- Email: [email protected]
Removable complete digital dentures: A workflow that integrates open technologies
DENTAL TECHNIQUE
Removable complete digital dentures: A workflow that integrates open technologies Lucio Lo Russo, DDS, PhDa and Angelo Salamini, Engb Digital technologies for the ABSTRACT design and fabrication of Digitalization of the design and manufacture of removable complete dentures has numerous adremovable complete dentures vantages. The workflow as presented integrates current open digital technologies into a functional have made rapid progress. protocol, enabling complete dentures to be designed and fabricated without system-specific Current innovations and techtrays or instruments. This is done by using a conventional technique to acquire anatomic nological developments in information. (J Prosthet Dent 2017;-:---) computer-aided design and digital technologies may sometimes be limited to denture computer-aided manufacture (CAD-CAM), such as milldesign, whereas production may still be based on a coning and rapid prototyping, allow the design and manuventional technique (CFD).7 facture of removable dentures to be fully digitized.1 Full 2 Thus, to exploit the benefits derived from incorpodigitalization leads to favorable clinical outcomes, better rating digital technologies and materials into complete retention,3 fewer patient visits,4 potentially enhanced denture prosthodontics, a workflow was developed to material properties and biocompatibility,5,6 advances in transfer as much of the conventional technique as standardization of both clinical results and research,1 possible into the digital approach. The aim was to avoid simplified identification of anatomical landmarks on the use of system-specific trays or instruments, exclusive digitized casts, reproducible and less time-consuming 7 dental materials, or system-inherent techniques. In tooth arrangements, easy data storage, and production addition, the idea was to integrate open technological of duplicate dentures. systems, thus facilitating the combined and efficient use To date, 5 different systems for digital complete denof any open scanner, CAD-CAM software, or milling ture fabrication have been described: Wieland Digital 8 5 machine. Denture (WDD), AvaDent Digital Dentures (ADD), These aspects may be beneficial for an easier transiWhole You Next Teeth (WYNT),9 Baltic Denture System 9 7 tion to the digital concept, as clinicians can still work with (BDS), and Ceramill Full Denture (CFD), and another 9 familiar techniques and devices. Clinicians can thus recently announced system, Vita Vionic. Many aspects of gradually change the way they work by incorporating these systems do not favor the routine application of new aspects without abandoning acquired expertise or digital concepts and workflows to complete denture discarding their equipment, all of which makes sense fabrication. In fact, some systems require system-inherent from a practical, financial, and psychological point of equipment, trays, or materials (WDD, ADD, WYNT, 9 10 view. BDS), have proprietary features that limit integration with other systems (WDD, ADD, WYNT, BDS, CFD), or TECHNIQUE cannot manage patients with a single edentulous arch 9 (WDD, DBS). In addition, as their clinical application 1. Make anatomic impressions (Alginoplast; Heraeus may be quite different from that of conventional procedKulzer GmbH) of the edentulous arches (Fig. 1A, B). ures, specific training and expertise are needed. Moreover, a
Associate Professor, Oral Diseases, Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy. Co-founder, Sintesi Sud Srl, Ariano Irpino, Italy.
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Figure 1. Preoperative conditions. A, Maxilla. B, Mandible.
Figure 2. Occlusal records. A, Occlusion rims with hard wax mounted on 3D-printed baseplates. B, Adapted occlusion rims register occlusal plane and other information needed for tooth arrangement.
2. Make casts and scan them with 3Shape Trios 3 color, enabling the function for gypsum scanning, and then process and export scans with the Trios software. Use Trios 3 also for all the other scans. 3. Design custom trays for definitive impressions. Use the specific workflow available in 3Shape Dental System 2016 (release 3). Use this software also for all the other steps in the design process. 4. Fabricate rapid prototype custom trays. Transfer the standard tessellation language (STL) files of the designed custom trays to the software application of the 3-dimensional (3D) printer (M200; Zortrax) to obtain the printable file. Use a 0.09-mm thickness of the material (Z-Ultrat; Zortrax). 5. Make definitive impressions (Impregum Penta; 3M ESPE). 6. Pour definitive casts (Vel-Mix Stone; Kerr Corp) and scan them. 7. Using the digitized definitive casts, design baseplates for occlusion rims. Use the workflow for individual impression trays, setting the space for the material to zero so that the baseplates are
THE JOURNAL OF PROSTHETIC DENTISTRY
Figure 3. Frontal view of scanned casts and occlusion rim alignment.
completely adapted to the mucosa. Add some mechanical retention for the wax rim to the baseplates. 8. Make rapid prototype baseplates for occlusion rims. Transfer the STL files of the designed baseplates to the software application of the 3D printer Lo Russo and Salamini
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Figure 4. Digital workflow for denture design. A, Setting occlusal plane: lateral view of aligned casts and occlusion rims. B, Tooth selection and proposal for tooth arrangement. C, Tooth position can be modified according to information integrated in occlusion rims. D, Software proposal for denture base design.
