How Digital Can Your Denture Workflow Get?

As digital dentures become more advanced and efficient in the past year, there are optimal ways to leverage them in the dental practice. Knowing how to do this starts with knowing what the digital denture ecosystem looks like now.

So, what's new in the digital denture space? J. Wayne Leonard, DMD, FICOI, Regional Doctor Mentor of Operations at Heartland Dental and clinician in Jacksonville, Florida, says digital dentures have exploded as a topic of interest in dentistry within the last year. More and more, general dentists realize that using scanners and 3D printers can save time, improve quality, and enhance esthetics in denture fabrication.

"Scanners have improved by leaps and bounds, and the majority of companies involved in scanning are emphasizing removable prosthodontics," Dr Leonard says. "The improved ability of scanners to accomplish complex scanning allows all dentists with scanners to jump into the digital denture world."

Dr Leonard also thinks that digital denture design is another exciting opportunity that continues to improve. This area is critical for laboratories, as technicians trained in traditional removable prosthodontics are becoming harder and harder to find.

"Just a decade ago, there was legitimate concern that removable prosthodontics would become a lost art in the laboratory world," Dr Leonard says.

By shifting to digital design rather than wax-based denture setups, Dr Leonard says newer technicians can use their digital training to support removable prosthodontics in the laboratory industry. He also says 3D printing continues to gain traction as a realistic option for denture fabrication.

"As materials continue to improve, 3D printing will replace traditional resin dentures as the restoration of choice," Dr Leonard explains. "For our labs, this shift will continue to allow them to keep up with industry demand, as technicians who are trained in traditional techniques leave the industry."

Neha Mehra, Principal Product Marketing Manager at Dandy Labs, agrees that digital denture technology has improved quickly. However, a misconception that printed dentures aren’t suitable as final restorations persists in the dental community. Mehra says that with 3D-printed dentures, the final product is a beautiful appliance if you use suitable materials and the right design library.

"I'm constantly blown away by how good these look," Mehra says. "Most people, and even most dentists, cannot tell the difference between a fully printed denture versus a conventional denture or milled denture."

"Companies like Dentsply Sirona that are dominant in traditional denture workflows have embraced 3D printing denture teeth and bases through resin development and helped to bring digital to the forefront," Miles Schuck, Head of Digital Dentures for Dandy Labs, agrees.

The Benefits of Digital Dentures for a Dental Practice

Dr Leonard says there are 2 critical aspects to the digital denture process, record-taking, and laboratory work. He also says the record-taking component is often overlooked, but scanners provide tremendous opportunities to save time.

For example, Dr Leonard says most patients present with some sort of existing denture, whether a healing denture, their current denture, or an ill-fitting one they never wear. Scanning these dentures and using them as a record-taking piece can save a tremendous amount of time and appointments.

"Final impression, bite registration, and try-in can be completed in 1 single visit," Dr Leonard says.

On the laboratory side, Dr Leonard thinks digital design and 3D printing allow for much better design customization. He says dentists who use digital design are not limited to standard denture tooth forms.

Schuck agrees digital denture design gives technicians more control over the anatomy and esthetics of the finished product. While additional finishing and characterization are still done by hand, Schuck says the software can handle things like stippling and festooning.

"With traditional workflows, you are super reliant on the talent of the individual technician. Because we can control so much from a design perspective and codify that in standard operating procedure, it gives us greater consistency overall. There is less reliance on the human element," Schuck says.

Dr Leonard adds that designs developed by dentists are replicated more accurately. Also, printed dentures continue to get stronger, and having them printed as 1 material decreases the risk of tooth separation.

3D printed resins have come a long way in the past year, too, Schuck says. Historically, 3D printed resins were neither esthetic nor strong enough to be a final prosthesis. However, the resins available now are as strong as traditional materials and carded teeth. Print-ready denture resins increase workflow efficiency, benefiting patients and clinicians alike with faster turnaround times.

"We're now doing dentures where you place an order on a Monday, and you can get the final prosthesis back the following Monday," Schuck says.

Moreover, the improvements in technology help practices capture scans for dentures, a less-than-ideal part of the workflow in the past. Dandy sends its dental practices a complimentary intraoral scanner to use with Dandy's online customer portal. Schuck says many dental practices are successful with the denture scanning process, whether for a new appliance or existing denture replacement, increasing digital dentures' popularity.

"With these workflows, it has allowed practices to get patients out the door with a brand-new denture without having to do 5 to 10 appointments," Schuck says.

"It makes it a more pleasurable experience, not just for the patient but for the dentist. We all know that dentures have an arduous workflow otherwise. So, to make it so much easier, it helps a practice be more willing to take more of those cases on," Mehra says.

In addition to quick turnaround times and fewer appointments, the digital workflow also increases patient acceptance. Learning that after 1 appointment, they can return to pick up their denture is a significant patient motivator to move forward with treatment, particularly in rural settings.

Dandy's digital denture program has existed for nearly a year. Schuck describes the growth of the program as "mind-blowing." In the beginning, they were doing just a few cases a month to thousands now. In addition, more dentists want to offer dentures now that they are digital. He attributes the program's popularity to the intuitive workflow practices enjoy and the improvements to the denture delivery process.

"They are looking for time savings, to grow their book of business, and to avoid having to do the cumbersome parts of analog workflows, like manually moving teeth or physically shipping to the lab," Schuck says. "That's changed a lot in the last year or 2."

How to Get Going with Digital Dentures

When it comes to advice for dental practices regarding adopting a digital denture workflow, Dr Leonard encourages clinicians to "dive in!" Dr Leonard started scanning 25 years ago using that approach, and he sees a similar path to success for digital denture workflows.

"Whether or not an office goes completely digital for dentures, there are so many opportunities to utilize scanners and 3D printers at some level in the area of removable prosthodontics," Dr Leonard explains. "With digital dentures, look for opportunities to scan existing dentures to facilitate record taking. This technique is utilized by many labs and is easy to learn. Also, have a conversation with your lab and see what options are available for digital design and 3D printed dentures."

Schuck says that partnering with a lab that provides resources to train and educate you on the digital denture process is also critical. For example, Dandy's training and education program include having certified technicians use TeamViewer to remote into the clinician's operatory to check scans and offer advice. Schuck says this extra guidance can help a practice get started because the first few cases can be tricky. Plus, it allows practices to get through the learning curve and its challenges.

"By showing how the benefits can outweigh the initial workflow transition, we're seeing practices have a ton of success," Schuck explains. "If you practice ahead of time, whether scanning a bite rim or scanning an existing denture, and you ask for help, then you're going to have success in that first case. After that, it becomes easier and easier until eventually, you won't believe you ever had to do this with the traditional methods."

"All of our workflows are reproducible, so you can also train your staff to start scanning. Then, you can take even more patient appointments than you typically do because your assistant is scanning while you take another patient," Mehra says. "So, there's more efficiency gain there."

In addition, Dandy encourages practices to communicate through the digital portal's Rx feature any specific information about what the dentist wants to change, like adjusting vertical dimension or the midline. Schuck and Mehra think leveraging your lab's resources is an excellent way to transition into digital dentures. It not only helps you with the knowledge you need to transition, but it also manages the change process.

"It can be frustrating if you don't have that support and that training because it is a completely different workflow," Mehra says. "Maybe newer dentists are taught to scan intraorally, but most have not experienced that. So, they are learning something completely new, and having those resources is key. And you need to have a lot of patience with yourself, and communication is key."

"If you are trained correctly, you will be successful," Schuck agrees. "The better communication we can have with the doctor, the more likely we will succeed in those initial cases."