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Total prosthesis fabrication: Traditional and digital methods

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Find out more about the fabrication of complete dentures - from traditional methods to digital technologies. 

1. Total prosthesis: Masterful fabrication for a perfect fit

The manufacture of complete dentures is an important area of dentistry that is characterized by continuous innovation. Toothlessness can severely impair quality of life. Eating, speaking and laughing become a challenge. A complete denture can help by replacing the missing teeth and restoring chewing function and appearance. This article provides a comprehensive insight into traditional and modern fabrication methods for complete dentures and shows how modern technologies are revolutionizing the field of complete dentures.

1.1 Basics of complete dentures

Definition of 

A complete denture, also known as a full denture ("dentures" or "third teeth" in common parlance), is a complete denture that is used to replicate a patient's entire natural dentition. It is used for people who no longer have any natural teeth due to tooth loss, illness or injury. The complete denture consists of a base that imitates the gums and jawbone and is made from a biocompatible plastic such as acrylic, as well as artificial teeth that are embedded in the base. 

Aim and functions of full dentures
The aim of a full denture is to replace missing teeth and the degraded jawbone in the upper and/or lower jaw. Complete dentures fulfill various functions:

1. Strengthening self-esteem and quality of life

Complete dentures restore the natural appearance of the dentition and thus improve the wearer's self-confidence and quality of life. They provide a natural facial shape by filling the space created by the loss of natural teeth. 

2. Restoration of chewing function and improvement of speech function

They allow users to chew and grind food effectively, which is essential for digestion. Making and fitting a complete denture requires a high level of expertise and precision, as they need to be customized to each patient's oral structure to ensure maximum comfort and functionality. Complete dentures also help with correct pronunciation and support articulation. 

3. Strengthening of the facial contours and prevention of bone loss in the jaw area

By supporting the correct alignment of the jaw, full dentures help to maintain the structure of the face and prevent further bone loss in the jaw area, which often occurs after tooth loss.

In conclusion, complete dentures significantly improve the quality of life of patients without teeth by making chewing and speaking easier, increasing self-esteem and facial aesthetics and also promoting the health of the jawbone.

1.2 Target group for complete dentures

The target group for complete dentures mainly includes people who have experienced a complete loss of their natural teeth, either in one or both jaws, as mentioned above. Here are some specific groups that often require complete dentures:

Older adults: As people age, they can lose their natural teeth due to various causes such as tooth decay, gum disease or injury. Complete dentures are a common solution to restore the function and aesthetics of the mouth in this age group.

People with extensive tooth loss: Some people lose all their teeth at a young or middle age. This can be caused by genetic conditions, nutritional deficiencies, certain diseases or accidents.

Patients with significant gum and bone problems: Individuals who have significant gum and bone recession and who are not candidates for implants or other dental procedures may also benefit from complete dentures.

People looking for cost-effective solutions: Compared to other dental treatments such as implants, complete dentures can be a more cost-effective option for total tooth loss.

The decision to opt for complete dentures is often a combination of functional and esthetic considerations, and they offer a viable solution to improve the quality of life of those affected.

1.3 Materials

Complete dentures are primarily made of PMMA, a special pink plastic that is widely used in medical applications for dental prostheses. In addition to PMMA, other types of plastic such as acrylates, polycarbonates and polyamides are also used, particularly for the production of prosthetic elements such as pads, support structures and retaining devices.

In addition, metal alloys, including those made of cobalt-chrome, are used for the framework and retainers of partial dentures. Titanium is also valued for its durability and strength, particularly in dental implants, which help to improve the stability of complete dentures.

The decision for the right material is made according to the patient's individual needs. A careful discussion of the advantages and disadvantages of different materials between the dentist and the patient is crucial in order to make the ideal choice.

1.4 Traditional (analog) production methods

The traditional manufacturing process for complete dentures is based on manual techniques that have been tried and tested over many years and enable a high degree of adaptability to individual patient requirements. The sequence of this process can be described as follows:

1. Initial examination and treatment planning (dental practice):
At the beginning of the process, the dentist or dental technician will carry out a comprehensive examination of the patient's mouth to assess the general health of the mouth and determine specific requirements. This will determine whether complete dentures are suitable and an individualized treatment plan will be created.

2. Situational impression (dental practice):
In the dental practice, an impression material is used to create an exact impression of the patient's upper and lower jaw. This situation impression serves as the basis for creating an initial model of the dentition.

3. Situation models (dental laboratory):
The impressions are then sent to a dental laboratory where situation models of the jaw are made. These models serve as a template for the design of the prosthesis and enable the dental technician to precisely adjust the size and shape of the future prosthesis by producing a customized plastic impression tray for the subsequent functional impression of the future prosthesis.