(M200; Zortrax) and then print with a 0.09-mm thickness of the material (Z-Ultrat; Zortrax). 9. Add hard wax to the baseplates for the definitive occlusion rims (Fig. 2A). 10. Record the vertical dimension, occlusal plane, and lip support. Adapt the occlusion rims to the patient in order to register all the relevant information for the tooth arrangement in terms of adequate lip support, maxillary incisor length, midline, vertical dimension, and occlusal plane. 11. Make the facebow and jaw relationship records. Use Arcus Digma II (KaVo Dental GmbH) to record settings for the virtual articulator and centric relation according to the following procedure: a. Adapt the para-occlusal spoon (KaVo Dental GmbH) to the mandibular occlusion rim and stabilize with hard wax. Create notches on the occlusal aspect of both rims. b. Obtain centric relation according to the guided method and workflow recommended by the manufacturer. c. Place recording material (Registrado X-tra; Voco) on the occlusal aspect of the rims. Gently Lo Russo and Salamini
guide the mandible into the registered jaw relation and hold in place until the material has completely polymerized (Fig. 2B). 12. Put the definitive casts on the occlusion rims and scan the buccal aspect of the rims and cast bases as a single object. The aim is to align the casts as detailed in the subsequent step and to transfer all the information registered and incorporated in the occlusion rims to the design process. Make small scratches on the rims to optimize the scanning, and create small notches on the cast bases to optimize the alignment (Figs. 3, 4A). 13. Create the order (“order” is how the design process is referred to in 3Shape Dental System software) for the maxillary and mandibular complete denture. 14. Import, in the order created in point 13, the digitized definitive casts (as obtained in point 6) and the scan of the occlusion rims (as obtained in point 12) and align them (Figs. 3, 4A). Carry this out using the 3-point method available in the specific workflow in the ScanItDental application, which is part of the 3Shape Dental System.
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and finalizing the design (Fig. 5A). At the end of the design process, an STL file of the denture bases is created. While creating this file, the CAD software automatically creates sockets for teeth in the denture base. Make a rapid prototype of the trial dentures. After printing with a 3D printer (M200; Zortrax), cover the trial dentures with a thin layer of pink wax (Fig. 5B). Clinically assess trial dentures to evaluate fit, esthetics, maxillomandibular relation, and occlusion (Fig. 5B). At this stage, changes are still possible and, if required, can be incorporated into the definitive dentures. Mill the denture bases from the STL files of the denture bases in Hyperdent CAM software (Fig. 6A) to create the corresponding project in a 25-mm-high poly(methyl methacrylate) blank (Smile Cam Total Prosthesis; Pressing Dental srl) and the corresponding output for the specific milling machine (Roland DWX-51D) (Fig. 6B-D). Bond commercial teeth (as selected during the design process) to the milled bases with a methacrylate-based bonding agent (IvoBase CAD Bond; Wieland Dental) (Figs. 5C, 7).
DISCUSSION
Figure 5. A, Definitive denture design. B, Clinical evaluation of trial dentures. C, Definitive dentures delivered to patient.
