Digital dentures: fabrication, workflow and benefits

Digital dentures are dental prostheses created with the help of scanners, design software and mills or printers. These digital tools can provide for more accuracy, efficiency and often more comfort for the patient.

The digital denture workflow can start in different ways: sometimes a conventional impression is still needed, sometimes a direct scan in the patient’s mouth can be done to create a digital impression for dentures, and sometimes an impression isn't needed because the clinician does a duplicate of an existing denture. The way the workflow looks depends entirely on the clinical situation and the type of denture that is created.

Intraoral scanning technology can replace the part of the workflow where patients were asked to sit with an uncomfortable impression tray in their mouth for long stretches of time. In addition, digital technology can take out some manual steps that used to be time consuming: time needed for resets due to inaccuracies in for example occlusion, vertical dimension, and/or aesthetics. If, for example, the patient’s midlines are skewed, the clinician would have to remove all teeth (as many as 28), re-wax, re-set each tooth individually, redo the wax confinement and then invest, process trim and polish.

With the advent of digital dental scanning technology, it became possible to do digital imaging for dentures in a few minutes with maximum comfort for the patient. In the design phase of the workflow, corrections that could previously take hours, are now done in ten to fifteen minutes. In addition, in the case of a digital removable prosthesis, the uniformity of the design is very beneficial. With the right software, the dental specialist can provide the clinic with cost-effective 3D printed dentures within a day, which reduces the duration of the treatment, number of visits needed, and time spent working with the patient. Challenging cases can even be tested with designs that are then digitally archived and can easily be referenced or duplicated. A 3D printed treatment is therefore a very cost-efficient solution.

As mentioned, digital denture design either starts with an existing prosthesis, or with a conventional or digital impression. For a direct mouth scan, the clinician uses a dental intraoral scanner, which outputs a 3D file of the oral cavity that is then used for designing, for example the try-in denture. If a direct impression isn't possible, the dental specialist will create a conventional impression. A combination of different imaging and impression taking methods is also possible 1. Hassan B, Greven M, Wismeijer D. Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation. J Adv Prosthodont. 2017 Oct;9(5):381-386. doi: 10.4047/jap.2017.9.5.381. Epub 2017 Oct 16. PMID: 29142646; PMCID: PMC5673615..

Regardless of the imaging and impression taking method, digital dentures are designed with the help of digital denture software to ensure that the end product is fitting well and restores function, esthetics and phonetics for the patient. Software used for design and production is also referred to as computer-aided design and manufacturing technology (or CAD/CAM, in short).

Digital denture fabrication can be done in different ways. With a digital file as a starting point, 3D printing is an option, especially when cost is a factor1. Lucio Lo Russo, DDS, PhD, Khrystyna Zhurakivska, DDS, PhD, Laura Guida, DDS, Konstantinos Chochlidakis, DDS, MS, Giuseppe Troiano, DDS, PhD, Carlo Ercoli, DDS, MBA. Comparative cost-analysis for removable complete dentures fabricated with conventional, partial, and complete digital workflows. May 31, 2022.. However, many dental specialists prefer milling the denture, or using a combination of 3D printing and milling, because the materials are well known and studied, and the outcome is seen as more predictable and durable.

For the creation of digital dentures, dental clinics, denturists and dental laboratories have to work together, unless the entire process is handled in-house by one specialist. Since not all clinics and labs have implemented digital technologies into their practice, the collaboration process may differ. Also, each denture is different: a duplicate from an existing denture is different from an immediate denture, just as much as a partial removable denture is different from a try-in denture. At a general level, we can say that a digital denture workflow includes the following steps:

1. The impression. Digital dentures cannot be created out of thin air: the clinician needs a 3D representation of the current situation. This is done by scanning or taking an analog impression. The process of taking digital scans for dentures may differ depending on the case: is the patient fully edentulous, or not? Is it the first time or are we creating a duplicate denture? When the data is captured, either with an intraoral or a dental model scanner, the clinic decides if they keep the case in-house or if it is handed over to a specialist (a denturist or lab). Along with the file, the clinic will usually be able to send comments, additional files such as pictures, etc. along in the communication software.
2. The digital denture design. The dental technician will load the files into digital prosthetics software, which allows for dental technicians to create personalized prostheses with a perfect fit. Whether it's for full or partial digital removable dentures, the software can help automate much of the denture design process: from model analysis to gingiva placement. In addition, CAD software can fully eliminate the need for analog re-sets. Digital design hence doesn’t only save design and treatment time, but also material costs.
3. When the partial or full denture design is ready, it’s time for production. This can either be done by milling or by 3D printing of dentures or a combination of the two. Usually, 3D-printed dentures are made from light curing resins, whereas milling uses traditionally tried and tested materials. In the scenario of 3D printing of complete or partial dentures, the denture base and the denture teeth are manufactured separately. After the digital denture printing, teeth are attached to the base and go through the final curing process.
4. The next stage of the digital denture workflow is optional and is called “characterization”. It is done in order to make the prostheses look and feel more lifelike and natural — by emulating the patient’s natural features with composites.
5. Once the dentures are produced, there is a final manual step. The denture goes for a two-stage polishing to smooth any possible roughness on the outer surfaces and make it easier to maintain hygiene.

The removable prostheses can be manufactured directly as the definitive version. Alternatively, a try-in version can be produced which allows the clinician to test the fit and function on the patient and make sure that they look natural and feel comfortable before the final prosthesis is made. A try-in stage also makes collaboration between a dental laboratory and a dentist more efficient and predictable. If the clinician and the patient accept the denture design, the definitive treatment is a safe next step.

If you are interested in learning more about digital dentures and other digital dental technologies, 3Shape has options. Book a virtual digital dentures course for example, or browse through the wealth of recorded webinars on digital dental technology to learn from the leading dental specialists in the field of digital dentistry. If you are a 3Shape Dental System user but do not currently have access to digital denture design functionality, you can use CAD points to get one-time access to the design software and try it out.