Definitive Impression Research Articles

A Questionnaire-based Study on Impression Materials and Techniques for Complete Denture Construction among Dentists Practicing in Central/Western Regions of Libya

Background: The success of complete dentures mainly depends on impression-making accuracy; thus, dentists need to select the proper impression materials and techniques to achieve optimal outcomes. Objective: To determine the favoured impression materials and techniques used for complete denture construction among dentists practicing in the Central/Western regions of Libya. Materials and Methods: This study was conducted between July 2023 and September 2023. The questionnaire was comprised of 30 questions, which were divided into two parts including; 11 questions for demographic and professional attitude and 19 questions focused on professional steps of complete denture fabrication for edentulous patients. Results: The response rate for this questionnaire was (66%). It was revealed that (96.1%) of respondents used only irreversible hydrocolloid (alginate) as an ideal option for primary impressions. In response to the same question for final impressions, (45.8%) of participants exhibited that polyvinylsiloxane was the favourite choice. Regarding custom trays, (41.7%) of practitioners preferred using light-cured acrylic resin as a custom tray to take definitive impressions. (87.4%) of prosthodontists border molded the custom tray in sections by (81.9%), using modelling plastic impression compound by (92.1%). The most used philosophy for final impression making was the mucostatic impression technique by (50.4%), while (37.0%) used selective pressure and (12.6%) selected muco-compressive. Implant-supported overdenture was discussed as an alternative treatment by (65.4%). The obtained data was statistically analyzed using SPSS 28. Conclusion: This study reflects a diversity of opinion among Libyan dentists during the construction of complete dentures. The most commonly used material for primary impression was irreversible hydrocolloid (alginate) and for final impression was polyvinylsiloxane, which coincides with professional practices worldwide. Modelling plastic impression compound was the most preferred material for border molding. The mucostatic technique was the predominantly used impression philosophy for final impression making.

The effect of bioelectric and manual impressions on quality of complete dentures and quality of life: A cross over pilot study

PurposeTo compare the quality of complete dentures and quality of life of participants rehabilitated by using TENS (Transcutaneous electric nerve stimulation) facilitated impression making with manual impressions. Material and methodsTen completely edentulous participants were enrolled in the crossover, pilot study. Participants were randomized in 2 groups. Five participants in each group were rehabilitated by dentures fabricated with TENS facilitated definitive impression technique (group T) and conventional impression technique (group C). In group T, Bioelectric border molding was done for the participants, that uses electric stimulation of the nerves supplying the muscles. In group C, incremental border molding using modeling plastic impression compound was carried out. Participants in each group used the dentures for 3 months. After 3 months, OHIP-EDENT questionnaire responses were obtained from the participants to observe the oral health related quality of life. A dental specialist recorded denture quality by Kapur scoring criteria. After one month wash period, the treatment was swapped between the groups. OHIP-EDENT scores and Kapur score were recorded for the alternate dentures after 3 months of use. Descriptive analysis was followed by Mann Whitney test to compare the overall scores between group T and group C for OHIP-EDENT, the scores for individual domains of OHIP-EDENT, and Kapur score for denture evaluation (α = 0.05). ResultsThe overall OHIP-EDENT scores within each domain were less in group T when compared with the scores in group C and Kapur score for group T was more than group C. The difference was statistically significant i.e. P = 0.002 & 0.003 respectively. ConclusionsLess OHIP-EDENT scores in group T imply better perception of quality of life of individuals due to better performance of stomatognathic system. The higher Kapur scores in group T signifies better quality of dentures when TENS was used for definitive impression making.

Accuracy of merging scans of definitive fixed prosthodontic impressions to obtain single, accurate digitized master casts.

