Digital vs. Traditional Dentures: Some Pros and Cons of Both

SERGEY RYZHOV / STOCK.ADOBE.COM

Technology has made digital dentures a possibility. However, there are still some great things about making dentures the traditional way. Let's discuss some of the pros and cons of each workflow.

The Pros of Analog Dentures
Love it or hate it, analog denture production is the most common way clinicians deliver dentures today. Some pros of this workflow are that most clinicians know how to do it, they already have the materials in inventory to handle it, and the office has an adequate and proven system for delivering the dentures.

But the Cons of Analog Denture Workflow Can Be Crippling
The analog workflow has a lot of steps and requires a lot of chair time. The conventional denture fabrication timeline includes some version of the following steps:¹

1. Taking an impression in stock trays

2. Making a custom impression tray and taking final impressions, followed by the creation of a definitive stone cast

3. Creating and perfecting wax occlusion rim

4. Registering the maxilla-mandibular relation record and articulator mounting

5. Adding teeth for the try-in prosthesis

6. Assessing the try-in prosthesis for fit and esthetics

7. Placing and adjusting the final denture

8. Fine-tuning after delivery of the prosthesis

9. Repeating the fine-tuning as needed

For some dentists, the number of appointments needed for dentures means they would prefer to send the case out rather than handle it in-house.

The Pros of Digital Dentures
A digital workflow has numerous pros for a dental practice. Digital denture workflows offer many benefits for the patient/clinician experience, like less chair time and fewer appointments. Also, a digital denture workflow means digital archiving of the case, much higher retention, and improved clinical and patient-centered outcomes. From a restorative performance perspective, digital dentures have higher mechanical and physical properties, including enhanced fit, reduced tooth movement, increased hardiness, great flexural strength, and superior elastic modulus.²

For some clinicians, their technology plays an integral role in the pros of digital dentures.

Andrew Johnson, DDS, says Roland's DGSHAPE DWX-52DCi has made digital dentures a possibility for his practice.

He also says the comparisons between digital denture and conventional denture production often focus on the production cost and user experience. Both labs and clinicians are typically concerned about overhead and look to technology to improve profit margins. However, Dr Johnson says when it comes to dentures, a digital workflow doesn't just mean faster production and cheaper fabrication strategies; it means higher quality results overall.

"While some may argue that digital dentures have inferior esthetics and/or add workflow complexity, there are multiple ways to address each concern about this evolving methodology," Dr Johnson explains. "For instance, we are no longer locked into a single material or method for digital fabrication. Esthetics concerns have been addressed with the development of a multitude of tooth/base material options ranging from direct fabrication to traditional manufactured tooth cards. As with other transformative technologies, over time, what was once a steep learning curve has become a user-friendly interface."

Dr Johnson says digital dentures surpass traditional analog dentures in fit, durability, hygienics, color stability, and other metrics when done right. However, the value of digital dentures transcends the product.

"It's in the process," Dr Johnson says of the value of digital dentures. "No longer are we beholden to the ever-degrading quality of the clinical information from primary impressions to the final polished result. With a digital workflow, we can quickly and consistently progress from high-fidelity scan data to computer numerical control in creating the prosthesis. Furthermore, we maintain all that accuracy—from records to design to production—and can reproduce that optimal solution as many times as a replacement denture is necessary at any point in the future."

Milling solutions like Roland DGA's DGSHAPE DWX-52DCi offer top-of-the-line milling quality and intuitive ease of use, per Dr Johnson. In addition, he says the digital workflow is significantly faster when comparing the digital and analog "setup steps" for denture production.

"In the time needed to prepare to send a full denture case to the mill (both denture bases and both sets of denture teeth), I would ordinarily be halfway through my traditional analog flasking process. The DWX-52DCi's worry-free automation includes a disc-changing process that occurs without any action on my part, which means that I can start milling, then come back to retrieve, remove, assemble, finish, and polish the prosthesis in the same amount of time I would have spent deflasking and post-processing with my analog workflow," Dr Johnson says.

Dr Johnson also appreciates how denture milling in a well-engineered, contained environment like the DWX-52DCi allows him to dedicate a fraction of the effort and the clean-up time that he was used to with traditional analog acrylic processing while freeing him up to perform other necessary tasks. In addition, he says operating with the certainty that denture designs can be translated into reality via an automated, computer-controlled process backed up in a database for any future refabrication needs is a massive boost in confidence for labs, providers, and patients.