15. Design complete dentures according to the straightforward 3Shape Dental System workflow. Briefly, the main steps of the workflow are setting the occlusal plane (as integrated in the occlusion rims) (Fig. 4A), identifying anatomic landmarks, blocking out undercuts, selecting teeth from available libraries (Fig. 4B), moving and arranging teeth according to the desired occlusal concept, considering information included in the occlusion rims (Fig. 4C), designing denture bases (Fig. 4D),
THE JOURNAL OF PROSTHETIC DENTISTRY
In the technique as presented, open digital technologies (3Shape Trios 3 [scanner]; 3Shape Dental System 2016 [CAD software]; Hyperdent [CAM software]; Roland DWX-51D [milling machine]; and Zortrax M200 [3D printer]) were integrated into a functional workflow to fabricate complete dentures (Figs. 5C, 7) from anatomic information acquired with a conventional technique procedure that does not require any system-specific trays or instruments. Milling the definitive denture base, which is still not feasible with other proposed systems (CFD),8 can be performed in a single step. This can be carried out in any equipped laboratory, with no need for a central milling laboratory. Just 1 blank is milled for each denture arch, whereas, for example, the WDD system requires 3 blanks to be milled. This is possible because 3D printing is used to produce the custom trays, baseplates for occlusion rims, and trial dentures to reduce the costs and time involved. With a workaround in the current release of 3Shape Dental System 2016, single arch dentures can also be created. This workflow can also be tailored to individual needs without affecting its functionality. For example, it is possible to scan impressions and avoid cast preparation, or prepare custom trays and occlusion rims according to the conventional procedure. Gothic arch registration of centric relation is possible by adding the necessary Lo Russo and Salamini
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Figure 6. Details of production phase. A, Computer-aided manufacture project of maxillary denture base with tooth sockets. B, Milled maxillary base. Note outline of holes in thin septa dividing tooth sockets. C, Intaglio of maxillary denture. D, Mandibular denture with teeth inserted to evaluate fit.
impression is made in the first visit by using existing dentures as trays or if the patient can wait approximately 2 hours for the custom trays to be built. The provision of maxillary and mandibular prostheses took an average of 90 minutes of chairside time, 150 minutes of laboratory time, and 270 minutes to mill 2 denture bases before manual polishing. The presented workflow is completely functional. However, the entire process can still be fine tuned, especially in terms of reducing production time and digitizing anatomic information. In addition, clinical trials addressing long-term results are needed.
Figure 7. Patient with definitive dentures.
equipment to the occlusion rims. The casts, rims, and their alignment can also be scanned with a laboratory scanner and a transfer stand. Dentures can normally be delivered within 5 clinical sessions: in 2 of 7 patients, minor adjustments were required in a further clinical session after denture delivery. Treatment may also be reduced to 4 visits by omitting the trial evaluation, or even to 3, if the definitive Lo Russo and Salamini
REFERENCES 1. Bilgin M, Baytaroglu E, Erdem A, Dilber E. A review of computer-aided design/computer-aided manufacture techniques for removable denture fabrication. Eur J Dent 2016;10:286-91. 2. Kattadiyil MT, AlHelal A. An update on computer-engineered complete dentures: a systematic review on clinical outcomes. J Prosthet Dent 2017;117: 478-85. 3. AlHelal A, AlRumaih HS, Kattadiyil MT, Baba NZ, Goodacre CJ. Comparison of retention between maxillary milled and conventional denture bases: a clinical study. J Prosthet Dent 2017;117:233-8. 4. Kattadiyil MT, Jekki R, Goodacre CJ, Baba NZ. Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting. J Prosthet Dent 2015;114:818-25.
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5. Infante L, Yilmaz B, McGlumphy E, Finger I. Fabricating complete dentures with CAD/CAM technology. J Prosthet Dent 2014;111:351-5. 6. Steinmassl PA, Wiedemair V, Huck C, Klaunzer F, Steinmassl O, Grunert I, et al. Do CAD/CAM dentures really release less monomer than conventional dentures? Clin Oral Investig 2017;21:1697-705. 7. Wimmer T, Gallus K, Eichberger M, Stawarczyk B. Complete denture fabrication supported by CAD/CAM. J Prosthet Dent 2016;115:541-6. 8. Schwindling FS, Stober T. A comparison of two digital techniques for the fabrication of complete removable dental prostheses: a pilot clinical study. J Prosthet Dent 2016;116:756-63. 9. Steinmassl PA, Klaunzer F, Steinmassl O, Dumfahrt H, Grunert I. Evaluation of currently available CAD/CAM denture systems. Int J Prosthodont 2017;30: 116-22.
