J Adv Prosthodont.  2017 Oct;9(5):381-386. 10.4047/jap.2017.9.5.381.

Integrating 3D facial scanning in a digital workflow to CAD/CAM design and fabricate complete dentures for immediate total mouth rehabilitation

• Hassan B
• Greven M
• Wismeijer

• KMID: 2393224
• DOI: http://doi.org/10.4047/jap.2017.9.5.381

Abstract

PURPOSE
To integrate extra-oral facial scanning information with CAD/CAM complete dentures to immediately rehabilitate terminal dentition.
MATERIALS AND METHODS
Ten patients with terminal dentition scheduled for total extraction and immediate denture placement were recruited for this study. The patients were submitted to a facial scanning procedure using the in-office PritiMirror scanner with bite registration records in-situ. Definitive stone cast models and bite records were subsequently submitted to a lab scanning procedure using the lab scanner (iSeries DWOS; Dental Wings). The scanned models were used to create a virtual teeth setup of a complete denture. Using the intra-oral bite records as a reference, the virtual setup was incorporated in the facial scan thereby facilitating a virtual clinical evaluation (teeth try-in) phase. After applying necessary adjustments, the virtual setup was submitted to a CAM procedure where a 5-axis industrial milling machine (M7 CNC; Darton AG General) was used to fabricate a full-milled PMMA immediate provisional prosthesis.
RESULTS
Total extractions were performed, the dentures were immediately inserted, and subjective clinical fit was evaluated. The immediate provisional prostheses were inserted and clinical fit, occlusion/articulation, and esthetics were subjectively assessed; the results were deemed satisfactory. All provisional prostheses remained three months in function with no notable technical complications.
CONCLUSION
Ten patients with terminal dentition were treated using a complete digital approach to fabricate complete dentures using CAD/CAM technology. The proposed technique has the potential to accelerate the rehabilitation procedure starting from immediate denture to final implant-supported prosthesis leading to more predictable functional and aesthetics outcomes.

Keyword

Prosthodontics; CAD/CAM; Facial scanning; Digital dentistry; Immediate denture

MeSH Terms

Dentition
Denture, Complete*
Dentures
Esthetics
Humans
Jaw Relation Record
Mouth Rehabilitation*
Mouth*
Polymethyl Methacrylate
Prostheses and Implants
Prosthodontics
Rehabilitation
Tooth
Polymethyl Methacrylate

Figure

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  Fig. 1 (A) Clinical photograph of the preoperative situation demonstrating the pathological tooth migration resulting from advanced periodontitis, (B) Digital 3D model of the preoperative intraoral situation with the bite record, (C) Digital immediate denture design proposal based on existing bite records.

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  Fig. 2 (A) Facial scan in natural position with lips sealed, (B) Facial scan with exaggerated smile, (C) Facial scan with cheek retractors to expose the labial teeth surfaces.

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  Fig. 3 (A) Reference image for the facial scanning registration procedure, (B) The forehead region in the facial scan with maximum smile is used as a fixed fiducial reference for the matching (registration) procedure, (C) The forehead region in the facial scan with cheek retractors is used as a fixed fiducial reference for the matching (registration) procedure.

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  Fig. 4 Registration of the digital 3D intraoral situation with the cheek retractor facial scan using the labial teeth surfaces as fixed reference.

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  Fig. 5 The matched (registered) digital 3D intraoral situation with the facial scanning.

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  Fig. 6 (A) The preoperative 3D intraoral scan overlaid on the smiling position facial scan, (B) The virtual immediate denture design proposal overlaid on the smiling position facial scan.

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  Fig. 7 (A) The polished milled upper immediate denture, (B) The polished milled lower immediate denture.

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  Fig. 8 The immediate denture in-situ.

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  Fig. 9 (A) The 3D printed immediate custom individual tray, (B) The definitive bite record taken with Avadent bite registration material.

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  Fig. 10 (A) The virtual teeth try in for the definitive prosthesis, (B) The definitive denture in-situ.

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