Computer-aided technology for fabricating complete dentures: systematic review of historical background, current status, and future perspectives.
TL;DR: A body of scientific literature related to computer-aided technology for complete dentures is emerging and prospective clinical trials with true clinical endpoints are necessary to validate this technology.
Abstract: Statement of problem Computer-aided technology is an emerging method for fabricating complete dentures. Consolidated information about historical background, current status, and scope for the future is lacking. Purpose The purpose of this systematic review was to analyze the existing literature on computer-aided technology for fabricating complete dentures and provide the reader with a historical background, current status, and future perspectives on this emerging technology. Material and methods An electronic search of the English language literature between the periods of January 1957 and June 2012 was performed by using PubMed/MEDLINE with the following specific search terms: CAD-CAM complete dentures, digital complete dentures, computer dentures, designed dentures, machined dentures, manufactured dentures, milled dentures, and rapid prototyping dentures. Additionally, the search terms were used on the Google search engine to identify current commercial manufacturers and their protocols. Results A total of 1584 English language titles were obtained from the electronic database, and the systematic application of exclusion criteria resulted in the identification of 8 articles pertaining to computer-aided technology for complete dentures. Since the first published report in 1994, multiple authors have described different theoretical models and protocols for fabricating complete dentures with computer-aided technology. Although no clinical trials or clinical reports were identified in the scientific literature, the Google search engine identified 2 commercial manufacturers in the United States currently fabricating complete dentures with computer-aided design and computer-aided manufacturing (CAD/CAM) technology for clinicians world-wide. These manufacturers have definitive protocols in place and offer exclusive dental materials, techniques, and laboratory support. Their protocols contrast with conventional paradigms for fabricating complete dentures and allow the fabrication of complete dentures in 2 clinical appointments. Conclusions A body of scientific literature related to computer-aided technology for complete dentures is emerging. Significant advancements in this technology have now resulted in their commercial availability with shorter clinical protocols. However, prospective clinical trials with true clinical endpoints are necessary to validate this technology. This could affect dental education, patient care, research, and public health worldwide.
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TL;DR: A comprehensive review of the current published literature investigating the various methods and techniques for scanning, designing, and fabrication of CAD/CAM generated restorations along with detailing the new classifications of CAD-CAM technology is presented.
359 citations
TL;DR: The present article reviews the main AM processes for polymers for dental applications: stereolithography (SLA), digital light processing (DLP), material jetting (MJ), and material extrusion (ME).
Abstract: There are 7 categories of additive manufacturing (AM) technologies, and a wide variety of materials can be used to build a CAD 3D object. The present article reviews the main AM processes for polymers for dental applications: stereolithography (SLA), digital light processing (DLP), material jetting (MJ), and material extrusion (ME). The manufacturing process, accuracy, and precision of these methods will be reviewed, as well as their prosthodontic applications.
253 citations
TL;DR: The present article comprehensively reviews various aspects and properties of PMMA biomaterials, mainly for prosthodontic applications and recent updates and modifications to enhance the physical and mechanical properties are discussed.
Abstract: A wide range of polymers are commonly used for various applications in prosthodontics. Polymethyl methacrylate (PMMA) is commonly used for prosthetic dental applications, including the fabrication of artificial teeth, denture bases, dentures, obturators, orthodontic retainers, temporary or provisional crowns, and for the repair of dental prostheses. Additional dental applications of PMMA include occlusal splints, printed or milled casts, dies for treatment planning, and the embedding of tooth specimens for research purposes. The unique properties of PMMA, such as its low density, aesthetics, cost-effectiveness, ease of manipulation, and tailorable physical and mechanical properties, make it a suitable and popular biomaterial for these dental applications. To further improve the properties (thermal properties, water sorption, solubility, impact strength, flexural strength) of PMMA, several chemical modifications and mechanical reinforcement techniques using various types of fibers, nanoparticles, and nanotubes have been reported recently. The present article comprehensively reviews various aspects and properties of PMMA biomaterials, mainly for prosthodontic applications. In addition, recent updates and modifications to enhance the physical and mechanical properties of PMMA are also discussed.
208 citations
TL;DR: Overall additive manufacturing produces little material waste and is energy efficient when compared to subtractive manufacturing, due to passivity and the additive layering nature of the build process.