4. Functional impression (dental practice):
After the initial assessment of the situation models, the functional impression is taken. This is more detailed and aims to capture the exact contours of the oral cavity and in particular the gums to ensure an optimal fit and functionality of the prosthesis.

5. Model making (dental technician):
After the functional impression has been taken, the dental technician again makes models on which he prepares aids using bite templates or bite registrations to determine the exact relationship of the upper jaw to the lower jaw.

6. Bite registration (dental practice):
In this step, the relationship between the patient's upper and lower jaw is determined. The dentist uses special materials and techniques to determine how the jaws relate to each other. This is crucial for the subsequent comfort and functionality of the prosthesis. 

7. First and, if necessary, second fitting (dental practice): The prosthesis is initially fabricated provisionally and presented to the patient for fitting. This involves checking whether corrections are necessary with regard to fit, bite position or aesthetics and phonetics. After adjustments have been made, a second fitting is carried out.

8. Completion (dental laboratory): Based on the feedback and adjustments from the try-ins, the prosthesis is finished in the laboratory. Attention is paid to high aesthetics and functionality.

9. Insertion (dental practice): In the final step, the finished prosthesis is fitted to the patient. This ensures that it fits perfectly and that the patient feels comfortable with the new dentures.

1.5 Digital manufacturing process

The digital manufacturing process for complete dentures ensures precise results and improves efficiency and accuracy.

1. Digital production process: 
The entire process is digital, which enables 
a high level of predictability, consistency and reproducibility.

2. Impression taking with an intraoral scanner: 
Instead of traditional impression materials, an intraoral scanner is used to create a digital image of the oral cavity. This enables precise and comfortable impressions without the traditional discomfort.

3. Bite registration with digital models: 
Digital technology allows bite registration and jaw movements to be determined directly in the patient's mouth using special hardware and software. The recorded data of the jaw relation and the movement of the lower jaw are automatically used in the design software.

4. Prosthetic diagnostics and tooth set-up: 
A virtual avatar of the patient is created using the digital data. The digital tooth set-up is carried out on this basis, whereby the position and alignment of the teeth are planned virtually.

5. Digital fittings and adjustments:
 Using digital technology, fittings and necessary adjustments can be carried out virtually, enabling fast and efficient fitting.

6. Completion: The final digital data of the full denture is designed in CAD software and sent via CAM software to the milling machine, where the denture is manufactured from the selected material.

1.6 The differences: advantages and disadvantages of analog and digital processes

1. Accuracy of fit and shrinkage

Digital: In the digital process, the accuracy of fit of dentures is often higher, resulting in greater consistency and a lower error rate. This is due to the fact that the digital impression and computer-aided fabrication enable a very precise reproduction of the oral conditions. 

CAD/CAM systems reduce human error and increase precision. In addition, the shrinkage that can occur with traditional materials during the curing of impression materials or casting materials is eliminated.

Analog: With analog fabrication, there is a risk of some shrinkage of the materials during the setting or curing process. This can affect the accuracy of fit of the finished prosthesis and often requires additional adjustments by the patient. The accuracy of fit can vary with analog methods as it is highly dependent on the craftsmanship of the technician. Traditional materials such as plaster used in the modeling process can shrink or distort, affecting accuracy.

2. Functional impression

Digital: One challenge of digital technology is the functional impression. While the digital capture of the static conditions of the dentition works well, it is more difficult to precisely capture the dynamic aspects of mouth movements (such as chewing or speaking) digitally. 

Analog: The analog functional impression makes it possible to capture the patient's individual dynamic mouth movements more accurately. This is particularly important for the functional fit and comfort of the denture.

3. Adaptability in the workflow

Digital: The digital workflow offers many advantages (faster, more predictable processes), but is still limited in terms of adjustments during treatment. In most cases, only minor adjustments to the tooth set-up can be made chairside (i.e. directly at the treatment chair). Larger adjustments often require a return to the digital planning and production process.

Analog: The analog method allows more extensive adjustments to be made directly in the dental practice. This can be particularly advantageous if unexpected changes become necessary during the fitting. The ability to react directly and flexibly to such situations is a clear advantage of the traditional approach.

In summary, digital methods offer advantages in many aspects of denture fabrication, especially in terms of precision and workflow efficiency, while analog methods can still be irreplaceable in certain situations due to their adaptability and proven techniques.

1.7 Conclusion: Full dentures - precisely manufactured for better functionality and patient comfort

The fabrication of complete dentures is on the verge of a revolutionary development, with digital CAD/CAM technologies increasingly taking center stage. These advanced methods offer more cost-effective and faster manufacturing processes, more precise results and an improved patient experience. Future technological innovations could further reduce the differences between conventional and digital methods and enable even more accurate, patient-focused prostheses.

Professionals interested in innovative digital manufacturing solutions for complete dentures will find comprehensive advice and customized products at imes-icore. We cordially invite you to get in touch with us.