Many elastomeric impressions sent to commercial laboratory dental technicians may include marginal defects. To fabricate accurate restorations, digital technology may be used to merge digital files of defective impressions into a single standard tessellation language (STL) file free of errors. This would save clinicians and patients time and may improve clinical care. The purpose of this study was to compare the accuracy of digital master casts reconstructed from merged STL files of defective impressions with the file of the original defect-free preparations. Ivorine teeth on a dentoform were prepared to receive a posterior fixed dental prosthesis (FDP) with complete coverage preparations. An impression was made in a stock tray using polyvinyl siloxane (PVS) impression material and an extraoral scanner (E3, 3Shape, Denmark) was used to digitize the impression; this was the reference cast. Wax was used to create defects on the buccal and lingual margins of the preparations. Fifteen PVS impressions were made of the FDP preparations with defects in the mesial and distal margins; another set of 15 PVS impressions was made of FDP preparations with defects in the buccal and palatal margins for a total of 30 impressions. All impressions were digitized using the same extraoral scanner (E3, 3Shape, Denmark). Corresponding STL files were paired and merged, and a master cast was created by eliminating the defects using the scanned data. This master cast was compared to the reference cast using reverse engineering software (Geomagic, Morrisville, NC, USA). The results were expressed as average errors and standard deviations in the master casts relative to the reference cast. To account for the presence of positive and negative values in the data set, in terms of errors, the root mean square (RMS) value was calculated for each sample. The mean average error in the sample was -0.4 μm. The average upper limit of 95% confidence interval was +36.5 μm, while the average lower limit of 95% confidence interval was -37.3 μm. The mean RMS of the errors found was 18.9 μm. The results of this study indicated that merging digitized definitive impressions to correct marginal defects resulted in master casts with a high level of accuracy relative to the reference cast.

An Evaluation of Retention of Complete Denture Bases Made with a “Modified Single-stage Impression” Technique Using a Heat-moldable Tray

Abstract Aim: Although most dental schools teach complete denture definitive impression techniques consisting of secondary impressions in border-molded custom impression trays, it has been found that later, graduates in clinical practice abandon this step because of its complexity and attempts to seek easier alternatives. To simplify two-stage techniques, single-step border molding with elastomeric impression materials and light-cured resin materials has gathered acceptance among clinicians. The study aims to evaluate the retention of record bases made with a modified single-stage impression technique that uses elastomeric impression material in a heat moldable tray with modeling compound as material for border molding. Settings and Design: This was an in vivo preliminary cohort study. Materials and Methods: Thirteen completely edentulous patients requiring complete dentures were included in the study. A traditional two-stage impression was made using custom trays fabricated over diagnostic casts and further border molding done with a modeling compound, and the final impression was made to use zinc oxide–eugenol impression material. Additionally, a modified single-stage impression technique using heat moldable impression trays was made. Master casts from each technique were made, and further record bases were made on each master cast. Wire loops were adapted on the palatal aspect of record bases. The retention of each record base was evaluated using a force gauge. Statistical Analysis: The Kolmogorov–Smirnov test was used to analyze the normality of variables and later Wilcoxon signed-rank test was applied. Results: The double-stage technique exhibited retention values in the range of 0.6–66.7 units, whereas the single-stage technique showed a range of 0.15–78.55. The tests showed no significant difference between double-stage and single-stage techniques (P > 0.05). Conclusions: The single-stage technique using heat moldable trays with elastomeric impression material and modeling compound as a material for border molding can produce denture retention compared to the conventional technique that uses a two-step impression technique. The use of the modified single-stage technique can additionally save an extra appointment for patients, although it is better to use such a technique as an advanced impression technique and not as a training technique for beginners or students, as the material cost is substantially higher than the conventional two-stage technique.

Digital Analysis of a Novel Impression Method Named the Biological-Oriented Digital Impression Technique: A Clinical Audit

This report aims to clinically evaluate the feasibility of a novel biological-oriented digital impression method for teeth prepared with a vertical preparation technique. Something that makes this case unique is that the definitive impression is taken without cord displacement, reducing the invasiveness for the patient. In addition, dental technicians can reproduce the exact emergence profile of the temporary restoration used to reshape the soft tissue contours and define the accurate finish line at the established prosthetic junction, potentially avoiding the aesthetic and biological issues of the double-cord technique. The finish line and emergence profile are transferred using the temporary restoration through a simple CAD procedure performed using the same software used to take the impression. This makes the proposed biological-oriented digital impression technique (BODIT) easy to perform, avoiding adjunctive time and costs for clinicians and patients. Conclusions: Finally, patients' satisfaction could be significantly improved.

Effect of Different Definitive Impression Techniques for Resorbed Mandibular Ridge on Retention of a Lower Complete Denture.

