Dr. Ajit Jankar1, Dr. Bhushan Bangar2, Dr Shashi Patil3, Dr. Vidya Channe4
Dr. Vaishnavi Amberkhane5
Professor And Head of The Department1
Post Graduate Student Department of Prosthodontics and Crown and Bridge, MIDSR Dental College, Latur.4,5
In the field of Prosthodontics, traditional methods have long been regarded as the gold standard for fabricating oral and facial prostheses. However, the introduction of CAD/CAM systems in the late 1980s has revolutionized various aspects of dentistry, including the fabrication of inlays, crowns, fixed partial dentures, implant abutments/prostheses, and even complete dentures. The introduction of CAD/CAM technology has revolutionized precision and speed to an extent that was once unimaginable. In the last two decades, this technology has undergone remarkable progress and growth. This piece delves into the valuable advantages offered by CAD/CAM complete dentures and offers insights into the complex methods that drive their creation.
This article aims to explore the potential advantages of CAD/CAM complete dentures and outline the techniques involved in their fabrication.
Keywords: CAD/CAM system, CAD/CAM dentures, polymethacrylate, digitalization, milled, machined, computerized
Edentulism, or the absence of teeth, contributes to disability and impairment of function that significantly affect the general health and overall quality of life of an individual. The use of complete dentures for rehabilitation of edentulous patients has acceptable outcomes for most patients. For decades, conventional complete dentures have been a promising treatment for edentulous patients. CAD/CAM has emerged as a new approach for the design and fabrication of complete dentures.1
The introduction of CAD/CAM technology to dentistry took place in 1989 by Mormann &
Brandestinni in Germany, and since then, it has found widespread application in all branches of Prosthodontics. These advanced technologies enable the precise design and fabrication of diverse restorations and dental prostheses, ensuring accuracy and precision in the process.2,3
The CAD/CAM process offers significant advantages for both dental practitioners and patients. In a single appointment lasting one to two hours, all the clinical data for complete dentures can be recorded, significantly reducing chair time and providing cost-effective and accurately fitting dentures.4 if the dentures are lost or broken, it can be refabricated from the records saved digitally. different manufacturers have developed different protocols and choosing the right denture system is crucial. Few reports on CAD/CAM fabricated dentures have been published, and those few studies refer mainly to two systems (AvaDent Digital Dentures, Dentca)5,6
Flow chart 1. Process of the Complete Denture by CAD/CAM Technology
Advantages of digital denture fabrication
- Enhanced efficiency leads to fewer appointments required for patients to receive their removable prostheses.
- Milling pre-polymerized acrylic resin causes shrinkage of the acrylic base, resulting in improved denture strength and fit.
- Streamlined processes reduce the time needed for prosthesis manipulation during fitting.
- Reduced risk of microorganism colonization on denture surfaces decreases the likelihood of infection.
- Significant advancements in standardization methods for clinical research on removable prostheses.
- Digital data storage enables easy replication and creation of trial dentures.
- Clinicians and technicians exhibit superior quality control, ensuring high-quality removable prostheses.7
Disadvantages of digital denture fabrication
- Manufacturing challenges arise from impression taking, OVD recording procedures, MMR transfer, and maintenance of lip support, as they closely resemble the procedures used in the conventional process.
- Difficulty in accurately determining the mandibular occlusal plane.
- Higher costs are associated with expensive materials and increased laboratory expenses compared to conventional methods.
