IF I HAD TO RANK PROCEDURES in my dental office that I loathe, pulpotomies and stainless steel crowns would top the list, followed closely by dentures. Up until last year, I was making dentures precisely as I was taught in dental school—border molding, wax rims, try-in, remakes (because the new dentures don’t fit like the 30-year-old set)—the whole kit and caboodle. But now, a couple of steps have changed in my office, and I can say (with a smile) that dentures have been crossed off my loathsome list, and it is all because of 3-D printing.
If I had to rank procedures in my dental office that I loathe, pulpotomies and stainless steel crowns would top the list, followed closely by dentures. Up until last year, I was making dentures precisely as I was taught in dental school—border molding, wax rims, try-in, remakes (because the new dentures don’t fit like the 30-year-old set)—the whole kit and caboodle. But now, a couple of steps have changed in my office, and I can say (with a smile) that dentures have been crossed off my loathsome list, and it is all because of 3-D printing.
Recently, I’ve been promoting low-cost dentures in my office to get a feel for a new workflow. Pretty much all of the steps have changed. I am going to outline two different scenarios in which I have utilized 3-D printed dentures, and I will share with you how I am empowering my team members to become rising stars in our dental practice.
The first type of patient who can benefit from printed dentures is the denture-replacement patient. The digital workflow for printed denture duplication or replacement is the simplest, but the patient is usually the most difficult to please. Fortunately in this case, Ray’s existing upper denture fit wonderfully, but his teeth were extremely worn, broken, or missing altogether (figure 1). Anything I gave him would be an improvement.
The first thing I have to do is get a digital replica of the patient’s existing upper denture. For these scans, I use a desktop scanner (Open Technologies Deluxe desktop scanner) that is more accurate than any intraoral scanner. In my scanning software or dental CAD software (exocad), I call this denture scan the upper jaw. Then, I can use my intraoral scanner (Medit i500) to capture the lower jaw and jaw relationship.
Traditional bite registration and jaw relationship records require the patient to maintain the jaw position (centric relation) for a period of time while the registration material sets up and hardens. Digital bite registrations, on the other hand, only require the jaw relationship to exist for a few seconds while acquiring the scan. I am able to use a vestibular scan, also known as a buccal bite scan, to relate the upper and lower jaws in a matter of seconds, not minutes.
In this case, I used the patient’s existing denture and a vestibular scan to record his jaw relationship. The existing denture tissue surface provided the upper jaw scan. At this point in the initial appointment, I had taken records of the upper jaw, lower jaw, the jaw relationships, and established vertical dimension. I had obtained everything I needed to make this patient’s denture in a single appointment. All I had to do then was design and print the denture.
Next-day dentures fabricated in your office are now a thing of the present, not the future, and they are made possible with lower cost 3-D printers. There is now a wide range of resins available to print dentures. You can choose to print pink denture bases and shaded printed denture teeth, or you can print monolithic dentures from single resins (figure 2).
For this case, I chose to print a denture for the patient with a single upper using Formlabs denture teeth A2 shade resin.
Once the denture was printed and processed, I handed the case over to my team to apply the finishing touches. Pink gingiva composite (Anaxgum from Anaxdent) was added to the denture base, providing an acceptable result to the patient (figures 3–5).
Another type of denture case where 3-D printing can save the day is denture replacement. Margaret’s son misplaced her upper denture, so she needed a replacement (figure 6). Since her lost denture was made recently, a low-cost replacement denture was her best option.
I started from nothing in this case—just an edentulous arch without any tooth or bite references to use like we had with Ray’s replacement denture—so I needed to find some way to replicate a bite registration and get accurate records. I needed to establish vertical dimension and determine appropriate teeth shapes, sizes, and landmarks, such as midline and canine positions; all the boxes to check off during the traditional occlusal rim appointment. How did I do this digitally, and what did the process look like?
For Margaret, I took a step from Ray’s earlier workflow, and instead of taking records with a baseplate and wax rims, I jumped ahead to a resin try-in. I designed the entire denture digitally in exocad and printed with a more economical resin (Formlabs grey or clear resin). The resin try-in denture did triple duty as a custom tray, occlusal rim, and preliminary setup.
At this stage in the denture appointment process, I could have chosen to finish with an analog workflow and used a polyvinyl siloxane (PVS) wash in the printed resin try-in denture, or I could have stuck to the digital route and designed digital dentures using the corrected jaw relationship (figure 7).
These are, by no means, premium products for my patients, although next-day printed dentures do serve a need for my patient base and provide an excellent alternative to more expensive, multivisit dentures. More uses for printed dentures include multiple backup or extra sets and transitional and conversion dentures for implant-supported cases. Now that 3-D printers are becoming more accessible and user-friendly, they are quickly being integrated into everyday dental lab setups.
If you’re building out a space for your in-office dental lab, you might consider allocating counter space for a 3-D printer, postprocessing equipment, such as curing boxes and wash stations, and multiple resin cartridges.
But if there is all this extra work with new equipment, materials, and workflows, why would anyone want to incorporate a fully digital workflow into his or her office? The digital workflow provides an excellent expedited service for the patient, empowers team members, and offers myriad opportunities to get involved in patient care—all in a more cost-effective way compared to traditional protocols.
As for me, I get personal satisfaction out of delivering a product I fabricated without (too much) outside assistance (figure 8). But if I wasn’t saving much in the way of lab fees and other overhead, I probably wouldn’t have continued on this digital journey for too long.
Here are the approximate costs involved in controlling your overhead for a leaner digital workflow.
Costs for a single arch
- Digital design—The cost can be $25 per patient, or if you’ve invested in dental CAD software (exocad DentalCAD from xocademy.com), this can be the hourly wage for one of your rising stars in the office once you’ve trained and delegated the steps.
- 10 mL tooth resin per arch (Formlabs denture tooth resin)—$5
- Anaxgum gingival composite (Anaxdent) —$20
Added up, this gives me an arch for right around $50. Even with multiple prints for jaw relations and try-ins, I’m still under $100 for a completed arch. That’s less than a quarter of what my lab fees are with traditional steps and not utilizing rapid prototyping technology.
These are just a few of the added side benefits of 3-D printer technology
- Controlling your overhead by in-sourcing some steps that are traditionally done in a dedicated dental lab and use expensive manual labor
- Reducing appointment intervals due to lack of physical workups and delivery times
- Encouraging team members to become more involved in patient care (these steps can be delegated!)
- Leading your team by identifying new areas of education and growth.
By bringing your lab into your office, empowering your team members, and giving them opportunities to become rising stars at the forefront of the industry, you are not only helping them grow and take ownership of their patient care, but you are also lowering overhead costs, providing expedited services to your patients, and offering the latest in modern dental technology.
SHAWN VAN de VYVER, DDS, a digital dentistry instructor, lectures with his company, V.I.P. Courses, on in-office milling and dental CAD. He is on the digital dentistry faculty of Dental Success Network, a member of the International Digital Dentistry Academy’s Restorative Appliance Committee, and creator of the online exocad e-learning platform xocademy.com. His course schedule is available at vipdentalcourses.com, and you may contact him at firstname.lastname@example.org.