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10. Bidra AS, Taylor TD, Agar JR. Computer-aided technology for fabricating complete dentures: Systematic review of historical background, current status, and future perspectives. J Prosthet Dent 2013;109:361-6. Corresponding author: Prof Lucio Lo Russo Via Serro D’Annunzio, 55 83050 Vallesaccarda, Avellino ITALY Email: [email protected] Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
Lo Russo and Salamini
Removable complete digital dentures: A workflow that integrates open technologies Lucio Lo Russo, DDS, PhDa and Angelo Salamini, Engb Digital technologies for the ABSTRACT design and fabrication of Digitalization of the design and manufacture of removable complete dentures has numerous adremovable complete dentures vantages. The workflow as presented integrates current open digital technologies into a functional have made rapid progress. protocol, enabling complete dentures to be designed and fabricated without system-specific Current innovations and techtrays or instruments. This is done by using a conventional technique to acquire anatomic nological developments in information. (J Prosthet Dent 2017;-:---) computer-aided design and digital technologies may sometimes be limited to denture computer-aided manufacture (CAD-CAM), such as milldesign, whereas production may still be based on a coning and rapid prototyping, allow the design and manuventional technique (CFD).7 facture of removable dentures to be fully digitized.1 Full 2 Thus, to exploit the benefits derived from incorpodigitalization leads to favorable clinical outcomes, better rating digital technologies and materials into complete retention,3 fewer patient visits,4 potentially enhanced denture prosthodontics, a workflow was developed to material properties and biocompatibility,5,6 advances in transfer as much of the conventional technique as standardization of both clinical results and research,1 possible into the digital approach. The aim was to avoid simplified identification of anatomical landmarks on the use of system-specific trays or instruments, exclusive digitized casts, reproducible and less time-consuming 7 dental materials, or system-inherent techniques. In tooth arrangements, easy data storage, and production addition, the idea was to integrate open technological of duplicate dentures. systems, thus facilitating the combined and efficient use To date, 5 different systems for digital complete denof any open scanner, CAD-CAM software, or milling ture fabrication have been described: Wieland Digital 8 5 machine. Denture (WDD), AvaDent Digital Dentures (ADD), These aspects may be beneficial for an easier transiWhole You Next Teeth (WYNT),9 Baltic Denture System 9 7 tion to the digital concept, as clinicians can still work with (BDS), and Ceramill Full Denture (CFD), and another 9 familiar techniques and devices. Clinicians can thus recently announced system, Vita Vionic. Many aspects of gradually change the way they work by incorporating these systems do not favor the routine application of new aspects without abandoning acquired expertise or digital concepts and workflows to complete denture discarding their equipment, all of which makes sense fabrication. In fact, some systems require system-inherent from a practical, financial, and psychological point of equipment, trays, or materials (WDD, ADD, WYNT, 9 10 view. BDS), have proprietary features that limit integration with other systems (WDD, ADD, WYNT, BDS, CFD), or TECHNIQUE cannot manage patients with a single edentulous arch 9 (WDD, DBS). In addition, as their clinical application 1. Make anatomic impressions (Alginoplast; Heraeus may be quite different from that of conventional procedKulzer GmbH) of the edentulous arches (Fig. 1A, B). ures, specific training and expertise are needed. Moreover, a
Associate Professor, Oral Diseases, Department of Clinical and Experimental Medicine, School of Dentistry, University of Foggia, Foggia, Italy. Co-founder, Sintesi Sud Srl, Ariano Irpino, Italy.
b
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Figure 1. Preoperative conditions. A, Maxilla. B, Mandible.
Figure 2. Occlusal records. A, Occlusion rims with hard wax mounted on 3D-printed baseplates. B, Adapted occlusion rims register occlusal plane and other information needed for tooth arrangement.
2. Make casts and scan them with 3Shape Trios 3 color, enabling the function for gypsum scanning, and then process and export scans with the Trios software. Use Trios 3 also for all the other scans. 3. Design custom trays for definitive impressions. Use the specific workflow available in 3Shape Dental System 2016 (release 3). Use this software also for all the other steps in the design process. 4. Fabricate rapid prototype custom trays. Transfer the standard tessellation language (STL) files of the designed custom trays to the software application of the 3-dimensional (3D) printer (M200; Zortrax) to obtain the printable file. Use a 0.09-mm thickness of the material (Z-Ultrat; Zortrax). 5. Make definitive impressions (Impregum Penta; 3M ESPE). 6. Pour definitive casts (Vel-Mix Stone; Kerr Corp) and scan them. 7. Using the digitized definitive casts, design baseplates for occlusion rims. Use the workflow for individual impression trays, setting the space for the material to zero so that the baseplates are
THE JOURNAL OF PROSTHETIC DENTISTRY
Figure 3. Frontal view of scanned casts and occlusion rim alignment.
completely adapted to the mucosa. Add some mechanical retention for the wax rim to the baseplates. 8. Make rapid prototype baseplates for occlusion rims. Transfer the STL files of the designed baseplates to the software application of the 3D printer Lo Russo and Salamini
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2017
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Figure 4. Digital workflow for denture design. A, Setting occlusal plane: lateral view of aligned casts and occlusion rims. B, Tooth selection and proposal for tooth arrangement. C, Tooth position can be modified according to information integrated in occlusion rims. D, Software proposal for denture base design.
