Digital Dentures

[Sheldon Lerner]

Hi
A few places have been moving along promoting digital denture production. It doesn't seem to have caught on.

How long does it take to do a complete set of dentures and typical costs to you in labor and materials for a nice set you would do for a good friend if not doing digital?

Couple of additional things I would like to know
1. Why do you think it hasn't caught on?
2. Is it too different for the clinician?
3. Is it really not a time saver to do digital?
4. If you had a magic wand... ( we specialize in magic)... what would you want changed to make it a standard part of what you do. Remember this is magic so you are unbound by previous methods.

Best
Sheldon

 

[CoolHandLuke]

Hi
A few places have been moving along promoting digital denture production. It doesn't seem to have caught on.

How long does it take to do a complete set of dentures and typical costs to you in labor and materials for a nice set you would do for a good friend if not doing digital?

Couple of additional things I would like to know
1. Why do you think it hasn't caught on?
2. Is it too different for the clinician?
3. Is it really not a time saver to do digital?
4. If you had a magic wand... ( we specialize in magic)... what would you want changed to make it a standard part of what you do. Remember this is magic so you are unbound by previous methods.

Best
Sheldon

it hasn't caught on for three reasons.

1. the process is the same for the clinician. nothing changes. still take impressions cause still gotta have that border moulding and captured frenums. in this respect it is still pretty impossible to digitize the clinician side. making the burden of digitization squarely the concern of the lab.

2. those who have gone through the process of scanning models to do it, have proprietary software and processes and won't share. they want people to send scans or send models instead of send designs. as a business decision this is a bandaid until someone comes along to cut the middleman out.

3. going digital for setup and such, is a proprietary process. it has to be. the modules for designing full dentures via 3shape are still 'in development' so only a handful of people accross the WORLD even know it exists. even fewer are able to translate what they see on the screen to a machinable process, so how it happens will naturally vary from lab to lab.

but it all depends on what level of digitization is desired. digitize the scans - impossible, see 1. digitize the baseplate/skirt - fine. digitize the teeth into a fully millable series of pontics for jamming into your milled base - questionably accurate and reliable.

make it one-piece milled skirt and one piece milled arch of teeth - not resettable. into an entire remake if somethings off.

so its difficult for any single lab to pinpoint the approach and integrate the proper solution that is both NOT labour intensive and infintely repeatable.

 

[pdent]

You are asking the dentist to capture a lot of information on the initial visit, probably more than they are comfortable with. Second, if the bite or the midline is off, they can't blame the lab. Third, it's more expensive than processed dentures.
If I had a magic wand, I would make the system more affordable for the average small to medium size lab.

 

[Sheldon Lerner]

Hi
So if we
1. slightly digitize what the clinician does
2. Cut out the middleman like we did in Blue Sky Plan and make the software non proprietary
3. Make the set up non proprietary and perhaps have 30-50 different set ups that can easily be moved around without redoing the digital set up
4. Make it so the final base and teeth separate entities with individual teeth that can be reset if needed
5. Improve the way the teeth are set into the denture so they are at least as stable as current dentures
6. Make it affordable for even a one person lab
Is $12 per case ok? That's about what a lab pays to do the export for an in house implant guide.

Is that the magic list?


Ok... We will get it done

What else?
How about how long should the lab digital side take?
Thx
Sheldon

 

[2000markpeters]

Heraus PalaDigital Dentures is a system we use in our lab. Dentist takes two impressions in specialized tray, lutes them together after doing a gothic arch tracing. We scan the impressions and the fixed bite. Send STL's off to Heraeus, they do CAD set up and print up a set of try in dentures. If ok, they finish using heat cure and real denture teeth. At third appointment patient has completed dentures.

 

[JohnWilson]

Let me know when this will make me more money and OR produces a better product and is not just digital for the sake of digital.

 

[JKraver]

Hi
So if we
1. slightly digitize what the clinician does
2. Cut out the middleman like we did in Blue Sky Plan and make the software non proprietary
3. Make the set up non proprietary and perhaps have 30-50 different set ups that can easily be moved around without redoing the digital set up
4. Make it so the final base and teeth separate entities with individual teeth that can be reset if needed
5. Improve the way the teeth are set into the denture so they are at least as stable as current dentures
6. Make it affordable for even a one person lab
Is $12 per case ok? That's about what a lab pays to do the export for an in house implant guide.

Is that the magic list?