- The absence of a trial denture prevents patients and dentists from evaluating the dentures before final fabrication.7
Systems For Fabricating CAD/CAM Complete Dentures
Systems for fabricating CAD/CAM complete dentures have advanced in recent years, providing improved precision and efficiency in the denture fabrication process. Some of the currently available systems in this field include:
- AvaDent System
- DENTCA System
- Baltic Denture System-
- Wieland Digital Denture system
- Ceramill full denture system
These systems aim to improve the traditional denture fabrication process by reducing manual labor, enhancing accuracy and providing customization options. By incorporating CAD/CAM Technology, they streamline workflows shorten production times and enhance the overall quality of complete denture
1. AvaDent System
AvaDent Digital Dentures by Global Dental Science LLC in Scottsdale, AZ, utilize advanced technology and subtractive manufacturing methods to create high-quality complete dentures. They offer both milled and printed trial dentures for evaluation. The definitive complete dentures come in two forms: milled denture bases with individually bonded teeth sourced from different manufacturers, or monolithic AvaDent XCL dentures. The XCL dentures have a single-unit construction, with the teeth and base milled together. There are two options within the XCL dentures: XCL-1 with monochromatic teeth, and XCL-2 with polychromatic teeth. The XCL-2 option provides a more realistic appearance, featuring translucent enamel-like acrylic resin covering a dentin-colored core8
Trays of anatomic measuring device
AMD at exact vertical dimension of occlusion ad Centric Relation
2. DENTCA System
DENTCA offers two-piece trays for both the maxillary (upper) and mandibular (lower) arches. These trays have detachable posterior segments, allowing for easy removal after taking final impressions. The anterior segments of these trays are utilized as a record base for obtaining a jaw relation record, utilizing the gothic arch tracing technique.
Two-piece impression trays for impression and jaw relation
In addition to this, DENTCA provides the option of 3D printing or rapid prototyping (specifically, stereolithography) for creating trial bases. These trial bases serve as temporary structures for testing and evaluation. However, the definitive denture is still processed using conventional methods, ensuring high-quality results9
3. Baltic Denture System
The Baltic Denture System offers the BDKEY Set components that enable the utilization of functional impression techniques. The initial set comprises adjustable record bases with teeth for both the upper and lower arches. These teeth come in three sizes (small, medium, or large) and are available in various sizes and shapes. By incorporating teeth into the tray, the clinician can assess esthetics, lip support, tooth alignment, and interocclusal space during the evaluation process.
The BDKEY Lock device provided in the kit facilitates the jaw relation record procedure. To mill the denture, the Baltic Denture System employs a 5-axis computerized numerical control machine, incorporating the tooth setup into a lingualized occlusion.10
Baltic denture system protocol
4. Wieland Digital Denture system
Wieland Digital Denture system utilizes a subtractive technique to fabricate denture bases with recesses. It begins with the scanning of a conventional impression and occlusal rim. Using CAD technology, denture teeth are selected from a software library and virtually arranged. After virtual occlusal adjustment, the machine, controlled by the operator, takes approximately 15 hours to fabricate two baseplates and two dentitions from acrylic composite plates.
Since the milling machine has specific limitations, the teeth and the base are milled separately. This is due to the machine accommodating a puck with a maximum diameter of 98 mm and a height of 25 mm. Subsequently, the teeth are bonded to the recesses, allowing the clinician to clinically evaluate the prosthesis for esthetics and phonetics. Finally, the denture teeth are permanently bonded to the definitive denture using a positioning jig.11,12
5.Ceramill Full denture system
The dentures fabricated by the Ceramill full denture system are design by the laboratory technician. The digital process commences within the laboratory environment, where a well-structured workflow comes into play. This workflow effectively aids in tasks such as tooth arrangement, the milling of wax trial bases, and the necessary adjustments to the denture teeth. These adjustments are carefully executed to facilitate the seamless insertion of the denture teeth into the tooth sockets present on the bases. It's worth noting that this integration is achieved without requiring further grinding, ensuring a precise and efficient production process.13
Recent advancements in dental technology have revolutionized the fabrication of removable dentures by utilizing CAD/CAM technologies throughout the entire process. This article reviewed the currently available techniques being used to fabricate CAD/ CAM complete dentures. Each system has its own advantages and disadvantages, The common advantages are reduced chair side and working time for both patients and dentists while delivering superior functional and esthetic outcomes. CAD/CAM fabricated dentures represent a promising frontier in modern dentistry, offering a more efficient, precise, and patient-centered approach to denture prosthetics. With ongoing advancements and refinements in technology, CAD/CAM denture fabrication is likely to play a pivotal role in shaping the future of restorative dental care.