"By integrating a completely digital workflow —from the first patient interaction through final fitting—we ensure a wonderful, predictable experience for all involved," Dr Johnson says.

Labs prefer digital denture workflows, also. Conrad Rensburg, ND, NHD in Tech, Owner of Absolute Dental Services, says the efficiency gains have been significant for the lab. They recently reviewed cases for last year and saw that 98 percent of their dentures were digital. Rensburg has a couple of technicians that can set teeth in an analog denture workflow, but 7 technicians that can design a digital denture.

"One digital designer can set up 10 to 12 high-quality dentures a day and be on the phone and do customer service. So, it's a way more efficient way for us to do it," Rensburg says. "And the remake rate is almost negligible on these, so that's a huge efficiency driver."

Moreover, digital denture workflow streamlines the collaboration process between clinicians and lab, Rensburg says. In the past, clinicians had a lot of back and forth with the lab. For example, Rensburg says some of his clients weren't great at using the bite rim, so they would require several back-and-forth collaborations that often required resetting the denture teeth each time. With new digital protocols, they use the existing denture as a prototype instead.

"The first try-in is much more efficient now," Rensburg says. "Digital dentures have changed how we do things."

Moreover, the digital denture workflow allows experienced technicians with a flair for contouring and artistry to put the finishing touches on the case rather than building it from the ground up. Where Rensburg says he went to 4 years of school to learn about contouring, line angles, and incisal edge position, now digital designers handle that for technicians.

"Then, when it comes to your bench, you can spend that last few minutes just to make it beautiful and double-check that everything is done right," Rensburg says.

For a replacement denture case, a digital workflow is also better for the lab and the patient. Rensburg estimates that a conventional denture workflow takes up to 5 weeks, which is a long time for a patient to go without teeth if they lost or broke their denture. When produced digitally, the lab can print a new prosthetic, put the finishing touches on it, and overnight it.

"We push a button; we make you a new one. It's there the next morning," Rensburg says.

The Cons of Digital Dentures
The most apparent con for digital dentures is that some practices will have to change everything about how they handle dentures from the first impression forward, which can feel daunting. Also, the digital denture workflow equipment investment can be steep if a dental practice starts from nothing.

In addition, some technology could hold you back, per Rensburg. For example, Rensburg has 4 carbon printers that can print 40 dentures daily. His milling unit takes 3 hours to mill a single denture. Therefore, it would take multiple milling units to keep up with the production of just 1 printer. Milling dentures doesn't make financial sense for labs, or even dental practices, that want to scale their denture business.

"If the quality on the back end is the same because that's, I think, the main driver, then there's no argument anymore," Rensburg says. "So, you should read between the lines when you implement new technologies and speak to your fellow clinicians who do it. And don't speak to the ones who get paid by the companies to say what they're going to tell you. That's always been my advice."

Moreover, some patients might require a different approach than digital dentures. Dr Johnson thinks that digital dentures do not allow for as much patient input before they are produced, which can sometimes be a problem.

"Honestly, for some extremely particular patients, having control of a traditional wax try-in that becomes the actual denture result is critical to ensure that the patient is satisfied with the final denture prior to production," he says.

Therefore, some of the advantages of traditional dentures do remain. However, they are dwindling by the day, per Dr Johnson.

"With the creative utilization of blended digital/analog approaches, we can still leverage the power of technology, even in circumstances of elevated expectations," Dr Johnson continues. "As the technology continues to evolve, we will see that even the harshest critics of quality and consistency will eventually embrace the higher standard of care that digital workflows afford us all. I believe that point of inflection is upon us. The time is right to face the digital future and help shape it together."

References

1. Foundation For Oral Rehabilitation, Complete Denture Clinical Protocol | FOR.org (2022). Available at: https://www.for.org/en/treat/treatment-guidelines/edentulous/treatment-procedures/removable-prosthetics/complete-dentures/complete-denture-clinical-protocol (Accessed: 13 December 2022).

2. Janeva NM, Kovacevska G, Elencevski S, Panchevska S, Mijoska A, Lazarevska B. Advantages of CAD/CAM versus Conventional Complete Dentures - A Review. Open Access Maced J Med Sci. 2018;6(8):1498-1502. Published 2018 Aug 4. doi:10.3889/oamjms.2018.308