(M200; Zortrax) and then print with a 0.09-mm thickness of the material (Z-Ultrat; Zortrax). 9. Add hard wax to the baseplates for the definitive occlusion rims (Fig. 2A). 10. Record the vertical dimension, occlusal plane, and lip support. Adapt the occlusion rims to the patient in order to register all the relevant information for the tooth arrangement in terms of adequate lip support, maxillary incisor length, midline, vertical dimension, and occlusal plane. 11. Make the facebow and jaw relationship records. Use Arcus Digma II (KaVo Dental GmbH) to record settings for the virtual articulator and centric relation according to the following procedure: a. Adapt the para-occlusal spoon (KaVo Dental GmbH) to the mandibular occlusion rim and stabilize with hard wax. Create notches on the occlusal aspect of both rims. b. Obtain centric relation according to the guided method and workflow recommended by the manufacturer. c. Place recording material (Registrado X-tra; Voco) on the occlusal aspect of the rims. Gently Lo Russo and Salamini
guide the mandible into the registered jaw relation and hold in place until the material has completely polymerized (Fig. 2B). 12. Put the definitive casts on the occlusion rims and scan the buccal aspect of the rims and cast bases as a single object. The aim is to align the casts as detailed in the subsequent step and to transfer all the information registered and incorporated in the occlusion rims to the design process. Make small scratches on the rims to optimize the scanning, and create small notches on the cast bases to optimize the alignment (Figs. 3, 4A). 13. Create the order (“order” is how the design process is referred to in 3Shape Dental System software) for the maxillary and mandibular complete denture. 14. Import, in the order created in point 13, the digitized definitive casts (as obtained in point 6) and the scan of the occlusion rims (as obtained in point 12) and align them (Figs. 3, 4A). Carry this out using the 3-point method available in the specific workflow in the ScanItDental application, which is part of the 3Shape Dental System.
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and finalizing the design (Fig. 5A). At the end of the design process, an STL file of the denture bases is created. While creating this file, the CAD software automatically creates sockets for teeth in the denture base. Make a rapid prototype of the trial dentures. After printing with a 3D printer (M200; Zortrax), cover the trial dentures with a thin layer of pink wax (Fig. 5B). Clinically assess trial dentures to evaluate fit, esthetics, maxillomandibular relation, and occlusion (Fig. 5B). At this stage, changes are still possible and, if required, can be incorporated into the definitive dentures. Mill the denture bases from the STL files of the denture bases in Hyperdent CAM software (Fig. 6A) to create the corresponding project in a 25-mm-high poly(methyl methacrylate) blank (Smile Cam Total Prosthesis; Pressing Dental srl) and the corresponding output for the specific milling machine (Roland DWX-51D) (Fig. 6B-D). Bond commercial teeth (as selected during the design process) to the milled bases with a methacrylate-based bonding agent (IvoBase CAD Bond; Wieland Dental) (Figs. 5C, 7).
DISCUSSION
Figure 5. A, Definitive denture design. B, Clinical evaluation of trial dentures. C, Definitive dentures delivered to patient.
