Considerations and Reported Outcomes in Digital Denture

WHAT is Expected? 

In this blog, and according to the updates from Pacific Dental Conferences’ Participants, I would like to review some principles of successfully produced dental prosthesis focusing on digital CAD- CAM denture, and to share with you the information on repoted outcomes from clinics and patients metadata as shared in some of conferences, it will list some advantages and disadvantages of digital Technology too.

First of all, denture is not just a product, but a customized product, this means that the denture is produced after the interaction of different parties using different methods and different products to serve and satisfy a specific customer. This concept is important in traditional method of producing denture, and it appears more important in producing digital CAD- CAM denture, why is it more important? After reading this artical, surly the answer will be easy to conclude.

CONSIDERATIONS

Prosthodontic consideration are necessary for any reabilitation of fixed or removable denture. It is important to assess the lip support, smile line, space, bone quality, opposing dentition, and assessing the parafunctional, but with all these parameters, it is important to understand  the the patient’s perspective of his/ her future denture.

The patient’s perception and the clinical evaluation are not similar. After all, any treatment must be in accordance with the patient needs and openion, the patient preferences, and the health conditions of the patient. No matter how great are your advices and how great is the level of the fonction of the rehabilitation, the patient has his/ her own point of view. Aesthetic is the most important factor for the majority of patients, and with demanding patient the treatment could end in failure.

It seems that psychological considerations are important for successful restoration. Clinician has to propose and customize a treatment for the patient according to his/ her needs and preferences, clinician has to guide the patient for best decision making too, by exposing all concerns, and the laboratory to exicute the prescription to produce the denture. 

What is recommended? Colaboration with clear communication is primordial.

All parties are involved in this procedure and colaboration is a must for better denture outcome. The formula is that the patient is ROI, but CAD- CAM technology doesn’t produce a denture with Hollywood smile. Generally, the patient will expect extraordinary result by opting for digital denture, maybe it is the reason why he will pay more😁. Imagine, and what if in the end of the procedures he is deceived?!!.

• Be sure to clarify to the patient the purpose and the need of digital denture.
• Never put the patient in confusion, or give cause of concern or anxiety. 
• In the first visit, it is important to understand the patient’s concerns with his previous denture, or his/ her perspective for his/ her future denture.
• A digital plan is needed to avoid a misunderstanding between the clinic and the laboratory.
• Discuss the digital plan with your patient too if possible.
• In try- in fit, ask only for how it feels, the size of teeth smaller or bigger, the colour darker or lighter, and finaly the position up or down, right or left. 
• The teeth set in wax helps insure patient and doctor are happy. 
• Functional try- in is recommended, it will give more usable information of the patient impression, bite fonction, and the esthetics. 
• In delivery stage, you have to reassure the patient of availability for any readjustment or concerns. 

Evaluating carefully these elements will lead to successful Final Customized Product. Keep in mind that multiple try-ins help patient feels that doctor is listening. 

Always, it is good to analyze the psychology of the patient. if the patient is not rushing, take your Time, doctors 😁😇⏰.

let’s now dive in some reported outcomes from clinics for digitalized denture 

Successful Digital Denture goes with The Principales of Intraoral Scanning Techniques, Digital Scanning Techniques for the Impression,  and The Denture Workflow.

The scanning strategy significantly impacts the accuracy of digital scans of completely edentulous arches. There is a significant interaction between scanner and strategy. Many strategies on data are available, just Google and learn about all these to adopt the best for your practice.

Similarly to conventional method, all these next parameters are important to observe when producing a customized digital denture: 

Sufficient support to insure the stability of the future denture, good rehabilitation of the Phonetics, Esthetics, Reestablish the Vertical Dimension of the Occlusion, Occlusal Primary Contacts to insure the  fonction, Chewing Ability, Adaptability, and a Home Care of the Denture.

Clinics Reported Outcomes

From weak to strong analysis, there is expert opinions, case reports, case control studies, groups study, systematic reviews, analysis data from different independent cases.

To the occlusion theories and importance, an arbitrary articulators are sufficient, no evidence that any impression method is superior, and implant will not solve all problems.

To the records, there is clinical records options, it is possible to use conventional impressions or intra oral scans, traditional methods used for trays and rims reports, possible use of reference denture, and there are different scanning methods strategies to report the alveolar structures’ information.

The CAD- CAM permits rapid exchange between clinician and laboratory, and to accelerate and reduce time frame delay for patient who needs rapid delivery.

The CAD- CAM technologies permits to the clinician to see the looks of the future restoration just by sending the patient’s photos. The system will fit the future denture to the photos in different angles/ profiles and creates data for doctor to evaluate the case and make changes if needed before the patient’s appointment.

A trial printed out prosthesis can be used to evaluate the aesthetic and the fonction preor to its finalization.

Digital records on file creaates data for the clinician, and easy to replace the denture for the patient if any problem arises. 

The CAM insure the strength of the future denture due to the Quality of material and the methods of production.

 Patient Reported Outcomes

Note: Digital complete dentures are suitable for all skeletal relationships 

The CAD- CAM technologies permits to the patient to see the looks of his/ her future restoration on file before the try in( if needed). I don’t recommend you to send any file for patient, but invite the patient to the clinic to show him/ her how it looks, this way you can assess the reaction of the first sight, and remove any worries may patients will express.

Digital records on file reduce appointment and steps, using fewer post insertion adjustment visits, insure better patient experience, and increse consistency.

The retention and fit are superior, have superior material properties, and gives patient more choises and affordability.

The milled methode offers lower incidence of sere spots and microbial colonizationHigh levels of patients’ satisfaction. 

Depending on case, it’s possible to record all clinical information in one appointment and place the CAD-CAM dentures in the second appointment. In some severe cases of health condition, the patient can enjoy fast rehabilitation of two appointments. 

Laboratory Reported Outcomes

Simplified steps in laboratory and elimination of hours of teeth setting and denture processing in conventional way, all is accomplished by CAD- CAM Technology. 

Because of high quality material and super fit of CAD- CAM denture, their fabrication permits a reduced thickness of the bases, and specific setup rules that will results in reducing visits for repeated occlusal adjustments. 

digital data information storage to reproduce spare or new prosthesis. May used in clinical reseach to improve standardization and Quality control. 

The bases produced by CAD- CAM are perfectly adapted to the upper and lower maxillary. It reduce significantly undesirable contacts and enhance the accuracy in dynamic mouvement in try- in, and stable enough to increase the accuracy of the records in inter-maxillary relationship. The bases are thinner then bases for conventional denture.

Disadvantages 

Trainings costs for specialized professionals.

Extra time in communication, planing and execution in starting stage, but experience may speed up these procedures.

Because of fewer try in may result in patient disappointment and failure of the treatment rendered, specially for sever cases.

There is a concerne regarding bond between artificial teeth and denture base. Milling and printing the denture as single unit is preferred.

Limitation in digital records for the relationship between the upper and the lower maxillary, for more accurate results, this must be done in conventional method. digital denture can be delivered in two appointments reducing some steps, but in the case of patient with TMJ disorder, following all steps are highly recommended.

Reading this blog, may you feel is missing information!! but, I didn’t want to repeat information I already talked about in my previous blogs. Hopefully, these updates will be for your great benefit, and it is always a pleasure for me to share with you information. Don’t hesitate to contact me, put comments and share your thoughts, thank you.