CAD-CAM removable complete dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes. (original) (raw)
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CAD/CAM Complete Denture Systems and Physical Properties: A Review of the Literature
Journal of Prosthodontics, 2021
Purpose: CAD/CAM complete dentures have increased in popularity and a wide variety of systems are currently available. These prostheses present many advantages for clinicians, technicians and patients. Subtractive manufacturing is used by most of the available systems while a few manufacturers use an additive manufacturing technique. This article describes the currently available systems and materials available for the fabrication of CAD/CAM complete dentures and reviews the literature relative to their physical properties. Methods: A comprehensive review of the literature was completed to enumerate the currently available techniques to fabricate CAD/CAM complete dentures and discuss their physical properties. A search of English language peer-reviewed literature was undertaken This article is protected by copyright. All rights reserved. 3 using MEDLINE and PubMed on research articles published between 2000 and 2019. A hand search of relevant dental journals was also completed. Results: The literature indicates the physical properties of CAD/CAM milled poly(methylmethacrylate) or PMMA as it is commonly described is superior to conventionally processed PMMA for the fabrication of complete dentures. Conclusion: The incorporation of CAD/CAM technology into complete denture design and fabrication streamlines the clinical and laboratory processes and provides improved physical properties that enhance denture quality. An important factor in the emergence of a completely new technology for making complete dentures was the use of computer-aided design (CAD) and computer-aided manufacturing (CAM) into many other aspects of dentistry. 1-4 That extensive use of CAD/CAM processes along with a shortage of qualified dental laboratory technicians with expertise in removable prosthodontics, 5 led both clinicians and dental laboratory technicians to explore the use of CAD/CAM technology for the fabrication of digital complete dentures. According to the Glossary of Digital Dental Terms, a digital denture is a complete denture created by or through automation using CAD, CAM and CAE (computer-aided engineering). 6 The term CAE is defined as the field of engineering where the accumulation and analysis of data is applied to design processes used to create dental prostheses. 7 Laboratory studies Maeda et al. 8 were the first to apply the 3D laser lithography (LL) technique to assess the use of a computer-aided system to design and fabricate complete dentures. They created a This article is protected by copyright. All rights reserved. 4 plastic shell of the dentition and a record base from photopolymerizing resin and the denture teeth were then fabricated using tooth colored composite resin material. Three years later, Kuwahata et al. 9 improved the duplication technique of a removable prosthesis using a computerized numerical control (CNC) machine to mill a denture using modeling wax. In their conclusion, they admitted that the technique still needs some enhancement. Another study incorporated scans of record bases and wax occlusion rims provided by a dentist into a CAD software program. They designed the virtual dentures (bases and teeth) and printed the
Assessment of CAD-CAM polymers for digitally fabricated complete dentures
The Journal of Prosthetic Dentistry, 2020
Statement of problem. Information on the mechanical properties of the materials used for manufacturing computer-engineered complete dentures is scarce. Purpose. The purpose of this in vitro study was to evaluate the mechanical properties of 3 prepolymerized polymethyl methacrylate (PMMA) resins used in the fabrication of computeraided design and computer-aided manufacturing (CAD-CAM) milled complete dentures (CDs), as well as 2 denture base polymers used for conventionally fabricated CDs. Material and methods. Three CAD-CAM materials were evaluated: Degos Dental L-Temp, IvoBase CAD, and Zirkonzahn Temp Basic Tissue. Two materials used for conventionally manufactured dentures were also included as controls (Palapress and Paladon 65). Each material type was sectioned into bars for flexural strength, nanohardness, elastic modulus, and surface microhardness evaluation (n=8/material). Half of the specimens were stored in water for 30 days while the other half was dry-stored. A 2-way analysis of variance (ANOVA) was conducted to detect the effect of material and storage on the evaluated properties (α=.05). Linear contrasts were conducted to compare the differences among the 3 CAD-CAM materials and the conventional ones. Results. Material type and storage had a significant influence on the flexural strength, nanohardness, elastic modulus, and surface hardness of the materials investigated (P<.001). The post hoc Scheffé test for flexural strength revealed a nonsignificant difference in the interaction 3 between Degos L-Temp and Paladon (P=1.000). In terms of nanohardness, no difference was found when comparing Palapress with Paladon, as well as IvoBase CAD with Zirkonzahn Temp Basic (P=1.000). A nonsignificant interaction in terms of surface hardness was also found between IvoBase CAD and Palapress (P=.575). Conclusions. The tested materials showed variation in their mechanical properties with satisfactory behavior of the CAD-CAM materials. However, the results obtained when testing the materials used for the conventional fabrication of complete dentures suggest that their use might still be advisable. CLINICAL IMPLICATIONS The mechanical behavior of the materials used for the fabrication of computer-engineered complete dentures varies among different CAD-CAM systems. The results presented here should allow clinicians to make comparisons between the systems investigated with the aim of improving patient care and satisfaction, as well as achieving more predictable treatment outcomes.
