CAD-CAM complete removable dental prostheses: A double-blind, randomized, crossover clinical trial evaluating milled and 3D-printed dentures

Murali Srinivasan,Nicole Kalberer,Nicolas Fankhauser,Manuel Naharro,Sabrina Maniewicz,Frauke Müller

doi:10.1016/j.jdent.2021.103842

Murali Srinivasan, Nicole Kalberer + Show 4 more

Open Access

https://doi.org/10.1016/j.jdent.2021.103842

Copy DOI

Abstract

ObjectiveThis double-blind, randomized, crossover, clinical trial aimed to evaluate and compare the differences between milled and 3D-printed complete removable dental prostheses (CRDPs). MethodsFifteen edentulous patients (men: n = 10, women: n = 5; age: 66.7 ± 8.0 years) rehabilitated with conventional CRDPs were recruited for this trial. Participants were randomized to first receiving either the milled or 3D-printed CAD-CAM manufactured CRDPs and then after 6-weeks cross over to the other set. Both, clinicians and participants were blinded to the group allocation. Outcomes included patient's denture satisfaction (PDS), oral-health related quality of life (OHIP-EDENT), willingness-to-pay analysis, final choice (FC) of CRDPs, clinician's denture quality evaluation (CDQE), chewing efficiency (CE), maximum-voluntary-bite-force (MBF), and prosthodontic maintenance needs. The outcomes were measured at baseline (with old CRDPs), at 1 and 6 weeks after new CRDP insertion; following crossover with the second set of CRDPs, an identical protocol was followed. Generalized linear regression for repeated measures was used for statistical analysis with α=0.05. ResultsAll participants completed the trial. 3D-printed CRDPs required more maintenance visits, adjustment time (p = 0.0003), and adjustment costs (p = 0.021). Patients were willing-to-pay an average of 606.67 Swiss Francs more than the actual cost for the milled CRDPs. There were no differences in the PDS, OHIP, FC, CDQE, CE, and MBF between the two CRDPs groups. ConclusionsThe findings of this double-blind randomized crossover clinical trial confirm that both milled and 3D-printed CRDPs are valid treatment modalities for edentulous patients, with the latter performing inferiorly with regard to the time and costs involved with the prosthodontic aftercare, as well as the patients’ willingness-to-pay. Clinical relevanceThe findings of this trial provide evidence to help the clinician in choosing the appropriate CAD-CAM manufacturing process for fabricating the CRDPs.

Highlights

There were no differences in the patient’s denture satisfaction (PDS), OHIP, final choice (FC), clinician’s denture quality evaluation (CDQE), chewing efficiency (CE), and MBF between the two complete removable dental prostheses (CRDPs) groups
The fabrication of complete removable dental prostheses (CRDPs) with the aid of computer aided designing and manufacturing (CADCAM) technology was first evaluated in the 1990s [1,2] and an exponential increase in its popularity has been witnessed in the recent years [3,4]
Within the participants an improvement was observed for the mandibular CRDP retention when comparing between the old and the new CAD- CAM CRDPs (p = 0.037, Table 3)

Summary

Introduction

The fabrication of complete removable dental prostheses (CRDPs) with the aid of computer aided designing and manufacturing (CADCAM) technology was first evaluated in the 1990s [1,2] and an exponential increase in its popularity has been witnessed in the recent years [3,4]. The process of fabricating CRDPs by CAD-CAM is achieved either by a subtractive process known as computerized numeric control (CNC) milling, or by an additive 3D-printing technique. The CAD-CAM fabrication of CRDPs is accomplished extensively by employing the CNC milling In the recent times the technique is gradually being employed more and more for fabricating definitive prostheses as well

Methods

Results

Discussion

Conclusion