Digital Dentistry
Name : Sara Mohamed Ismail
ID : 21021
Supervisor: DR. Amr Emara
Digital impressions for complete denture:
Digital impression has been introduced since the 1980s, and its use is increasing
till now with better and more sophisticated software systems . In digital
impression, an intraoral scanner is used to directly capture the required intraoral
area of hard and soft tissues for the dentures. The acquired information is then
generated by CAD-de-sign software to form Virtual working model
THROUGH THE DIGITAL CAD-DESIGN SOFTWARE, THE DENTURE WAS THEN FABRICATED VIA 3D
PRINTING OR MILLING. THE FABRICATION PROCESS INCLUDES THE CONSTRUCTION OF SPECIAL
TRAYS, BASEPLATE AND WAX RIMS, TRIAL PLATES FOR TOOTH SETTING ASSESSMENT, AND
FINALLY, THE DEFINITIVE DENTURES. SEVERAL WORKFLOWS WERE REPORTED ON DIFFERENT
METHODS PERFORMED BY THE DENTIST'S PREFERENCE, WHICH SHOWED NO SIGNIFICANT
DIFFERENCE IN ACCURACY, DENTURE RETENTION, AND PATIENT'S SATISFACTION
DIGITAL IMPRESSIONS MAY ALSO BE PRODUCED THROUGH EXTRAORAL SCANNERS BY SCANNING
THE WORKING MODELS PRODUCED FROM CONVENTIONAL IMPRESSION-MAKING. THIS METHOD
DOES NOT ELIMINATE MOST OF THE CONVENTIONAL PROCEDURES IN THE DENTURE
CONSTRUCTION PROCESS. IT AIMS TO SIMPLIFY THE TOOTH SET-UP PROCEDURE AND DENTURE
TRY-IN USING TEETH SETTING SOFTWARE FOR DENTURES HOWEVER, THE POSSIBILITY OF
DISTORTION OR DIMENSIONAL CHANGES IN DENTURE CONSTRUCTION MAY OCCUR POSSIBLY
DURING THE COMBINATION OF CONVENTIONAL IMPRESSION TAKING WITH SCANNING THE
WORKING MODELS PRIOR TO THE TOOTH SETTING STAGE.
The workflow and protocol of the digital complete denture procedure differed
between different types of digital or CAD/CAM systems. Clinicians have to
choose the protocol according to the system used and their own preferences.
Method of scanning, either by intraoral or extraoral scanner, are similar even for
a different system; however, the number of visits or length of the visit will be
slightly varied between two to three visits for the denture to be ready for inser-
tion. While this has decreased clinical chair time, the procedures involved with
complete denture impressions have remained unchanged .
The elimination of conventional impression techniques in digitally fabricated
dentures offers more benefits in increasing patient comfort, reduction of
dimensional changes of the impression, disregarding the need for custom trays,
reducing or removing the use of the impression mate-rials, and potential cost-
and time effectiveness .
Advantages of digital dentistry :
considering the use of the scanning device without investing in the cost of
impression material and the fabrication of special trays.
Apart from this, the scanning device has the ability to patch any missing area
on the initial impression by rescanning the required area in just a few seconds
and it is more convenient for patient and clinician . This would be a preference
for patients with gag reflexes and disability. It was suggested for clinicians
understand and learn the process of a digital denture and the use of a variety
of available software. Digital impression is practical and easy to manipulate.
It does not require expertise to achieve the same level of proficiency as the
conventional impression .
Disadvantages of digital dentistry:
inaccuracy of the software to capture and process the digital data and transform the
impression into a virtual study model, as reported by Goodacre. Goodacre
suggested the use of tissue additives, such as pressure indicating paste (PIP) and
composite resin markers, to improve the scanning result, which can improve the
ability of the scanner . In addition, from the current observation, the technology of
artificial intelligence in software has rapid advancement over the years, and the
scanner performance would be much improved.
MILLING:
Milling is the most popular method of fabricating digital dentures. Once the design of
the prosthesis is approved, the CAD stereolithography (STL) file is sent to a milling
software that directs the milling machine to perform a series of movements.The
artificial teeth may be either milled with the prosthesis (monolithic) or milled
individually or as a complete arch in tooth shade material, or selected from a
prefabricated series and bonded to the milled denture base
Monolithic dentures are resistant to staining. They also help alleviate the concern of
debonding of the teeth from the denture base, however, the prostheses may have a
monochromatic appearance with a not-as-favorable esthetic outcome.- To
circumvent this problem, some manufacturers have developed resin blanks with
several layers that help fabricate denture bases with polychromatic teeth that mimic
the dentin and enamel thereby improving the sthetics.'
milled complete denture bases have an ‹cellent fit owing to the elimination of the
polymerization shrinkage inherent in traditional fabrication processes of polymethyl
methacrylate (PMMA) dentures.
Milled complete dentures have a superior fit, dimensional stability, flexural strength, and
surface hardness compared to conventional and 3D-printed dentures.The disadvantage of
milling a denture is that a large portion of the blank remains unused and is wasted during the
process and they are more expensive compared to 3D-printed dentures.
milled complete denture
Steps for fabricating complete denture by
digital dentistry :
1. Step: Setup (scan & CAD design)
In order to switch to the digital process, the models are digitized with
the laboratory scanner. The digital model analysis is the basis for
setting up the teeth in the CAD software. Then the desired tooth set or
tooth shape is selected from the tooth li-brary. The software generates
the setup based on the tooth selection and the select-
ed setup concept.
2. Step: Try-in
If the denture is digitally set up, the try-in follows. With some digital
processes, this step is not necessary. But as you know, most dentists want
a try-in, and for good reason. The try-in is used to optimize the denture
through possible modifications of the setup. You do not have to omit this
with digital full dentures either. To make a try-in, you need a 3D printer or a
milling unit.
3. Step: Adjustments (optional)
If a change is necessary after the try-in (e.g., to optimize the esthetics), this can be
implemented with more or less effort, depending on the process and material sys-
tem. It is inconvenient if the try-in is carried out with the milled or printed PMMA
dental arch made for the final denture, and modifications are then necessary. In this
case, the dental arch has to be milled again or reprinted. A try-in with a monoblock
denture made of wax or with a milled wax base
and fixed, prefabricated teeth is much more convenient. Any adjustment is scanned
in again. The occlusal contact relationship is automatically reconfigured.
4. Step: Fabricating the final denture
To fabricate the final denture, you need a 3D printer or a
milling unit and, depending on the procedure, prefabricated
teeth. If you decide on a material system that is compatible
with many different printers
and milling units, you can normally use existing laboratory
equipment. The VITA VIONIC Material System (VITA
Zahnfabrik), for instance, has been validated for all well-
established milling units and many 3D printers.
5. Step: Finishing of the dentures
The finishing is different depending on which digital manufacturing process
you choose. In the multi-part process (e.g., VITA VIONIC), teeth that are
specially prefabricated for the digital denture are glued into the milled or
printed cavities of the denture base. With the VITA VIONIC VIGO tooth, the
basal surface of the teeth is optimized so that you can bond the teeth
without any preparatory work or reworking. As in a modular system, the
teeth fit securely and rotation-free in the base and are permanently attached
with the VITA VIONIC BOND adhesive. The interdental spaces are simply
sealed with a flow composite. Polishing is completely effortless as the
prefabricated teeth already have a perfect sur-face.
Compare between digital and conventional impressions
Thank you