Abstract: Additive manufacturing or 3D printing is becoming an alternative to subtractive manufacturing or milling in the area of computer-aided manufacturing. Research on material for use in additive manufacturing is ongoing, and a wide variety of materials are being used or developed for use in dentistry. Some materials, however, such as cobalt chromium, still lack sufficient research to allow definite conclusions about the suitability of their use in clinical dental practice. Despite this, due to the wide variety of machines that use additive manufacturing, there is much more flexibility in the build material and geometry when building structures compared with subtractive manufacturing. Overall additive manufacturing produces little material waste and is energy efficient when compared to subtractive manufacturing, due to passivity and the additive layering nature of the build process. Such features make the technique suitable to be used with fabricating structures out of hard to handle materials such as cobalt chromium. The main limitations of this technology include the appearance of steps due to layering of material and difficulty in fabricating certain material generally used in dentistry for use in 3D printing such as ceramics. The current pace of technological development, however, promises exciting possibilities.
194 citations
TL;DR: The step-by-step method necessary to obtain impressions, maxillomandibular relation records, and anterior tooth position with an anatomic measuring device is described, which allows the generation of a virtual denture, which is milled to exact specifications without the use of conventional stone casts, flasking, or processing techniques.
Abstract: Conventional complete denture prosthetics require several appointments to register the maxillomandibular relationship and evaluate the esthetics The fabrication of milled complete dental prostheses with digital scanning technology may decrease the number of appointments The step-by-step method necessary to obtain impressions, maxillomandibular relation records, and anterior tooth position with an anatomic measuring device is described The technique allows the generation of a virtual denture, which is milled to exact specifications without the use of conventional stone casts, flasking, or processing techniques
186 citations
Cites background from "Computer-aided technology for fabri..."
...As a result of the highly condensed resin, there is a decrease in free monomer, a decrease in the porosity when compared to a conventionally processed denture, and a decrease in the retention of Candida albicans by the denture base.(10) Manufactured acrylic resin teeth, which are not CAD/CAM produced, are used....
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...work is simplified and fewer appointments are needed.(10) Recently, Bidra(11)...
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References
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TL;DR: A triangular, full thickness flap from the lower lip used to fill in a deficit in the upper lip for the relief of deformity due to double harelip.
Abstract: A Abbe flap \ăb# e flăp\ [Robert Abbe, New York, N.Y. surgeon, 18511928]: eponym for a lip switch operation. A triangular, full thickness flap from the lower lip used to fill in a deficit in the upper lip. Specifically applied to the midportion of the upper or lower lip— called also lip switch operation Abbe, R. A new plastic operation for the relief of deformity due to double harelip. Med Rec 1898;53:477. ab duct \ăb dŭkt#\ vt (1834): to draw away from the median plane— comp ADDUCT ab er rant \ă-bĕr#ant\ adj (ca. 1798)1: a deviation from the normal or usual course, form, or location 2: straying from the normal way ab frac tion \ăb frăk#shun\ n (1991): the pathologic loss of hard tooth substance caused by biomechanical loading forces. Such loss is thought to be due to flexure and chemical fatigue degradation of enamel and/or dentin at some location distant from the actual point of loading—comp ABLATION, ABRASION, ATTRITION, and EROSION ab la tion \ă-bl a#shun\ n (15c) 1: separation or detachment; extirpation; eradication 2: removal of a part, especially by cutting—see ABFRACTION, EROSION abrade \uh-br ad#\ vt (1677): to rub away the external covering or layer of a part—comp ATTRITION, EROSION abra sion \ă-br a #shun\ n (1656) 1: the wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process 2: an abnormal wearing away of the tooth substance by causes other than mastication—comp ATTRITION, EROSION abra sive \uh-br a # siv, -ziv\ n (1853): a substance used for abrading, smoothing, or polishing abra sive \uh-br a # siv, -ziv\ adj (1875) 1: tending to abrade 2: causing irritation—abra sive ly adv, abra sive ness n ab ra si vity \uh-br a#siv-ı̆-t e, -ziv-ı̆-t e\ v (1998): the property of one material to wear away another material by means of frictional contact absorbed dose \ab-sôrbd#,-zôrbd# d os\: the amount of energy from ionizing radiation absorbed per unit mass of matter, expressed in Gray units ab sorp tance \ab-sôrp#tans, -zôrp#tans\ n (ca. 1931): the ratio of the radiant energy absorbed by a body to that incident upon it ab sorp tion \ab-sôrp#shun, -zôrp#-\ n (1741) 1: the uptake of substances into or through tissues, e.g., mucosa, skin, and intestine 2: in radiology, the uptake of energy by matter with which the radiation interacts—see A. of RADIATION—comp ADSORPTION absorption of radiation \ab-sôrp#shun ŭv r a#d ea#shun\: collisionlike interactions between the individual particulate or quantum components of a beam of radiation and the subatomic parts of matter that occur at random during irradiation. Each interaction may result in partial or complete transfer of energy abut ment \a-bŭt#ment\ n (1634) 1: that part of a structure that directly receives thrust or pressure; an anchorage2: a tooth, a portion of a tooth, or that portion of a dental implant that serves to support and/or retain a prosthesis—usage see ANGULATED A., HEALING A., DENTAL IMPLANT A., INTERMEDIATE A., ONE PIECE A., PREPARATION PIECE A., STANDARD A., TWO PIECE A. DropB
1,296 citations
TL;DR: The use of dental CAD/CAM systems is promising not only in the field of crowns and FPDs but also in other fields of dentistry, even if the contribution is presently limited.
