Construction of Complete Denture using CAD/CAM Technology
Oral infections affect most ageing population across the globe and this has been a subject
of concern of the past decades. Periodontal diseases, endentualism and gingivitis are some of the
oral infections which eventually lead to a person losing some of their teeth or all teeth
(Alghazzawi, 2016). Most hospitals across the world have developed advanced diagnosis
mechanism for the diseases. Advancement in technology has developed ways of treatment of the
infections efficiently and to satisfy patients demands. The computer aided design and computer
aided manufacturing is a digital advanced technology used in the fabrication of a complete
denture.
When patients teeth are removed or lost, then they always require a complete denture
construction. CAD/CAM technology uses the integration of computer software and laser
scanners to design artificial teeth that best suit a patient and is later milled and manufactured
through acrylic resins and inserted on a patients denture(Alghazzawi, 2016). Moreover, there are
also some digital advancement in this form of technology. This paper will therefore focus on
discussing computer-aided design and computer-aided manufacturing technique, the literature
review of the technologies for a complete denture, steps for complete denture fabrication,
conventional complete denture construction and lastly the advantages and disadvantages of
digital complete denture fabrication.
CAD/CAM Technology
Computer-aided design and computer- aided manufacturing is a technique of construction
of complete denture using several steps that design virtual appearance of the image and later the
manufacturing equipment mills the artificial denture in relation to virtual image. This technique
of complete denture proves to be more efficient as compared to other forms of complete denture
construction. The computer- aided design constitute of several techniques in the designing of
virtual image;, avaDent®, Ivoclar vivadent®, dentca™ and wieland® digital denture® (Janeva
et al., 2017).
These techniques work through different principles in designing of complete denture.
Wieland® digital denture® is a technique which uses integration of five axis milling equipment,
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laser scanner and computer software in the fabrication of a complete denture. AvaDent®
technique of complete denture fabrication applies the use of computer software, laser scanning as
the bases of the artificial teeth are trimmed by proprietary software. Dentca™ technique of
complete denture construction uses conventional method of artificial replacement to produce a
virtual representation of mandibular and maxilliary ridges for construction of a complete denture.
Computer manufacturing technique can be realize through subtraction technique which involves
visualization of clear images from interference and manufacturing acrylic resins into artificial
teeth for through milling. When the overall process of designing and manufacturing is done, the
artificial teeth are the inserted to a patient’s complete denture.
Literature Review of Different Digital Technologies used for Complete Denture Construction
The construction of complete denture dates back to 1980s when invention of technology
for construction of complete denture begun (Han et al., 2017). The traditional construction of
complete denture utilized aids of sight impression and manufacturing of artificial teeth from
plates and later insert them to a patients jaw. However, the traditional method of construction of
complete denture was inefficient due to painful nature of operation and the resultant construction
base was not also stable. This led to invention of another technique known as conventional
construction of complete denture. This method was more efficient than traditional method and it
also uses impression but through laser scanner or camera of 2D virtual display to construct
artificial teeth from acrylic resins.
Recently, the invention of computer-aided design and computer-aided manufacturing has
received tremendous recognition as a system which provides universal process of complete
denture construction efficiently and faster as compared to other forms of complete denture
construction. The system integrates the use of virtual imaging and scanning software in 3D form
to provide a clear representation of the scanned image for milling and manufacturing of artificial
teeth. Moreover, the CAD/CAM has been advanced through digital forms of complete denture
fabrication (Han et al., 2017). The digital complete denture fabrication is able to design 3D
images and formulate best suit of artificial teeth of a patient and construct the patient’s complete
denture. The Computer Numeric Control has also been designed to calculate analyze the
parameters and geometric shade of the artificial teeth to be constructed during complete denture.
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Advanced technology goes as far as radiology application in the scanning of the oral system
while examining or constructing a complete denture.