15. Design complete dentures according to the straightforward 3Shape Dental System workflow. Briefly, the main steps of the workflow are setting the occlusal plane (as integrated in the occlusion rims) (Fig. 4A), identifying anatomic landmarks, blocking out undercuts, selecting teeth from available libraries (Fig. 4B), moving and arranging teeth according to the desired occlusal concept, considering information included in the occlusion rims (Fig. 4C), designing denture bases (Fig. 4D),
THE JOURNAL OF PROSTHETIC DENTISTRY
In the technique as presented, open digital technologies (3Shape Trios 3 [scanner]; 3Shape Dental System 2016 [CAD software]; Hyperdent [CAM software]; Roland DWX-51D [milling machine]; and Zortrax M200 [3D printer]) were integrated into a functional workflow to fabricate complete dentures (Figs. 5C, 7) from anatomic information acquired with a conventional technique procedure that does not require any system-specific trays or instruments. Milling the definitive denture base, which is still not feasible with other proposed systems (CFD),8 can be performed in a single step. This can be carried out in any equipped laboratory, with no need for a central milling laboratory. Just 1 blank is milled for each denture arch, whereas, for example, the WDD system requires 3 blanks to be milled. This is possible because 3D printing is used to produce the custom trays, baseplates for occlusion rims, and trial dentures to reduce the costs and time involved. With a workaround in the current release of 3Shape Dental System 2016, single arch dentures can also be created. This workflow can also be tailored to individual needs without affecting its functionality. For example, it is possible to scan impressions and avoid cast preparation, or prepare custom trays and occlusion rims according to the conventional procedure. Gothic arch registration of centric relation is possible by adding the necessary Lo Russo and Salamini
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2017
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Figure 6. Details of production phase. A, Computer-aided manufacture project of maxillary denture base with tooth sockets. B, Milled maxillary base. Note outline of holes in thin septa dividing tooth sockets. C, Intaglio of maxillary denture. D, Mandibular denture with teeth inserted to evaluate fit.
impression is made in the first visit by using existing dentures as trays or if the patient can wait approximately 2 hours for the custom trays to be built. The provision of maxillary and mandibular prostheses took an average of 90 minutes of chairside time, 150 minutes of laboratory time, and 270 minutes to mill 2 denture bases before manual polishing. The presented workflow is completely functional. However, the entire process can still be fine tuned, especially in terms of reducing production time and digitizing anatomic information. In addition, clinical trials addressing long-term results are needed.
Figure 7. Patient with definitive dentures.
equipment to the occlusion rims. The casts, rims, and their alignment can also be scanned with a laboratory scanner and a transfer stand. Dentures can normally be delivered within 5 clinical sessions: in 2 of 7 patients, minor adjustments were required in a further clinical session after denture delivery. Treatment may also be reduced to 4 visits by omitting the trial evaluation, or even to 3, if the definitive Lo Russo and Salamini
REFERENCES 1. Bilgin M, Baytaroglu E, Erdem A, Dilber E. A review of computer-aided design/computer-aided manufacture techniques for removable denture fabrication. Eur J Dent 2016;10:286-91. 2. Kattadiyil MT, AlHelal A. An update on computer-engineered complete dentures: a systematic review on clinical outcomes. J Prosthet Dent 2017;117: 478-85. 3. AlHelal A, AlRumaih HS, Kattadiyil MT, Baba NZ, Goodacre CJ. Comparison of retention between maxillary milled and conventional denture bases: a clinical study. J Prosthet Dent 2017;117:233-8. 4. Kattadiyil MT, Jekki R, Goodacre CJ, Baba NZ. Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting. J Prosthet Dent 2015;114:818-25.
THE JOURNAL OF PROSTHETIC DENTISTRY
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5. Infante L, Yilmaz B, McGlumphy E, Finger I. Fabricating complete dentures with CAD/CAM technology. J Prosthet Dent 2014;111:351-5. 6. Steinmassl PA, Wiedemair V, Huck C, Klaunzer F, Steinmassl O, Grunert I, et al. Do CAD/CAM dentures really release less monomer than conventional dentures? Clin Oral Investig 2017;21:1697-705. 7. Wimmer T, Gallus K, Eichberger M, Stawarczyk B. Complete denture fabrication supported by CAD/CAM. J Prosthet Dent 2016;115:541-6. 8. Schwindling FS, Stober T. A comparison of two digital techniques for the fabrication of complete removable dental prostheses: a pilot clinical study. J Prosthet Dent 2016;116:756-63. 9. Steinmassl PA, Klaunzer F, Steinmassl O, Dumfahrt H, Grunert I. Evaluation of currently available CAD/CAM denture systems. Int J Prosthodont 2017;30: 116-22.
THE JOURNAL OF PROSTHETIC DENTISTRY
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Issue
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10. Bidra AS, Taylor TD, Agar JR. Computer-aided technology for fabricating complete dentures: Systematic review of historical background, current status, and future perspectives. J Prosthet Dent 2013;109:361-6. Corresponding author: Prof Lucio Lo Russo Via Serro D’Annunzio, 55 83050 Vallesaccarda, Avellino ITALY Email: [email protected] Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.
Lo Russo and Salamini