Abstract: In this article, we review the recent history of the development of dental CAD/CAM systems for the fabrication of crowns and fixed partial dentures (FPDs), based on our 20 years of experience in this field. The current status of commercial dental CAD/CAM systems developed around the world is evaluated, with particular focus on the field of ceramic crowns and FPDs. Finally, we discuss the future perspectives applicable to dental CAD/CAM. The use of dental CAD/CAM systems is promising not only in the field of crowns and FPDs but also in other fields of dentistry, even if the contribution is presently limited. CAD/CAM technology will contribute to patients' health and QOL in the aging society.
791 citations
TL;DR: The clinical implications are twofold: First, practicing dentists will find that a sizable minority of the patient population will continue to need complete denture services; and second, if training in complete dentures prostheses is eliminated from the dental education curriculum, millions of patients will be forced to seek dentures services from alternative providers.
Abstract: Currently, there is much speculation among dental educators that the need for complete dentures will decline markedly in the future and that complete denture training should be removed from the dental curriculum. Estimates based on national epidemiologic survey data indicate that edentulism has declined by 10% every decade and that only 90% of edentulous adults obtain and wear complete dentures. However, when the number of adults in each specific age group is multiplied by the percentage who need a complete maxillary or mandibular denture, the results suggest that the adult population in need of 1 or 2 complete dentures will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism experienced each decade for the past 30 years will be more than offset by the 79% increase in the adult population older than 55 years. The clinical implications of these findings are twofold: First, practicing dentists will find that a sizable minority of the patient population will continue to need complete denture services; and second, if training in complete denture prostheses is eliminated from the dental education curriculum, millions of patients will be forced to seek denture services from alternative providers.
479 citations
TL;DR: A prototype 3-D tooth arrangement program is described in this article that serves as an example of the type of program than can be used to arrange prosthetic teeth virtually as part of the overall CAD/CAM fabrication of complete dentures.
Abstract: The clinical impression procedures described in this article provide a method of recording the morphology of the intaglio and cameo surfaces of complete denture bases and also identify muscular and phonetic locations for the prosthetic teeth. When the CAD/CAM technology for fabricating complete dentures becomes commercially available, it will be possible to scan the denture base morphology and tooth positions recorded with this technique and import those data into a virtual tooth arrangement program where teeth can be articulated and then export the data to a milling device for the fabrication of the complete dentures. A prototype 3-D tooth arrangement program is described in this article that serves as an example of the type of program than can be used to arrange prosthetic teeth virtually as part of the overall CAD/CAM fabrication of complete dentures.
211 citations
TL;DR: It is shown that it is possible to fabricate a complete denture using a CAD/CAM system and the deviations from the master 3D image were 0.50 mm for the occlusal surface.
Abstract: The purpose of this study was to evaluate the fabrication of a complete denture using a CAD/CAM system. Cone beam CT was used to measure the complete denture and the artificial teeth. After a 3D complete denture image was structured using 3D CAD software, we factored out the artificial teeth and obtained a 3D denture base image. A machining center cut an acrylic resin block, and fabricated an acrylic complete denture base. The artificial teeth were bonded to the cut denture base using resin cement. A 3D digitizer digitized the fabricated acrylic denture. We measured the deviations between the master 3D complete denture image and the 3D data of the fabricated acrylic denture. The average deviations from the master 3D image were 0.50 mm for the occlusal surface. This present study indicates that it is possible to fabricate a complete denture using a CAD/CAM system.
158 citations