Ok... We will get it done

What else?
How about how long should the lab digital side take?
Thx
Sheldon

Open in house we make that is affordable will be the magic list of what lab techs want. The profit in our pocket not just little fat left that barely scrapes by and keeps us feeding your company.

I would like millable wax bases. Teeth on a card that the intaglio is milled to correct form of what was designed. Then after wax up be able to scan any modifications and either mill corrected acrylic base and cold cure teeth or process traditionally. That is what I imagine would be a really good system.

 

[CoolHandLuke]

i think specifically i would like to address these hurdles:

working in 3shape means working backwards, so starting from the setup and working toward the baseplate.

digital setup with two key features: custom designed teeth or premade teeth.

in both cases create an indexing method whereby the tooth sockets into place, such as square/triangular base which are easier to manufacture in the case of custom teeth forms. this index is then transferred to the base skirt.

then make the skirt printable to save on milling tools and finishing adjustments.

the indexing created digitally should also provide enough surface area for the invested acrylic to adhere to the tooth forms unless somehow space is too compromised.

 

[lcmlabforum]

Dr. Lerner, good to have you on the forum (assuming this would be yourself and not someone
stealing your name).
The greatest advantage would be in the hybrid full arch fixed detacheable scenario. It saves
everyone so much effort whenever the pt returns for a 'retoothing' few years down the road.

Anything on a removable system is just asking for trouble because you are trying to solve
an analog problem with a digital solutions. Yet, the end result can matter so much when
a centric is accurate or otherwise.
The best you can hope for, would be to recreate the prosthesis from a CBCT/CBVT images
of a patient's full dentition before an immediate denture is placed, and hope it is close to
CR.
Just my 2 cents.
LCM

 

[pdent]

Let me know when this will make me more money and OR produces a better product and is not just digital for the sake of digital.

 

[pdent]

I agree with John. I've invested a lot of money in products and systems that were supposed to be the next big thing. Now instead of hoping and praying, I want to see how it's going to make money for me before I invest another dime.

 

[Yourgoes]

Problem is three fold from my perspective
1)Impressions - Not digital as mentioned... and no IOS to date can do it. Identifying the functional sulcus depth is tricky too.
2)Bite/functional occlusion - Good luck. Nothing, is repeatable. Most problems come from here .. well, non esthetic problems... speaking of which
3)Esthetics - U of M did a study a while back and showed that the traditional method resulted in the highest patient satisfaction.. Lots of room for improvement in the digital world

 

[kytoothdude]

Only real advantage, now anyway, is after fabrication lost or damaged denture can be easily remade with no new impressions.

 

[JKraver]

2)Bite/functional occlusion - Good luck. Nothing, is repeatable. Most problems come from here .. well, non esthetic problems...

Amen, You could take 6 bites and they would all be different.

 

[JKraver]

Only real advantage, now anyway, is after fabrication lost or damaged denture can be easily remade with no new impressions.

Inherently dentures get loser over time. This may be an advantage if its within a year or so, beyond two a reline is probably needed.

 

[highscore]

Heraus PalaDigital Dentures is a system we use in our lab. Dentist takes two impressions in specialized tray, lutes them together after doing a gothic arch tracing. We scan the impressions and the fixed bite. Send STL's off to Heraeus, they do CAD set up and print up a set of try in dentures. If ok, they finish using heat cure and real denture teeth. At third appointment patient has completed dentures.

There's a huge drawback to this system. The try in. If the patient is unhappy with the try in, you can't simply take your case into the lab and physically make changes to the arrangement. As all of us know, there are patients who require more than one simple "hey is this okay" wax try in.
A 3d printed try-in is "nifty", but it's not cost or time effective if you need to keep remaking the try-in in a far-away lab.

 

[patmo141]

Regarding the impression issue. I would like to see a contact based scan. Perhaps something like this...miniturized and digitized of course. Maybe a quadrant size, still allowing for overlap and stitching and with adjustable "stiffness." You could run the scanner across the tissues at adjustable "viscosities," then blend the scans in areas you want mucostatic vs mucodynamic and roll the scanner around to capture undercuts.

 

[rkm rdt]

Ultrasonic?

 

[patmo141]

I think it shows promise for imaging, but it's still not going to get a functional or any kind of tissue displacement with ultrasonic. I think some kind of contact device will be needed if the clinical side is going to get digitized for fully edentulous prosthetics.

 

[zero_zero]

It would be possible with a spring loaded CMM touch probe incorporated into the IOS I think...