Advances in dentistry as well as prevention policies have led to a decline in the percentage of totally edentulous people, nevertheless this percentage is still very high among the very old in developed countries. Complete edentulism is still highly prevalent in countries with socio-economic hardship. The need to replace all teeth with a prosthetic appliance remains a treatment modality used daily by dentists. These prostheses aim to restore masticatory function, aesthetics, and give the patient a better ability to speak.
The study, promotion, and improvement of the digital workflow in the fabrication of complete removable dental prosthesis (CRDP) has an immediate impact on the quality of life of older adults in Europe and developed countries. Furthermore, it will have an important impact on the accessibility, the quality and production of these prosthetic devices in other contexts with socio-economic challenges soon. Although the process of fabrication is still dependent on measurement and intraoral registrations, the workflow can lead to a standardization of the quality of the resulting prosthesis, an increased access with additive manufacturing and lower cost.
For the prosthesis to remain stable in the mouth during chewing and speech, it must rest on the entire surface of the ridges available and create a vacuum between the base of the prosthesis and the tissues. The determination of the extension of the prosthesis is a critical phase during the manufacturing of a CRDP. To do this, the clinician goes through a precise impression of the jaws and a determination of the peripheral contour of the prosthesis. Currently, the 'technique for tissue impression for a complete denture starts with the registration of the peripheral functional seal and registration of all the edentulous ridges including the intaglio surface of the future prosthesis. This technique is tedious and therefore clinicians are always looking for a simplified alternative.
Digital arch scans are becoming a common technique for young graduate dentists, moving away from the conventional technique but their validity for the registration of denture bearing areas is still to date questionable. In a first study, we have identified the most appropriate scan for the registration of the entire denture bearing area and have validated the methodology for the evaluation of the accuracy of the digital scans. The investigators have demonstrated the feasibility of digital scans of denture bearing areas and identified their shortcomings, investigated the digital workflow and compared it to the conventional one in terms of fit and retention of denture bases as well as patient reported outcomes. The fit of denture bases was good as visualized by metrology generated color maps. Computer assisted manufacturing such as 3D printing or milling can have advantages for both clinicians and patients in terms of fit. The excellent clinical fit can be translated to less adjustments visits in clinical practice, hence increasing patient comfort and reducing clinician’s stress. Clinicians have the information that allows them to select the workflow that is most adequate for the patient. The digitization of the process includes the care instruction forms that need to be communicated with the patient and caregiver, a proactive approach to prevent tooth loss in advanced age.