Technical steps of Complete Denture construction with CAD/CAM
The designing of complete denture begins with creation of work order which involves
creation of basal surface for the construction of complete denture while separating the upper and
the lower dentition and choosing the artificial teeth that suit the dentition structure. Collection of
3D digital models is then conducted through the 3D digital scanner to construct the virtual image
of wax occulsal plane rims in the mandibular, maxilliary base in artificial dentition structure
(Saponaro et al., 2016). Model analysis is then done to check for the arrangement and positioning
of the artificial teeth through 3D virtual image while considering mandibular, alveolar and
maxilliary teeth arrangement.
Model analysis works to design the best suit model for a patient’s dentition. The artificial
teeth are then arranged through adjusting the teeth in sagital, horizontal and coronal process
while arranging the dentition. Through this process the artificial teeth is inserted to the basal
layers of the ooclusal plane while fixing the teeth in the right geometric parameters for the
complete denture. Trimming relief area then follows to remove the defected parts of the
complete denture that may affect the insertion of the artificial denture. Occlusal adjustment is
then conducted through the computer aid to mimic the action of movement of the artificial teeth
and determine if there are any defects in the action of the artificial dental system. Finally the
artificial denture is inserted to the patient’s mouth as a restoration of the patient’s teeth.
Conventional methods of Complete Denture construction
Conventional method of complete denture is uses to construct artificial teeth for a patient
through impression of the teeth damage. Conventional construction is usually done 8-12 weeks
after the patients teeth are removed and examined for preparation of complete denture
construction (AlHelal et al., 2017). The method constructs artificial teeth from acrylic resins and
arranged along the waxed occlusal plane base through the mandibular and the maxilliary
alignments. After construction of a complete denture, the artificial dentition is inserted to the
patient’s mouth as a restoration of lost teeth.
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Advantages of conventional methods of CD construction
Conventional method of complete denture construction is relatively cheap and affordable to the
patients and the hospitals that purchase conventional equipment for replacing artificial teeth
(AlHelal et al., 2017). The process of manufacturing of the artificial teeth is simpler since
denture construction does not go through a complex process for replacing the complete denture
like the computer-aid design and computer-aid manufacturing.
Through Conventional denture construction the patient is able to gain or realize a normal activity
of a healthy person of biting, chewing, pronunciation and talking.
This method provides a person with a presentable appearance of the teeth and smile. Some of
the artificial teeth also enhance beauty since there are gold and silver artificial teeth that improve
the facial appearance of a person
Conventional method of complete denture is reliable and accessible since the technique is more
available to many hospitals as compared to other construction techniques that require
sophisticated methods of denture construction.
Conventional construction method also helps in maintaining hygiene to the mouth since the teeth
are waxed and acrylic hence they do not readily react to micro-organism that cause oral disease.
Conventional construction also appears to be more accurate since examination of the
performance of the teeth is done before insertion of the teeth in the mouth.
Disadvantages of conventional methods of CD construction
Administration of complete denture to a patient causes sore spots in the tissues of the mouth and
the gums due to compression exerted by the dental structure (AlHelal et al., 2017). However, this
effect can be corrected by adjusting the affected areas of the denture
This method supports the lower jaw with a weak base since the method uses waxing plates to
support the artificial teeth.
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The administration of artificial teeth is less efficient due to the pain experienced by patients
while administering the artificial teeth and the long duration of completing the process to acquire
complete denture.
Conventional administration method increases the reactivity of micro-organism to cause diseases
that affect the teeth. This is as result of the reactive wax and metal plates that rust and produce
bacteria that act on the surface of the gum.
The method is time consuming since patient wait for 8-12 weeks before insertion of a complete
denture (AlHelal et al., 2017). The patient also goes through several processes during the
insertion of a complete denture.
Digital compete Denture Fabrication
The digital complete denture fabrication is a method of denture fabrication which applies
CAD/CAM technique to design and manufacture artificial teeth structures in relation to the three
dimensional shapes displayed on computer screen (Russo & Salamini, 2018). This method is
reliable and effective however, it has some limitation that affects the manufacturing process.
