Digital Denture: What you should know as a dentist
Your dental technician may have talked about it or you may have read it in the trade press. Or you may even have come across it at the last IDS: Digital Denture, an innovative, CAD/CAM-based procedure for the manufacture of complete dentures. Read on to learn what you need to know about it.
Innovative: CAD/CAM-fabricated complete dentures
The term “Digital Denture” describes an integrated manufacturing process for CAD/CAM-based complete dentures prosthetics. The Digital Denture process was presented to the public for the first time at IDS 2015. Key elements of this process include innovative devices, software programs and coordinated materials geared towards the needs of dental technicians and clinicians. Especially designed software programs streamline complex working steps, e.g. the setup of denture teeth. Digital Denture results in accurately fitting CAD/CAM denture bases and reduces the active working time required for accomplishing complete dentures.
Digital Denture: A clearly structured process
The important feature: Digital Denture is a clearly structured process consisting of a well-defined number of working steps. There is an ongoing interplay between the dentist and the dental technician who alternate in contributing their part to achieve the desired result. The good thing about it: each of them can decide which parts of the process they want to accomplish digitally and which parts they want to do conventionally. Digital, flexible and highly efficient – this is what characterizes complete denture prosthetics in the 21st century.
First clinical step: Initial impression-taking
The work of the clinician is pivotal. You come into play at the very start of the Digital Denture procedure. The first working step is performed in the dental practice: the primary impression. At the same appointment, a preliminary record of the patient’s centric and vertical relationship is taken using a Centric Tray. This information forms the basis for the fabrication of customized impression trays with integrated bite plates.
At the first patient visit, the patient-specific occlusal plane can be determined with the help of the preliminary bite registration. For this purpose, a UTS CAD device is attached to the handle of the Centric Trays. Once positioned in the patient’s mouth, the basic bow is aligned parallel to the Camper’s plane (CP) and the bipupillary line (BP). The position of the occlusal plane can be read from the BP and CP scales respectively. The clinician forwards these data, together with the initial impression and preliminary bite registration, to the dental technician.
Second clinical step: Functional impression-taking
After the dental technician has fabricated the customized bite plates digitally, i.e. without models or a physical articulator, the clinician takes the functional impressions. Subsequently, a closed-mouth impression is made while the patient is performing functional movements. The position of the occlusal plane may be checked another time using the UTS CAD and corrected as necessary.
The maxillo-mandibular relation is determined using the Gnathometer CAD, which simply clicks into the milled bite plate. The vertical height of both jaws is set by adjusting the thread of the tracing stylus. The picture below shows a typical needle point tracing record.
After the centric relation between the upper and lower jaw has been determined, the bite plates are immobilized using a registration silicone. Lastly, the patient’s esthetic lines – e.g. the midline, canine-to-canine line, lip closure line and smile line – are marked on the record. This information assists the dental technician in setting up the anterior teeth in line with the patient’s specific esthetic characteristics.
Third clinical step: Try-in on the patient
After the dental technician has generated the single-coloured functional models, they are tried in on the patient. In the process, occlusion, esthetics and suction effect are checked, similar to conventional wax try-ins. If necessary, desired corrections to the position of the teeth can be marked on the try-in denture or on a digital photograph, or, alternatively, directly communicated to the technician. The technician uses this information to modify the design accordingly.
Fourth clinical step: Final incorporation
Once the technician has called up the saved denture design and has milled the final denture, the dentist incorporates the dentures into the mouth of the patient. Particularly noteworthy is the excellent basal fit of the dentures. As the manufacturing process is not affected by polymerization shrinkage or any other thermal influences and results in the precision typical of CAD/CAM methods, the dentures exhibit an exceptional accuracy of fit and provide an outstanding suction effect.
In this blog post we have shown which working steps of the Digital Denture procedure need to be performed by you, the dentist.