This study aimed to evaluate the effect of different definitive impression techniques for the resorbed mandibular ridge on the retention of lower complete dentures. Ten completely edentulous male patients with severe atrophic mandibular ridge were selected from the Prosthodontic Department's outpatient clinic, Faculty of Dentistry, Sinai University (Kantara branch). Each patient received four dentures. Dentures were divided into four groups according to the type of final impression, Group I: Conventional impression techniques (open mouth technique), Group II: Cocktail impression techniques, Group III: Modified functional impression technique, and Group IV: Wire impression technique. Each denture was used for one month and at the end of the month the retention test was carried out and the results were tabulated and statistically analyzed. There is a statistically significant difference between the groups. The results also showed that the highest mean value was in group IV, whereas the lowest mean value of retention was in group I. Wire impressions produce lower dentures with higher retention, whereas conventional impressions produce lower dentures with the lowest retention, so it is considered to be more advantageous. The wire impression technique is superior in the management of resorbed ridges as compared with other techniques.

Effect of Impression Technique on Denture Retention and Patient Satisfaction: A Comparative Clinical Study

Objectives: To compare satisfaction levels of patients wearing maxillary completes denture fabricated by closed mouth and an open mouth impression techniques. Methods: This Comparative clinical study was conducted at the Department of Prosthodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi. Eighty-four edentulous patients were included in this study; the patients were randomly allocated into two groups. Group A patients were provided with dentures fabricated by closed mouth impression technique and Group B patients were provided with dentures fabricated by open mouth impression technique. The patient’s satisfaction level was assessed after six weeks of denture insertion with a questionnaire attached as Annex-A. Results: Out of 42 patients in group A, 12 were highly satisfied, 28 moderately satisfied and 2 poorly satisfied. In group B patients, 9 were highly satisfied, 25 moderately satisfied and 8 poorly satisfied. Retention was highest (81.0%) in patients of group A compared to group B (19%). Moderately satisfied patients were more significantly (p=0.04) more (69.0% in group A and 71.4% in group B) comfortable compared to highly satisfied (26.2% in group A and 19.0% in group B) and poorly satisfied (4.8% in group A and 19.5% in group B) in both groups. There was no statistically significant difference among patients in both groups when their satisfaction with their ability to chew with dentures was compared. Regarding satisfaction with speech ability more patients were moderately satisfied (28.6% in group A) compared to the number of patients (21.4%) in group B. Overall, 70.2% of moderately satisfied category showed significantly higher frequency of patients followed by 17.9% patients each lying in highly satisfied and poorly satisfied patients, categories. Clinical implication: Final impression in complete denture (CD) fabrication is very crucial step that can affect overall prognosis of CD treatment and therefore, patient satisfaction with CDs. A simplified closed mouth impression approach to complete denture treatment, omitting the border molding and definitive impression appointment, has been suggested as an alternative to the conventional open mouth approach. Conclusion: Dentures fabricated by closed mouth impression technique are more stable and functionally better compared to those constructed by open mouth impression technique. Keywords: Final impression technique, complete dentures, Retention, Comfort, Speech ability, Patient Satisfaction

Refabrication of an implant-retained obturator using the denture duplication technique in a bilateral maxillectomy patient with a free fibula osteocutaneous flap.

We aimed to introduce a simple method for refabrication of an implant-retained obturator using the denture duplication technique while retaining the custom abutments for a patient who underwent bilateral maxillectomy and reconstruction with a free fibula osteocutaneous flap. We have proposed this technique to facilitate the impression-making procedure for this extensive maxillary defect and to avoid lengthy and complicated laboratory procedures. A custom tray was developed by duplicating the fitting surface of an old obturator using silicone putty. The tray was used for a bite-pressure impression wherein both definitive impression and jaw relation were obtained simultaneously, reducing the time required for the placement of a new obturator. We used the denture duplication technique to refabricate an implant-retained obturator while retaining the custom abutments. Decreased chairside time, fewer visits, the use of easily available materials, and uncomplicated laboratory procedures make this technique more economical and acceptable for patients. Using this approach, the patient was able to use the old prosthesis until the delivery of the new prosthesis. The replacement obturator that was developed using this method maintained an acceptable level of oral function.

Evaluation of the Efficacy of Novel Self Disinfectant Solution in Irreversible Hydrocolloid Impression Material - An Experimental Study.

