Opportunities and Challenges of Removable Prosthetics: Can Dentistry Meet Demand With “Digital Dentures”?
Gerard Kugel, DMD, MS, PhD; and Pam Johnson
By the year 2020, the average life expectancy in the United States is projected to increase—again—to an all-time high of 79.5 years of age.1 Medical research methods have led to such advances as personalized medicine, advanced life-saving technology, and overall better options for leading a quality, productive life well into very old age. The diseases and conditions that were feared to be fatal just 20 years ago can be successfully managed today with carefully targeted medications and therapies, thanks to years and years of research and development.
Dentistry, too, is in the midst its own R&D renaissance. Everything from diagnostic tools—such as digital radiography and light-based caries detection—to the latest generations of porcelain and ceramic restorative materials is vastly improved over their decades-old counterparts. However, one segment of the dental market that has seen the most dramatic change is that of removable prosthetics.
Complete dentures have been used to replace human teeth for about 500 years or so, during which time the materials used to make dentures evolved gradually, and the 20th-century procedures used to fabricate them mostly stayed the same for a number of decades—until computer-aided design/computer-aided manufacturing (CAD/CAM) technology began to impact the denture-making process.2
Now, with the US denture market valued at more than $2.6 billion and projected to exceed $3.6 billion by 2019,1 and the newer technologies advancing the materials and fabrication processes, the opportunities for dentists to make removable prosthetics a healthy revenue stream in their practices is virtually unprecedented. However, with opportunities come challenges as well.
As Demand Grows, Patients’ Tolerance for Long Waits Will Drop
Dentistry’s ability to meet the increased and projected demand for precision-made removable prosthetics using the traditional prescription and fabrication processes may not be able to satisfy patients’ expectations for much longer. Although a majority of dental schools are still teaching students the five-appointment denture protocol,2 they are also at the same time reducing their prosthodontic curricula, placing less emphasis on fabrication techniques and requiring students to complete fewer denture cases. This is leading to what are now several generations of new dentists not as well-schooled in the principles of traditional removable prosthetics, leaving those skills to fade with every retiring prosthodontic dentist. Simultaneously, there are fewer and fewer skilled, experienced denture technicians on the laboratory side now as well, leading to longer fabrication processing times in the lab, as well as inconsistencies in the quality of the dentures being produced.1
Patients, however, are not going to be as understanding or tolerant of dentistry’s challenges to meet the anticipated demand. For in addition to the number of denture units that are projected to increase over the next decade or so, the demand for removable solutions that are more functional, comfortable, and esthetic than they have been in years past is also on the rise, thanks largely to the aging Baby Boomer patient base. These patients, and all of those who will follow, have now come to expect dentistry to restore their dentition to completely natural function and esthetics as good if not better than what they had before. In today’s modern 24/7 society, gone too are the days where patients will accept the traditional five-appointment protocol with the long waiting times between those appointments for the laboratory work to be done. With current estimates of 20.5% US adults older than 65 years of age having lost all of their teeth due to decay or disease,1 it is not difficult to see just how demanding this population segment is poised to become—the number of fully edentulous adults who will need a full set of dentures has been projected to reach 37.9 million by 2020.3
“Digital Dentures” in the Dental Practice
This is where CAD/CAM technology comes in. These techniques, which dramatically changed the way in which crown-and-bridge and implant-supported prostheses are produced, are now extending to the fabrication of what are being called “digital dentures.” Rather than dental technicians manually fabricating a base plate and occlusal rims onto which they set denture teeth, the 3-dimensional (3-D) modeling software of CAD/CAM technology combines data gathered from a large cross-section of patients with a specific patient’s clinical information supplied from the dentist into an algorithm that is then used to identify the patient’s incisal edge position, lip support, and midline.2,4 Then, a prototype of the 3-D denture model can be printed and tried in the patient’s mouth, and adjusted if necessary; fabrication of the final denture is based on the adjusted prototype.
All of this can be accomplished in less than the five visits typically required by the conventional denture-fabrication process. Most commonly, digital dentures only require two to three visits, with total chairtime cut from 5 hours to 1 hour, and average total laboratory fabrication processing time cut from 30 days to just over a week.2
The advent of digital dentures could not have come at a better time. With the number of edentulous patients on the rise and the number of dentists and dental technicians who can fabricate full dentures dropping, digital dentures offer clinicians and their patients several critical advantages.
For those dentists who are not currently treating fully edentulous patients because of concerns about their own proficiency, the clinical technique in a digital approach is greatly simplified over the traditional approach, with the CAD/CAM algorithm ensuring accuracy. Dentists can easily learn the digital approach and implement it into their practices.
For those dentists who are not currently treating fully edentulous patients because of concerns about the length of the traditional denture fabrication process, a digital approach can also offer tangible benefits. Depending on the digital system chosen, at least two of the appointment steps in traditional denture fabrication can be eliminated, cutting down on both the clinician’s and the patient’s chairtime. For those patients who demand high-quality, functional, well-fitting, esthetic full dentures in less time than traditional prosthetics, digital dentures enable dentists to offer an alternative option.
With the shortage of dental laboratory technicians who are qualified and experienced in removable prosthetics projected to deepen, the increased expectations from patients for better-fitting and better-looking prosthetics in less time, and the ever-growing number of patients in that population segment, the ability for dentists to fabricate digital dentures themselves may offer them a valuable revenue stream within a simplified clinical technique that delivers predictable results to their patients, allowing them to seize the opportunities that removable prosthetics present while eliminating the challenges.
About the Authors
Gerard Kugel, DMD, MS, PhD
Associate Dean for Research, and Professor of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts; Dr. Kugel has published more than 120 articles and 200 abstracts in the field of restorative materials and techniques, and has given over 300 lectures both nationally and internationally. Dr. Kugel is part of a group practice, the Boston Center for Oral Health, located in Back Bay, Boston. He also serves as Editor-in-Chief, Inside Dentistry.
Editor-in-Chief, Inside Dental Technology
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2. Holt LR. Streamlining and Simplifying the Fabrication Denture-Making Process with Digital Denture Processes. CDEWorld eBooks. 2015;2(7):1-7.
3. Douglass CW, Shih A, Ostry L. Will there be a need for complete dentures in the United States in 2020? J Prosthet Dent. 2002;87(1):5-8.
4. Sawiris MM. The role of anthropometric measurements in the design of complete dentures. J Dent.. 1977;5(2):141-148.