dentures have shown promising short-term clinical performance, positive patient-related results and reasonable cost-effectiveness. 3D printing has potential to modernize and streamline the denture fabrication techniques, materials and workflows. However, more research is required on the existing and developing materials and printers to allow for advancement and increase its application in removable prosthodontics.
Journal Article
Retention of 3D-printed versus conventional metal-reinforced acrylic mandibular denture bases: a comparative study
Objective
To evaluate the retention of complete mandibular dentures produced via 3D-printing in comparison to those constructed from metal-reinforced acrylic resin regarding their retention.
Materials and methods
This in vivo study involved the selection of twenty patients who were completely edentulous from the outpatient clinic of the Removable Prosthodontics Department at Misr University of Science and Technology. The participants were divided into two groups, each containing an equal number of patients; the first group received complete dentures produced via 3D printing technology. For the second patient group, metal-reinforced acrylic resin was used to make mandibular dentures, while conventional maxillary dentures were constructed. The evaluation of retention was carried out for both groups.
Results
A study of various types of dentures revealed that 3D-printed dentures exhibited a statistically significant improvement in retention (
P
< 0.05) relative to acrylic resin dentures that were reinforced with metal. Moreover, pairwise comparisons revealed significant increases in mean retention values at the one-month and three-month follow-up assessments.
Conclusion
The results of this clinical study led to the following conclusions: Compared to complete denture bases manufactured via conventional manufacturing techniques, those fabricated via 3D-printing offer superior fit and retention. The retention of dentures, irrespective of their type, tends to improve over time.
Journal Article
Impact of a removable prosthesis on chewing ability, quality of life, and patient satisfaction
This study aimed to investigate the effects of removable prostheses on oral health-related quality of life (OHRQoL), the effects of removable prostheses on chewing ability and the effects of prosthesis type (Removable partial denture RPD versus complete denture CD) and sociodemographic factors on both chewing ability and OHRQoL. Data from 90 participants were collected using a questionnaire. Chewing ability and OHRQoL were assessed before and after treatment through questionnaires. A two-tailed α of 0.05 and 95% confidence intervals were applied to identify statistically significant results in this survey. Differences between the RPD and CD treatment groups in terms of demographic variables (gender, age, income, education level, smoking status, medical history, and social connections) and previous denture experience were analysed using the Mann‒Whitney U test. Participants with RPD or CD demonstrated significant improvements in chewing ability and OHRQoL post-treatment (
p
< 0.05), except for females in the RPD group, who showed no significant changes. Compared with the CD group, the RPD group had significantly better chewing ability both before (
p
< 0.001) and after (
p
= 0.027) treatment. The RPD group also reported better outcomes in many aspects, including less jaw pain, greater comfort while eating, and improved denture stability (
p
< 0.05). Stepwise regression revealed that higher income and smoking were associated with better pre-treatment outcomes, whereas having multiple dentures and smoking predicted worse post-treatment chewing scores. Notably, higher post-treatment chewing scores were associated with improved OHRQoL. Both the RPD and CD groups reported improved chewing ability and OHRQoL, with RPD resulting in superior functional outcomes. Sociodemographic factors such as income, sex, age, and smoking habits influenced the results both before and after treatment. These findings highlight the importance of individualised patient assessment and support the clinical value of RPDs in partially edentulous patients.
Journal Article
Three dimensional analysis on the deformation of the master cast during maxillary complete denture fabrication
This study aimed to assess the changes in maxillary master casts that occur during complete denture fabrication, focusing on a compression molded denture. Digital merging techniques were used to measure the changes in 12 maxillary master casts at various fabrication stages. Measurements were performed from master cast formation to teeth arrangement using scanable ball markers and digital overlay techniques. The changes observed in the master cast were categorized as follows: S12 for the alterations from cast fabrication to occlusal rim formation, S23 for the alterations from recording jaw relations to teeth arrangement, and S13 for the overall changes throughout the entire fabrication process. The posterior seal area exhibited the most significant changes, until the jaw relation stage (S12). Statistical analyses revealed significant differences in changes among anatomical areas at different fabrication stages. These findings underscore the importance of considering alterations in the master cast during denture fabrication, when using traditional methods. Traditional techniques, such as the flask-pack-press, can induce substantial alterations in areas critical for denture retention and stability. This study highlights the need for a comprehensive assessment of fabrication processes to enhance denture quality and patient satisfaction. It provides valuable insights into master cast alterations that occur during complete denture fabrication. Efforts to minimize deformations in master casts are essential for improving patient satisfaction and oral health outcomes.
Journal Article
Reliability and validity of a questionnaire for self-assessment of complete dentures
Background
Demand for complete denture treatment is expected to rise over several decades. However, to date, no questionnaire on complete dentures, as evaluated by edentulous patients, has been shown to be reliable and valid. This study sought to assess the reliability and validity of Patient’s Denture Assessment (PDA), which provides a multidimensional evaluation of dentures among edentulous patients.
Methods
Patients, who had new complete dentures fabricated at the University Hospital of Dentistry, Tokyo Medical and Dental University through 2009 to 2010, were enrolled. The reliability of the PDA was determined by examining internal consistency and test-retest reliability. Internal consistency for all of the question items and the six subscales was measured using Cronbach’s α and average inter-item correlation coefficients among 93 participants. For 33 of these participants, test-retest reliability was determined at a 2 month-interval using the interclass correlation coefficients (ICCs) and 95% confidence interval for the summary scores and the six subscale scores. The PDA was validated in 93 participants by examining the difference in the summary score and the six subscale scores of the PDA before and after replacement with new dentures by the paired t-test. Ability to detect change was also tested in 93 patients using effect size.
Results
The Cronbach’s α for the PDA ranged from 0.56 to 0.93. The average inter-item correlation coefficients ranged from 0.28 to 0.83. ICCs for the PDA ranged from 0.37 to 0.83. The paired t-test showed a significant difference between the summary score and the six subscale scores before and after replacement with new dentures (
p
< 0.05) and the effect size was 0.97.
Conclusions
The PDA demonstrated good reliability by assessing internal consistency and test-retest reliability. In addition, the PDA demonstrated good validity by assessing discriminant validity. Thus, the PDA could help dentists obtain a detailed understanding of the patients’ perceptions in using their dentures.
Journal Article