Irreversible hydrocolloid materials are widely used for both diagnostic and definitive impression procedures. Impressions can be disinfected by immersion or spraying in any compatible disinfectant. Disinfectants should not adversely affect the dimensional stability of the impression and physical properties of impression material and subsequent dental cast. The study aims to evaluate the efficacy of a hypochlorous disinfectant solution mixed with irreversible hydrocolloid on setting time, antibacterial efficacy, and dimensional stability. Three groups were made with one control group and three alginate impression was made for each participants in the maxillary arch with 24-hours intervals between one another using the same brand of commercially available chromatic alginate. The working and setting time were noted. Bacterial swabs were collected using a dry sterile cotton swab in the mid palatal region. Dental casts were made using type III gypsum. The working and setting time had significant differences whereas the dimension among the cast has no significant difference. Microbial growth analysis had distinct differences among the groups. The self disinfection method using a pioneer solution of hypochlorous HOCl (100 ppm) to mix the alginate impression material rather than the water with the same powder-liquid ratio prescribed by the manufacturer had the same dimensional stability with improved antimicrobial action.

Use of Sectional Tray Design in Recording Edentulous Impressions for Microstomia Patients: A Case Report

Prosthetic rehabilitation of patients with microstomia presents a major challenge to dentist as limited oral opening makes access to the oral cavity for any dental procedure difficult. The primary hurdle during the fabrication of dentures in such patient is making an impression. This article describes the treatment of a patient with microstomia where maxillary and mandibular custom sectional impression trays were used for making definitive impressions.

Custom Sectional Impression Tray With Sectional Handle for Microstomia Patients.

Microstomia presents a unique challenge to the dentist as well as the patient. Microstomia patients often face difficulty in inserting or removing removable dental prostheses due to constricted opening of the oral cavity. Dentists often face difficulty in inserting impression trays in these patients because of the limited mouth opening. Standard impression procedures need to be modified in such patients. This article describes a simple design for the fabrication of a sectional handle for a definitive impression in microstomia patients. The sectional handle could be sterilized and reused.

Performance of high-translucent zirconia CAD/CAM fixed dental prostheses using a digital workflow: A clinical study up to 6 years

Background/purposeZirconia has recently become a popular material for fixed restorations. The purpose of this study was to use a digital workflow to fabricate monolithic zirconia fixed dental prostheses (FDPs) and assess the connection between variable connector sizes compared to their clinical performance. Materials and methodsClinicians evaluated monolithic zirconia FDPs in 58 patients. After definitive impressions were made, stone casts were obtained. The stone casts were scanned to a standard triangle language (STL) file. A digital wax up was fabricated, and corresponding provisional restorations were milled. Final FDPs were fabricated from a high-translucent zirconia material. During digital fabrication, the connector area of each FDP was recorded while meticulous attention was paid to ensure that the connector cross-sectional area was ≥9 mm2 for the 3-unit restorations (pontic to retainer) and ≥12 mm2 for the 4-unit restorations (pontic to pontic). Biological an technical outcomes of the FDPs were performed at 1 week, 6 months and then annually for 6 consecutive years. ResultsA total of 23 men and 35 women received a total of 63 full-contour zirconia FDPs in the posterior regions and were observed for a time period ranging between 50 and 70 months. No decementation occurred and no caries were detected during the observation period, however signs of gingivitis were detected in 4 patients. The dimension of the connector areas was 12 mm2 in the two broken 4-unit FDPs. ConclusionThe results of this study suggest that the use of digital scanning and milling to fabricate monolithic zirconia FDPs of posterior regions may be an acceptable alternative restorative approach to traditional metal-ceramic restorations.

Splinting Open Tray Impression Copings Using Long Shank Carbide Burs during Definitive Impression: A Dental Technique

To splint implant impression copings using long shank carbide burs for definitive implant impressions. The accurate transfer of the orientation recorded by impression copings to a definitive cast is a challenging step in implant prosthodontics. For achieving a passive fit from the mouth to the cast may include some discrepancies. Traditional methods of splinting can be time-consuming and troublesome to handle. This article describes a technique by using long shank carbide burs for splinting implant impression copings. The favored implant splinting, evidence was inconclusive, and the data supporting splint pickup was the better performing technique, especially with an increased number of implants. This technique causes minimal discomfort and is straightforward when compared to other techniques.

