Digital Denture Capabilities Expanding to Meet Anticipated Demand
As baby boomers age, CAD/CAM solutions for full and partial removable prosthetics are multiplying
By Keith Miolen, CDT
The dental industry in recent years has entered a digital era far beyond the comprehension or expectations of many within dentistry. This digital advancement was launched gradually in various phases and continues to progress annually with new software, equipment, materials, and techniques.
Throughout the digital revolution, technology has impacted our technical processes. It has either altered or eliminated many procedural steps in the fabrication of various prostheses. This progression continues not only in terms of consistency but also accuracy when applied correctly. Implant placement is one such example, as digital methods have led to more accurate surgical guides and the improved ability to find much needed bone density.
Digital dentistry has continued to expand based on the demands and needs of the patient population. Today, that demand is coming from the 76 million-plus Baby Boomer population, the largest generation of Americans born in US history. With increased numbers of baby boomers hitting retirement age each year and wielding considerable amounts of disposable income, full and partial denture prosthetics represent significant growth potential in the industry. Not surprisingly, new advancements in technology and materials geared toward digital fabrication capabilities for complete and partial dentures have evolved to meet this future demand.
Although digital denture production methods are relatively new, they appear to be on their way to occupying a significant portion of the dental technology market. Baby boomers are turning 65 at a rate of approximately 8000 per day, and they control 70% of the total US net worth.1 The full or partial edentulism often associated with advanced age means an inevitable demand for dentures from that population base.
Projections on the direction of the market now and in the near future have led many manufacturers to take steps to meet the demand by introducing innovations that feature the accuracy and quality of digital fabrication. From 3D printing solutions to millable denture base materials to advancements in CAD software, technology is evolving rapidly in this arena.
Full and Partial Denture Solutions
AvaDent Digital Dental Solutions (Global Dental Science, avadent.com) and Pala Digital Dentures (Heraeus Kulzer, paladigitaldentures.com) have been the only digital processes on the market until recently with clinical inputs for creating a digitally produced full denture. Both processes capture patient information using custom impression trays, with the materials being scanned in at the laboratory. The information is then sent to outsource centers, where digital processes are used to eventually create the final denture. AvaDent mills a full arch from a single block of material complete with denture teeth, while Pala Digital Dentures 3D prints a denture try-in and uses a proprietary process to complete the final prosthetic. The benefits of these processes include accuracy, efficiency, and digital records for future use.
Several new in-house solutions are becoming available for producing full dentures via a digital process as well. Ivoclar Vivadent (ivoclarvivadent.us) plans to introduce a complete laboratory-supported solution that includes clinical tools, exclusive 3Shape software, a specialized 5-axis milling unit, and new millable materials. The system, previewed at the International Dental Show (IDS) earlier this year, is expected to be formally introduced in the US in 2016. The IDS preview included the Wieland Zenotec Ion mill, equipped with an 8-disc changer and ionization system that directs ionized compressed air onto the material and tools during the milling process to neutralize the static electricity of particles when milling acrylic materials and producing full-arch dentures. The denture base is milled from IvoBase CAD PMMA.
Amann Girrbach also previewed a full digital denture solution at IDS: Ceramill FDS (Full Denture System) (amanngirrbach.com). This system, which is now available in the US, is unique in that the entire in-house fabrication process, up to the wax try-in stage, is possible within a laboratory. The system was developed with the intention of offering a reliable, economical, and highly precise solution for producing full dentures. The system eliminates the need to trim the denture teeth by hand, as the ridge lap surfaces of the teeth can be adapted to the alveolar ridge in the CAD software and then, using a special denture tooth holder designed for use in the Ceramill Motion 2 (Amann Girrbach), the denture tooth surfaces can be trimmed via milling technology.
Valplast International Corporation provided IDT with a preview of its new CAD/CAM system for producing digital full dentures. Using existing CAD software, technicians can virtually arrange the new Valplast library of denture teeth, design the denture base with gingiva, and generate a 3D file that can be used with either milling or injection molding techniques for fabrication of the final denture. This technique, the company says, represents the first completely open-architecture system for the design and production of digital dentures and can be used with a combination of existing scanners, CAD software, printers, and mills. Materials, education, and outsourcing services will be available to laboratories in early 2016.
Materials
One factor that has limited the development of the digital denture processes is the lack of materials that have been cleared by the FDA for use in a permanent denture. That is changing, however.
Valplast introduced a 3D printable resin at IDS. Touted as the first Class IIA (European Union) and Class II (USA) denture base resin that will yield a permanent restoration directly from 3D printing, the new Valplast resin is expected to be available once the production models of associated equipment are ready.
In August, DENTCA announced that its new 3D printable denture base material had received FDA clearance for long-term use in the mouth. This light-cured resin is indicated for fabrication and repair of full and partial removable dentures and baseplates, according to DENTCA. The company says 3D printing will make the denture production process quicker, more accurate, and more predictable.
Another new innovation is Harvest Dental’s ZCAD PolyGum™, a millable disc billed as an esthetic gingiva solution with its tissue coloration, vein simulation, and translucency.
Software
Another challenge has been the development of open-architecture, non-proprietary CAD software. However, several companies now are offering software for laboratories to utilize in the digital production of dentures.
Sirona Dental, Inc.’s completely open inLab SW 15 includes a new partial framework feature and a separate design element for producing restorations with a gingival component. The software can import any STL files and export to any mill.
Dental Wings’ DWOS Full Dentures CAD software offers a functional tooth setup and esthetic gingiva proposal. According to the company, there is no fastidious modeling of the gingiva necessary, as the software generates a natural look.
3Shape’s Denture Design software, which combines the flexibility of 3Shape’s Smile Composer™ with the Gingiva Creation Tool, now includes tools for improving denture occlusion and function.
Another new full denture module is available through exocad. This module analyzes edentulous models and occlusal rim to automatically provide both pre-articulated tooth setup and denture base proposals. Also, exocad plans to announce its new Partial Denture module in 2016.
Digital production of denture prosthetics is a new technological frontier in dentistry that promises to revolutionize a centuries-old production process. We are only at the threshold of future advancements and new possibilities.
Reference
1. Syrop J. Here Comes the [Baby] Boom [Business]. Inside Dental Technology. 2014;5(10):44-51.
About the Author
Keith Miolen, CDT, is a Pillar Scholarship recipient and COO of Aurora Dental Lab in Auburn, New York.
