Digital Denture Workflow Enables Patient Satisfaction; A Prospective Cohort Study

Objectives: Conventional dentures require careful adjustment at delivery to account for processing errors. This often extends over several patient visits and increases cost and burden of therapy. This object of this study was to determine the patient satisfaction and adjustment burden for complete dentures produced using a digital denture workflow and CAD/CAM milled prostheses.
Methods: Twenty one edentulous (> 6 months) subjects were recruited and consented to this IRB approved study. Dentures were fabricated using a four visit protocol involving a) preliminary impressions, centric relation (CR) record and facebow recording (ITS CAD, Ivoclar); b) final impressions and CR record using CAD/CAM impression trays and integrated CR recording (Gnathometer CAD, Ivoclar); c) try-in of milled denture prototypes and communication of design adjustment, d) delivery of milled definitive dentures. Patients were followed 1 week, and 6 months later to evaluate satisfaction, denture stability, and denture quality.
Results: Workflow analysis revealed 100% acceptance of custom trays. Five of the 21 subjects (24%) required more than two try-in appointments for varied reasons. At delivery, two of 21 subjects required clinical adjustment for CR discrepancy, and 1 subject required esthetic modification. Dentists found denture stability and retention to be high in all but one case, where undercuts precluded accurate milling of the maxillary denture base. Dentists’ esthetic satisfaction was high (entirely satisfied/satisfied. No subject indicated “Unsatisfied” and one registered “moderated criticism” at the baseline assessment; all other subjects were “satisfied/entirely satisfied at baseline.” Fifteen of 21 subjects required one or no post-delivery denture adjustment. Complications following delivery include one tooth fracture, two high plaque accumulation.
Conclusions: Consistently stable and retentive dentures associated with few post insertion adjustment and with high patient satisfaction were provided by milling of dentures using a digital workflow. Continued workflow improvements have enhanced success at the try-in stage of care.