Simplified versus conventional complete dentures: A randomized crossover clinical trial

Statement of problemA simplified approach to complete denture treatment, omitting the border molding and definitive impression appointment, was suggested as an alternative to the conventional approach. However, comparison clinical trials are lacking. PurposeThe purpose of this randomized crossover clinical trial was to assess the satisfaction of edentulous patients and their oral health impact profile when provided with complete dentures fabricated through the simplified or the conventional approach. Material and methodsForty completely edentulous patients seeking complete dentures were randomly divided into 2 groups (n=20). Each group received 2 sets of dentures. The first group received conventionally fabricated complete dentures, and the second group received complete dentures fabricated through the simplified approach. After 2 months, participants rated their overall satisfaction and their satisfaction regarding comfort, retention, stability, and efficiency of mastication and speech on a 100-mm visual analog scale (VAS). Participants also filled out the oral health impact profile for edentulous patients (OHIP-EDENT) questionnaire. Each group was then given the alternate set of dentures and reviewed again after 2 months. The results were analyzed by using the Mann-Whitney U and Wilcoxon-signed rank tests (α=.05). ResultsThe simplified complete dentures had significantly higher VAS scores for general satisfaction with maxillary dentures (P=.036), satisfaction with retention of maxillary dentures (P=.002), satisfaction with stability of maxillary dentures (P=.003), and satisfaction with speaking (P=.002). No statistically significant differences were found between the 2 groups regarding the other VAS items or OHIP-EDENT scores (P>.05). ConclusionsThe simplified denture fabrication approach required fewer appointments and resulted in higher patient satisfaction and similar OHIP-EDENT scores compared with the conventional approach. The simplified approach can be recommended over the conventional approach.

Establishing the posterior palatal seal area by using a clear acrylic resin custom tray during the definitive impression: A dental technique

Recording the posterior palatal seal intraorally should be accurate and cause minimal discomfort. This article describes a technique for recording the posterior palatal seal area by using a clear acrylic resin custom tray without drawing directly on the palate. The technique is straightforward and causes minimum discomfort when compared with other techniques.

Definitive Impression Technique for Maxillary Defects in Patients with Reduced Mouth Opening- A Novel Approach

Palatal defects are categorised as a multicausal pathology, with its aetiology ranging from trauma and microbial infections to oncogenic origin. This by and large leads to surgical defects of the palatal tissues which warrants immediate treatment. Due to this, the patient faces a plethora of challenges, namely psychological, functional and social. These defects can be catered to by means of surgical closure or prosthetic therapy. Thereby, this uplifts the patient’s self-confidence and performance of day-to-day activities. However, surgical closure by free flaps is not feasible in all cases due to the dearth of favourable tissues or prevalent co-morbid conditions. So, this makes fabrication of a palatal obturator the treatment of choice to rehabilitate these cases. An obturator is a maxillofacial prosthesis which blocks the oro-nasal communication and thus ameliorates the mastication, phonation and aesthetic profile of the affected subject. For fabricating well-fitting obturator prosthesis, making an accurate impression with appropriate spatial orientation of the orofacial structures is imperative. Many obstacles come in the way of a prosthodontist while making impression in such cases due to the complexity of the supporting stomatognathic system in terms of compressibility and multitude of geometric planes of the tissues. These patients present with restricted mouth opening due to scarring of tissues or radiation therapy. In this article, the authors describes a technique which predominantly addresses most of the problems related to the impression making procedures in patients treated with maxillectomy experiencing limited mouth opening.

Workflow for complete dentures fabrication in three appointments: A dental technique

This technical report describes a novel workflow for complete denture fabrication designed to abbreviate the necessary steps for dental prostheses delivery by using a 3-appointment protocol in which preliminary impressions are made in the first session together with the registration of maxillary lip support, occlusal plane, and reference lines for tooth arrangement. A trial denture is fabricated with conventional or computer-aided design and computer-aided manufacturing procedures and is evaluated in the second appointment for esthetics, the definitive impression, and the maxillomandibular relationship record to provide precise references for definitive denture fabrication.

A modified impression technique for flabby and severely atrophic mandibular ridge: A case report

Complete denture fabrication in clinically compromised situations such as flabby ridge and/ or atrophic ridge is a challenging task for the prosthodontist for years. Flabby ridge and highly resorbed residual mandibular ridge is commonly observed in older patients. Accurate impressioning of these tissues plays a major role in ensuring a well-fitting and stable prosthesis. This article describes a technique for making a definitive impression for highly displaceable and resorbed residual ridges. The technique is especially applicable for mandibular edentulous ridges. The choice of the impression materials, as well as the design of the impression tray, focuses on preventing distortion of the displaceable residual ridges during impression making.