- Yüzbaşioğlu E, Us Yö, Özdemir G, Albayrak B. Clinical Outcomes and Complications of Cad-Cam Fabricated Complete Dentures; An Update And Review. Journal Of Experimental nd Clinical Medicine. 2021 May 2;38(3s):92-7.
- Masih A, Choukse V, Srivastava R, Sharma N. Cad Cam Complete Dentures: A Review. Mp State Dent. J.(1). 2018.
- Uzun G. An Overvıew of Dental Cad Cam Systems. Journal Of Biotechnology & Biotechnological Equipment. 2008(1).
- Wimmer T, Gallus K, Eichberger M, Stawarczyk B. Complete Denture Fabrication Supported By Cad/Cam. The Journal of Prosthetic Dentistry. 2016 May 1;115(5):541-6
- Goodacre Cj, Garbacea A, Naylor Wp, Daher T, Marchack Cb, Lowry J. Cad/Cam Fabricated Complete Dentures: Concepts and Clinical Methods of Obtaining Required Morphological Data. The Journal of Prosthetic Dentistry. 2012 Jan 1;107(1):34-46.
- Infante L, Yilmaz B, Mcglumphy E, Finger I. Fabricating Complete Dentures with Cad/Cam Technology. The Journal of Prosthetic Dentistry. 2014 May 1;111(5):351-5.
- Bilgin Ms, Baytaroğlu En, Erdem A, Dilber E. A Review of Computer-Aided Design/
Computer-Aided Manufacture Techniques for Removable Denture Fabrication. European Journal of Dentistry. 2016 Apr;10(02):286-91.
- Baba Nz, Goodacre Bj, Goodacre Cj, Müller F, Wagner S. Cad/Cam Complete Denture Systems and Physical Properties: A Review Of The Literature. Journal Of Prosthodontics. 2021 May;30(S2):113-24.
- Steinmassl Pa, Klaunzer F, Steinmassl O, Dumfahrt H, Grunert I. Evaluation Of Currently Available Cad/Cam Denture Systems. Int J Prosthodont. 2017mar 1;30(2):116-22.
- John Av, Abraham G, Alias A. Two-Visit Cad/Cam Milled Dentures In The Rehabilitation Of Edentulous Arches: A Case Series. The Journal Of The Indian Prosthodontic Society. 2019 Jan;19(1):88.
- Baba Nz. Materials And Processes for Cad/Cam Complete Denture Fabrication. Current Oral Health Reports. 2016 Sep;3:203-8.
- Aeran H, Kumar V, Seth J, Sharma A. Computer Aided Designing-Computer Aided
Milling in Prosthodontics: A Promising Technology for Future. Ijss Case Report & Reviews. 2014 May;1(1):23-7.
- Sariga Kanakaraj Hk, Ravichandran R. An Update on Cad/Cam Removable Complete Dentures: A Review on Different Techniques and Available Cad/Cam Denture Systems.
- Bidra As, Taylor Td, Agar Jr. Computer-Aided Technology for Fabricating Complete Dentures: Systematic Review of Historical Background, Current Status, And Future Perspectives. The Journal of Prosthetic Dentistry. 2013 Jun 1;109(6):361-6.
- Miyazaki T, Hotta Y, Kunii J, Kuriyama S, Tamaki Y. A Review of Dental Cad/Cam: Current Status and Future Perspectives From 20 Years of Experience. Dental Materials Journal. 2009;28(1):44-56.
- Russo Ll, Salamini A, Troiano G, Guida L. Digital Dentures: A Protocol Based on Intraoral Scans. The Journal of Prosthetic Dentistry. 2021 Apr 1;125(4):597-602.