Advantages of CAD/CAM versus Conventional Complete Dentures - A Review
Open Access Macedonian Journal of Medical Sciences
BACKGROUND: The introduction and evolution of CAD/CAM technology into complete dentures fabrication brought high expectations in improving disadvantages associated with conventional methods.AIM: The purpose of this review was to analyse the existing literature on computer-engineered complete dentures and to determine their advantages over the conventional dentures.MATERIAL AND METHODS: An electronic search of the English literature from January 1994 to March 2018 was performed in PubMed/MEDLINE, using the following keywords: CAD/CAM complete dentures, computer-engineered complete dentures, complete digital dentures, complete milled dentures, and rapid prototyping dentures.RESULTS: A total of 179 English language titles were obtained from the database, and 14 were relevant to fulfil the purpose of this review. A review of 7 articles is summarized in 2 tables for presenting a comparison between CAD/CAM and conventional dentures in clinical and laboratory studies.CONCLUSION: Following ...
CAD-CAM milled dentures: The Geneva protocols for digital dentures
The Journal of Prosthetic Dentistry
Initial attempts to fabricate complete dentures (CDs) with computer-aided design and computer-aided manufacturing (CAD-CAM) technology began in the 1990s 1-3 ; since then, there has been an evolution of the techniques and the associated technologies. 4-10 The infusion of CAD-CAM techniques into CD fabrication methods has led to the evolution of modified and easier clinical protocols, 11,12 the use of materials with improved properties, 13-18 better fit and retention of the CDs, 19-29 reduction in the chairside and laboratory times, 12,30-32 and overall reduction in clinical and laboratory costs. 30 High patient and clinician satisfaction with CAD-CAM CDs has been reported. 33-35 The CAD-CAM clinical protocols used are modified versions of the conventional clinical steps followed during the fabrication of CDs. Although promoted by various manufacturers as being more straightforward and easier, the CAD-CAM protocols require extended time to learn the procedure and to digitize the analog clinical procedures. 34,36 Elaborate instruments, depending on the manufacturing system, are often required to carry out these novel clinical protocols.
This study evaluated the biocompatibility, mechanical properties, and surface roughness of CAD-CAM milled and rapidly-prototyped/3D-printed resins used for manufacturing complete dentures. Methods: Six groups of resin specimens were prepared, milled-base (MB), milled-tooth shade (MT), printed-tooth shade (PT), printed-base with manufacturer-recommended 3D-printer (PB1), printed-base with third-party 3Dprinter (PB2), printed-base in a vertical orientation (PB2V). Human epithelial (A-431) and gingival (HGF-1) cells were cultured and tested for biocompatibility using Resazurin assays. Three-point bending and nanoindentation tests measured the mechanical properties of the resin groups. Surface roughness was evaluated using a high-resolution laser profilometer. ANOVA and post-hoc tests were used for statistical analyses (α = 0.05). Results: : There were no significant differences in biocompatibility between any of the investigated groups. MB revealed a higher ultimate strength (p = 0.008), elastic modulus (p = 0.002), and toughness (p = 0.014) than PB1. MT had significantly higher elastic modulus than PT (p < 0.001). Rapidly-prototyped resin samples with a manufacturer-recommended 3D-printer (PB1) demonstrated higher ultimate strength (p = 0.008), elastic modulus (p < 0.001), hardness (p < 0.001) and a reduced surface roughness (p < 0.05) when compared with rapidly-prototyped groups using a third-party 3D-printer (PB2). Rapidly-prototyped samples manufactured with a vertical printing orientation (PB2V) revealed a significantly lower elastic modulus than samples groups manufactured using horizontal printing orientation (PB2) (p = 0.011). Conclusions: : Within the limits of this present study, CAD-CAM milled and rapidly-prototyped complete denture resins performed similarly in terms of biocompatibility and surface roughness. However, the milled denture resins were superior to the rapidly-prototyped denture resins with regard to their mechanical properties. Printing orientation and type of 3D-printer can affect the resin strength and surface roughness. Clinical significance Appropriate CAD-CAM manufacturing technique should be considered whilst manufacturing removable complete dentures (CDs) as the mechanical properties and surface roughness may vary. When fabricating CDs with the rapid-prototyping technique, it is important to employ the correct printing orientation, and a 3D-printer that is recommended by the resin manufacturer.
