Which clinical and laboratory procedures should be used to fabricate digital complete dentures? A systematic review

Abstract

Digital workflows for digital complete denture fabrication have a variety of clinical and laboratory procedures, but their outcomes and associated complications are currently unknown. The purpose of this systematic review was to evaluate the clinical and laboratory procedures for digital complete dentures, their outcomes, and associated complications. Electronic literature searches were conducted on PubMed/Medline, Embase, and Web of Science for studies published from January 2000 to September 2022 and screened by 2 independent reviewers. Information on digital complete denture procedures, materials, their outcomes, and associated complications was extracted. Of 266 screened studies, 39 studies were included. While 26 assessed definitive complete dentures, 7 studies assessed denture bases, 2 assessed trial dentures, and 4 assessed the digital images only. Twenty-four studies used border molded impression technique, 3 studies used a facebow record, and 7 studies used gothic arch tracing. Only 13 studies performed trial denture placement. Twenty-one studies used milling, and 17 studies used 3D printing for denture fabrication. One study reported that the retention of maxillary denture bases fabricated from a border-molded impression (14.5 to 16.1N) was statistically higher than the retention of those fabricated from intraoral scanning (6.2 to 6.6N). The maximum occlusal force of digital complete denture wearers was similar across different fabrication procedures. When compared with the conventional workflow, digital complete dentures required statistically shorter clinical time with 205 to 233minutes saved. Up to 37.5% of participants reported loss of retention and up to 31.3% required a denture remake. In general, ≥1 extra visit and 1 to 4 unscheduled follow-up visits were needed. The outcomes for patient satisfaction and oral health-related quality of life were similar between conventional, milled, and 3D-printed complete dentures. Making a border-molded impression is still preferred for better retention, and trial denture placement is still recommended to optimize the fabrication of definitive digital complete dentures.