Clinical dentistry has accepted technology into nearly all facets of dental restorative procedures. Denture processes, however, have been slower to integrate, but digital denture protocols in this area of dentistry are now developing rapidly. At Burbank Dental Lab, we have been at the forefront of integrating computer-aided design/computer-aided manufacturing (CAD/CAM dentistry) into our removable workflows. One of the new and exciting systems that we have implemented is the Ivoclar Digital Denture System.
The emergence of the digitization of the denture process has enticed more clinicians to provide removable services. With the reported number of completely edentulous patients estimated at 23 million and 12 million with an edentulous arch, according to the American College of Prosthodontists, there is an opportunity to provide a much-needed service to these patients. This is especially true considering that the edentulous patient’s problem may lead to a severe decline in health issues, which may cause illnesses such as cancer, diabetes, coronary issues, obesity, and nutritional challenges.
"In the geriatric population the ratio of edentulous individuals is 2 to 1. About 23 million people are completely edentulous and about 12 million are edentulous in one arch."
Creating Case Success
A digital denture workflow is designed as a complete manufacturing process. It provides streamlined procedures that improve the efficiencies of removable full-arch dentures. These workflows integrate the steps in the dental office with the digital production processes in the lab. Predictable results require not only the records provided by clinicians but laboratory processes that include the latest design software, advanced materials, and an understanding of manufacturing strategies that will give predictable results.
Being one of the first laboratories to incorporate Ivoclar’s Digital Denture system has helped Burbank Dental Lab to fully integrate and understand what is needed for success with these types of cases. Digital workflows can be done in many different ways, including some case reports indicating workflows that start with digital denture impressions or scans. However, we have found that currently, the greatest success starts with conventional impression methods.
Benefits of Ivoclar Digital Dentures
One of the main challenges of analog denture workflows is the time it takes to get to an accurate and successful outcome. These challenges occur because of issues with vertical dimensions, esthetics, and inaccurate occlusion. If something is off in a digital workflow, a correction can be made quickly and easily by making changes to the digital input. With analog denture workflows, if something is off, such as the midline, this would mean a complete removal of all teeth and wax to start over. It is a very time-consuming labor-intensive process.
Other benefits of digital workflows
- The arch form of the patient’s palate is replicable at 2.5 - 2.75mm of thickness.
- The patient has comfort and adaptability.
- Reduction of the number of patient visits can improve profits and reduce costs.
- The patient’s experience with the denture process is significantly improved.
- Milled dentures have a significantly higher flexural strength over traditional analog dentures.
- Digital procedures provide more predictable outcomes.
- There is no model work, resulting in fewer possibilities of errors. The impressions are digitally scanned.
- The 3D bite plate ensures an extraordinarily accurate and duplicatable bite.
- The milled tooth try-in will be an exact fit of the final denture.
- Stored design files mean a duplicate denture can be replicated at any time.
- Milled denture bases release zero monomers.
Digital workflows have created improvements in all areas of dentistry, and digital dentures are no exception. With the ability to make a try-in denture digitally with a printed model, the clinician can refine the occlusion, flanges, and post dam as well as make decisions regarding final tooth positioning. These modifications can be merged with the original scan, which will result in the final denture.
Ivoclar Digital Denture Workflow
While it is possible to collect the initial records digitally, the outcomes of these records are not as predictable as we would like to see. Therefore, it is recommended to take the original records, including impression and bite records, utilizing conventional methods.
- Take a void-free anatomical impression
Use Alginate or PVS impression material
- A border mold impression should be used
- Mark the dorsal margin and reinsert impression
- Take a void-free anatomical impression
Record the vertical
- Make a dot on the patient’s nose and chin and measure and record the distance.
- Use Ivoclar’s centric tray to take the jaw record.
- Insert the centric tray into the mouth and have the patient close to the VDO previously marked.
Attach UTS face-bow to the centric tray and record the measurements. This measurement is essential in orienting the digital models to create 3-D bite plates.
Information is digitally scanned, and a 3D bite plate is fabricated.
Record the adjusted measurements from the UTS CAD and communicate to the lab. This allows the lab to orient the digital models in the Ivoclar Design System, and create 3-D bite plates.
Verification and measurements
- Verify that the bite is level
- Ensure proper fit
- Determine the final occlusal plane
Take the final impression
Scans are imported into the Ivoclar digital denture software
A monolithic denture is milled for try-in purposes to ensure the accuracy of the following:
- Smile line
- Lip support
- Buccal corridor
- Incisal edge position
- Equilibrate occlusion
- Speech issues
Final Denture is fabricated.
The milling of the final denture is done by milling a tissue-colored denture base or vestibular. Then the dental arch is milled in the chosen tooth shade. The teeth are cured into the tissue material. A final fine milling process is done with the bonded white and pink material together to create a close fit. The denture is then finished and polished.
It is important to note, since the material being milled is already cured/static, there is no deforming or warping of the denture over time, thus allowing the denture to be made with an ideal fit and adaptation of the palate. We have created cases without the post palatal seal, just because the dentures fit so well they did not need it.
This is considered to be a premium product since the cost is comparable to that of a premium denture, but with fewer visits.
The use of a digitally designed and milled denture using Ivoclar's digital denture workflows can streamline the process of complete denture fabrication for patients. While there are multiple workflows available for removable dentures, the digital denture process allows clinicians to individualize treatments for their patients that significantly improve predictability, lower costs and help create a more pleasant experience for those patients who undergo removable procedures. Contact the removable team at Burbank Dental Lab to find out how digital protocols can significantly impact the way you do dentistry.