The Journal of prosthetic dentistry, 2016
Reports of sound, evidence-based treatment outcomes of computer-aided design/computer-aided manufacture (CAD/CAM) of complete dentures (CD) are lacking in publication databases. The purpose of this retrospective survey study was to assess patient preferences and satisfaction when treated with digitally fabricated CDs, by using a questionnaire. A total of 50 patients who received digital CDs were included in this study. A 10-item questionnaire was sent to the patients in order to assess their satisfaction with their digital CD experience. The items, or statements listed, were concerned with patient satisfaction and also the treatment technique and final outcome. Results of patient satisfaction questions were evaluated using descriptive statistics, means, and medians. All statistical tests were performed using commercially available software. Responses to the questionnaire provided by patients were analyzed using the Mantel-Haenszel chi-squared test (α=.05). The questionnaire was sent...
CAD/CAM complete dentures: a review of two commercial fabrication systems
Journal of the California Dental Association, 2013
The use of computer-aided design and computer-aided manufacturing (CAD/CAM) has become available for complete dentures through the AvaDent and Dentca systems. AvaDent uses laser scanning and computer technology. Teeth are arranged and bases formed using proprietary software.The bases are milled from prepolymerized pucks of resin. Dentca uses computer software to produce virtual maxillary and mandibular edentulous ridges, arrange the teeth and form bases. The dentures are fabricated using a conventional processing technique.
Assessment of Conventionally and Digitally Fabricated Complete Dentures: A Comprehensive Review
Materials
CAD/CAM technology is gaining popularity and replacing archaic conventional procedures for fabricating dentures. CAD/CAM supports using a digital workflow reduce the number of visits, chair time, and laboratory time, making it attractive to patients. This study aimed to provide a comparative review of complete dentures manufactured using CAD/CAM and conventional methods. The PubMed/Medline, Science Direct, Cochrane, and Google Scholar databases were searched for studies published in English within the last 11 years (from 2011 to 2021). The keywords used were “computer-engineered complete dentures”, “CAD/CAM complete dentures”, “computer-aided engineering complete dentures”, and “digital complete dentures”. The search yielded 102 articles. Eighteen relevant articles were included in this review. Overall, computer-engineered complete dentures have several advantages over conventional dentures. Patients reported greater satisfaction with computer-engineered complete dentures (CECDs) du...
Applied Sciences
In the last years, both medicine and dentistry have come across a revolution represented by the introduction of more and more digital technologies for both diagnostic and therapeutic purposes. Additive manufacturing is a relatively new technology consisting of a computer-aided design and computer-aided manufacturing (CAD/CAM) workflow, which allows the substitution of many materials with digital data. This process requires three fundamental steps represented by the digitalization of an item through a scanner, the editing of the data acquired using a software, and the manufacturing technology to transform the digital data into a final product, respectively. This narrative review aims to discuss the recent introduction in dentistry of the abovementioned digital workflow. The main advantages and disadvantages of the process will be discussed, along with a brief description of the possible applications on orthodontics.