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29 October 2021

Removable complete dentures: CAD/CAM vs conventionally method

Lara Figini


Epidemiological investigations reveal that the life expectancy is getting longer, and people keep their natural teeth until old age, as tooth loss now almost always occurs in an older age segment. In the last decades, computer-assisted design and production techniques (CAD-CAM) have been added to the realization of total removable prostheses according to a proven and consolidated conventional method (CD), which allow the speeding up of times for the construction of dentures. , attributable to only two clinical visits. At the first visit, all the medical records and the fingerprints using intraoral scanning technology. The files are always sent to the dental laboratory in digital form, where the entire prosthesis is virtually designed. For some techniques it is even possible to preview the project by the clinician for approval, before the dental laboratory actually mills the total prosthesis. At the second clinical visit, the prostheses are ready for insertion. While this technology is still in its infancy, it can offer significant benefits especially for older patients, due to the fewer clinical appointments needed as well as the best fit ratios and better properties.


Materials and Methods
In a systematic review, available online on Journal of Dentistry, August 2021, the authors compared the differences between total removable dentures produced using CAD-CAM methodology and those produced conventionally (CD). In this review, 73 studies were included that reported data on the fabrication of dentures in the traditional way (CD) in comparison with those in CAD-CAM (milled / 3D-printed). The latest bibliographic search was performed on 03/15/2021.
Two researchers performed the literature search using the following electronic databases: PubMed (MEDLINE), Embase, CENTRAL, and online search engines (Google). A manual search of the gray literature was also carried out.
Studies that reported data on reliability, biocompatibility, mechanical, surface and chemical properties, chromatic and microbiological characteristics, analysis of the time-cost ratio and clinical results were included in the review. The meta-analysis was performed on the extracted parameters.


Results
Meta-analysis revealed that 3D printed CAD-CAM prostheses are more reliable than conventional prostheses (p = 0.039). Milled CAD-CAM prostheses demonstrated greater flexural strength than conventional and 3D printed CAD-CAM prostheses. Milled CAD-CAMs showed a higher flexural modulus than 3D printed CAD-CAMs (p <0.0001). Milled CAD-CAM prostheses showed higher yield strength than injection molded ones (p = 0.004) and 3D printed ones (p = 0.001). The milled CAD-CAM prostheses showed better hardness (p <0.0001) and surface roughness (p <0.0001) than the others. Traditional prostheses showed low color stability compared to the other groups (p = 0.029). CAD-CAM prostheses proved to be better in retention (p = 0.015). Conventional CD prostheses showed a higher point of deformation at yield than milled CAD-CAM prostheses (p <0.0001) and better aesthetic results than 3D printed ones (p <0.0001). The fabrication of CAD-CAM total prostheses required less time spent in the chair (p = 0.037) and lower overall costs (p <0.0001) compared to conventional CD prostheses.

Conclusions
From the data of this systematic review, which must be confirmed in other similar reviews, it can be concluded that the CAD-CAM removable complete dentures have a series of mechanical / surface properties better than those conventionally denutures, proving to be not inferior to conventional ones.


Clinical implications
The realization of total prostheses with CAD-CAM methodology should be considered for completely edentulous patients as this technique offers several advantages including better retention, better mechanical and surface properties but, above all, preserves the data digitally by reducing the realization times. This can be a great benefit for older people with difficulty reaching the dental facility multiple times and enduring prolonged treatment in terms of time.


For additional information:  CAD-CAM Removable Complete Dentures: A systematic review and meta-analysis of trueness of fit, biocompatibility, mechanical properties, surface characteristics, color stability, time-cost analysis, clinical and patient-reported outcomes


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