Longitudinal Study of Dental Implants in HIV-Positive Patients.

This study compared the clinical outcome of dental implants and their implant-supported restorations over a 3-year period involving patients both positive and negative for the human immunodeficiency virus. Twenty patients testing positive for the human immunodeficiency virus were recruited for this study. Twenty-one negative control patients were also selected, for a total of forty one patients. Diagnostic impressions were collected and cone beam computed tomography images were obtained. Implant size and positioning were planned using cone beam computed tomography software. Two stage or single surgery was performed as determined by the surgeon (periodontist). After a 6-month healing period, definitive impressions were fabricated using polyvinyl siloxane impression material. Implant stability quotient values were obtained at the time of surgery and placement of the restoration. Screw-retained custom titanium abutments were designed, milled, and placed with 25 N·cm torque using a calibrated torque controller. Porcelain fused-to-metal complete coverage restorations were then cemented with elastomeric resin implant cement. Implants and restorations were assessed at 6-month intervals over a period of 3 years for stability, peri-implant health, and patient satisfaction. Over the 3-year period, 25 of 42 implants placed in the negative control group were assessed, and 17 of 27 implants placed in the positive control group were evaluated. The overall patient retention rate was 77%. At the 3-year follow up, restorations examined were fully functional and causing no pain. Overall implant retention within the positive group was 96%. Implant retention within the negative control group was 100%. No differences were noted between groups for bone loss based on statistical tests. Within the limitations of this clinical investigation, the presence of human immunodeficiency virus per se was not a contraindication to dental treatment with implant-supported restorations.

Accuracy of anterior denture tooth arrangements of CAD-CAM complete removable dental prostheses made with a tooth mold template

Statement of problemResearch evaluating the accuracy of anterior tooth mold templates to computer-aided design and computer-aided manufacture (CAD-CAM) fabricated complete removable dental prostheses (CRDPs) is limited. PurposeThe purpose of this in vitro study was to investigate the accuracy of the anterior denture tooth arrangement on CAD-CAM complete removable dental prostheses made with the anterior tooth mold template. Material and methodsA maxillary and mandibular edentulous model was mounted on a semiadjustable articulator to simulate a patient’s maxillary arch. Definitive impressions and jaw relation records were made as per the manufacturer’s protocol. A maxillary and mandibular anatomic measuring device was completely seated onto the edentulous models, centered on the edentulous model midline, and horizontally positioned parallel to the mandibular ridge. A medium-size anterior tooth mold template sticker was attached on the anatomic measuring device to identify the maxillary dental midline and incisal edge position and was sent to the manufacturer as the proposed tooth arrangement reference for the definitive complete removable dental prostheses. A total of 10 milled complete removable dental prostheses were generated for 2 groups by using 2 different tooth arrangement techniques. One group (n=5) used the monobloc milling technique without bonding of denture teeth, while the other group (n=5) used the bonding system for denture teeth on the milled denture base. For comparison, a camera mounted on a tripod was used for photographic documentation. Reference markers placed on the edentulous model were used to orient and measure the difference of 4 aspects of the anterior tooth arrangement: average incisal edge position, intercanine distance, midline, and clinical crown length of the left central incisor. The difference values between the tooth mold template and definitive complete removable dental prostheses were statistically analyzed by multivariate ANOVA (α=.05) and 1-sample t tests (adjusted α=.0125). ResultsOverall, statistically significant differences were found between the tooth mold template (control) and definitive complete removable dental prostheses at all measuring aspects except for the midline of the midline of the milled arrangement technique (P<.0125). In terms of the midline value, the value of the milled group did not show a significant difference compared with tooth mold template (-0.19 mm). However, the value of the bonded group indicated a significant difference of midline (0.44 mm toward to the left of the tooth mold template midline). When the complete removable dental prosthesis milled denture tooth and complete removable dental prosthesis bonded denture tooth techniques were compared, there was no difference in the tested variables between the milled and the bonded groups (P>.0125). ConclusionsThe tooth mold template did not represent an accurate position for definitive complete removable dental prostheses for either the milled or bonded techniques. The largest differences were found at the average incisal edge of the anterior teeth and the intercanine distance for both groups. However, there was overall no clinical difference between the 2 groups (milled and bonded) of CAD-CAM complete removable dental prostheses.