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Article history: Patient: A 60-year-old man presented for refabrication of his maxillary complete denture. In this case, a
Received 23 January 2017 digital process was chosen to replace the ill-fitted complete maxillary denture. A specialized scan
Received in revised form 19 April 2017 retractor was used to retract the mobile tissues of the lips, cheeks and vestibule while taking a digital
Accepted 24 May 2017
impression. The interocclusal record obtained in the patient’s mouth was scanned in order to digitally
Available online 16 June 2017
register the occlusal vertical dimension. The denture base and teeth were designed on virtual models that
were mounted at the occlusal vertical dimension, and were made using CAD/CAM technology.
Keywords:
Discussion: Unlike conventional impression techniques, intraoral scanning is not able to be performed
Digital denture
Complete denture
while the tissue is moving. This case report used a scan retractor that facilitated stretching and fixation of
Digital impression the vestibular area. It also helped to retract the lips and cheeks. This report also demonstrates that virtual
Dental CAD/CAM models at OVD can be obtained without the use of conventional stone models, flasking or processing
techniques. One of the main shortcomings in the existing CAD/CAM denture fabrication technology is
that it is not able to produce customized denture teeth. The present article demonstrates that the digital
denture fabrication workflow can provide customized denture teeth to optimize occlusion.
Conclusion: This case demonstrated how digital complete dentures can be made without requiring
conventional stone models or mounting the models in an articulator.
© 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jpor.2017.05.005
1883-1958/© 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
J.-H. Fang et al. / journal of prosthodontic research 62 (2018) 116–120 117
Fig. 1. Preoperative clinical view. Fig. 3. Scan retractor positioned on the maxillary edentulous jaw.
Fig. 2. Specialized scan retractor for digital impressions of the maxillary edentulous
jaws.
Fig. 5. Scanned image of the mandible taken using an intraoral scanner (TRIOS).
Fig. 9. Virtual models that were mounted according to the scanned interocclusal
record.
Fig. 6. Record base made using heavy and light-body putties.
Fig. 7. Interocclusal record made by injecting interocclusal record material into the
area between the record base and the occlusal surfaces of the mandibular teeth.
edentulous arch (Fig. 6). A vinyl polysiloxane interocclusal record Fig. 10. Virtual models mounted at OVD.
material (EXABITE II NDS Bite Registration Creme; GC America Inc.,
Alsip, Il, USA) was injected into the area between the record base interocclusal record (Fig. 9). In order to do so, the two scanned
and the occlusal surfaces of the mandibular teeth. The patient’s images were aligned using the interocclusal record image by
mandible was then immediately guided to the OVD, where it was means of best-fit matching. After mounting the two scanned
stabilized until the interocclusal record material was completely images, the interocclusal record image was deleted. Next, the
polymerized (Fig. 7). The interocclusal record was then removed virtual models mounted at the OVD were obtained (Fig. 10). The
from the mouth and scanned using the intraoral scanner (Fig. 8). obtained data were imported into the software to design the
The scanned maxillary edentulous jaw and the scanned mandibu- complete dentures. The denture base and maxillary teeth were
lar teeth were virtually mounted according to the scanned virtually designed by using denture planning software (Dental
J.-H. Fang et al. / journal of prosthodontic research 62 (2018) 116–120 119
patient’s edentulous jaw. The second step is to digitally register the well on the patient’s arch without relining it. One of the main
OVD. The last step is to mill the denture bases and teeth using CAD/ shortcomings in the existing CAD/CAM denture fabrication
CAM technology. The first step was the most difficult in this case; technology is that it is not able to produce customized denture
this was because the mobile tissue of the lips, cheeks, and vestibule teeth. The present case demonstrates that the digital denture
constantly changed while taking the digital impression. Unlike fabrication workflow can provide customized denture teeth to
conventional impression techniques, intraoral scanning could not optimize occlusion. A further controlled clinical study will be
be performed while this tissue was moving [9]. It was more necessary to determine whether the digital workflow for dentures
difficult to scan mobile soft tissues, such as the vestibule, than it is an improvement over the conventional technique in terms of
was to scan immobile soft tissues, such as the palate or alveolar denture-base fitness and occlusion.
ridge. The main advantage of the scan retractor used in this case is
that it facilitated stretching and fixation of the vestibular area. It 4. Conclusion
also helped to retract the lips and cheeks. The time needed for the
full-arch scans was approximately 2 min for the maxillary arch and This report presents a digital workflow for CAD/CAM fabricated
1.5 min for the mandibular arch. During the intraoral scanning complete dentures. Digital impressions of edentulous jaws are
procedure in the edentulous patient’s mouth, the patient felt taken directly in patients’ mouths using a specialized scan
comfortable and pleasant in the dentist’s chair. During the retractor and intraoral scanner. The digital registration of the
intraoral scanning procedure in the edentulous patient’s mouth, maxillomandibular relationship is made using scanned images of
there were no specific stitching problems. However, many pictures the interocclusal record. Both the denture base and teeth are milled
were taken, and considerable time was required to stitch the using CAD/CAM technology. This digital workflow allows dentists
separated pictures. Approximately 2000 3D pictures were used to to make complete dentures without using conventional stone
capture the maxillary arch and about 4 min were needed to stitch models or mounting stone models in an articulator.
the pictures, whereas approximately 1000 3D pictures were used
to capture the mandibular arch and about 2 min were needed to Acknowledgments
stitch the pictures.
With regard to the second step in the digital denture fabrication The author would like to express appreciation for the support
workflow, scanned images of the interocclusal record were used to provided by the Ministry of Trade, Industry & Energy (MOTIE,
record the maxillomandibular relationship. Virtual models were Korea) under Industrial Technology Innovation Program (grant #
mounted according to the scanned interocclusal record. Prior to 10060000).
this case, it has not been possible to use intraoral scanners to
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