Advantages of Digital complete Denture Fabrication
Through digital complete denture fabrication results are realized within a number of
appointments usually one or two appointments as compared to other forms of complete denture
fabrication such as convectional which require many appointments to meet complete denture
fabrication.
The shrinkage characteristics of acrylic base of the designed artificial teeth of resins or plates
increases the strength and reliability of fit of the denture to the gum surfaces where they are
aligned.
Digital complete denture fabrication helps eliminate and reduced duration for prosthesis
manipulation and reaction that causes bacteria to the gums or the tooth.
Complete denture fabrication decreases the risk of development of micro-organism that might
cause affect the gums or cause periodontal disease(Russo & Salamini, 2018).
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This method of dentition is advanced in the conduction of dentition research and clinical
removable prosthesis of antibacterial infections.
The method is easy and efficient to apply since the digital manufacturer duplicates the designed
image on the computer according to the geometric shape to fit the position and gums of the
mouth.
This method of dentition offers superior quality control by dentist and technicians in the
reviewing of the performance of the teeth and any movement that can alter the arrangement of
the teeth to its respective sites.
Disadvantages of Digital complete Denture Fabrication
Manufacturing challenges are posted in the overall design of the shape geometry caused by
OVD- recording procedures in the alignment of mandibular and maxilliary joints in the mouth to
support or fit the designed artificial teeth (Russo & Salamini, 2018).
Sometimes digital complete denture may find it difficult to define and interpret mandibular
occlusal plane to design the right artificial teeth to fit the respective sites of attachment.
Digital complete denture integrates sophisticated expensive equipment in the manufacturing of
artificial teeth hence increased laboratory cost and management as compared to other methods
such as convectional method.
There is also lack of trail denture and system that can wear the artificial teeth before it is proven
to meet the optimum effective condition on the area applied and gums of the teeth (Russo &
Salamini, 2018). The computer system is not able to design trial structures to check for
suitability of the designed artificial teeth.
Conclusion
Oral infection treatment has been a primary concern across several years to ageing
population in the world. These oral infections cause loss of partial or all teeth to the person.
However, technology has made it possible to construct a complete denture for patients. The
methods of constructing a complete denture include; conventional complete denture, traditional
and CAD/CAM techniques. Since the traditional complete denture construction technique was
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less efficient and unreliable, advanced construction of complete denture emerged to improve the
process of construction of a complete denture.
Computer-aided design and computer-aid manufacturing uses the computer software to
design shades of artificial teeth in 3D representation and manufacture the artificial teeth through
milling of acrylic resins. The method is more efficient and safe to patients during complete
denture construction. Advancement of the CAD/CAM technique in complete denture fabrication
has also contributed to more efficient result in the restoration of artificial teeth. Patients and
dentist should therefore utilize the advanced technique for complete denture construction.
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References
Alghazzawi, T.F., 2016. Advancements in CAD/CAM technology: Options for practical
implementation. Journal of prosthodontic research, 60(2), pp.72-84.
AlHelal, A., AlRumaih, H.S., Kattadiyil, M.T., Baba, N.Z. and Goodacre, C.J., 2017.
Comparison of retention between maxillary milled and conventional denture bases: a
clinical study. The Journal of prosthetic dentistry, 117(2), pp.233-238.
Han, W., Li, Y. and Zhang, Y., 2017. Design and fabrication of complete dentures using
CAD/CAM technology. Medicine, 96(1).
Janeva, N., Kovacevska, G. and Janev, E., 2017. Complete dentures fabricated with CAD/CAM
technology and a traditional clinical recording method. Open access Macedonian journal
of medical sciences, 5(6), p.785.
Russo, L.L. and Salamini, A., 2018. Removable complete digital dentures: A workflow that
integrates open technologies. The Journal of prosthetic dentistry, 119(5), pp.727-732.
Saponaro, P.C., Yilmaz, B., Heshmati, R.H. and McGlumphy, E.A., 2016. Clinical performance
of CAD-CAM-fabricated complete dentures: a cross-sectional study. The Journal of
prosthetic dentistry, 116(3), pp.431-435.