Date of Completion
Dr. John Agar, Dr. Thomas Taylor, Dr. Arthur Hand
Field of Study
Master of Dental Science
Statement of the problem: Currently, there are no studies that presented patient centered outcomes for a CAD/CAM 2-visit digital denture.
Purpose: To study: 1) if a 2-visit CAD/CAM denture was satisfactory to patients who evaluated 12 specific clinical outcomes. 2) If there are any patient reported differences between various clinical outcomes, when evaluated at baseline (within 1 month of insertion) and at a 12 month follow-up since insertion. 3) If there are any adverse clinical and patient-satisfaction outcomes related to CAD-CAM complete denture prostheses.
Materials and methods: A total of 20 subjects who presented with an existing set of maxillary and mandibular complete dentures were selected to take part in the study. Each set of complete dentures were duplicated in a clear acrylic resin. These duplicate dentures were then used as the custom tray, in which the patients went through border molding movements followed by a final impression. Jaw Relation Records was taken in centric relation at the appropriate occlusal vertical dimension and the correct incisal edge position. The mold and shade of the teeth were then selected. The duplicated dentures with occlusal rims and impression were then shipped to AvaDent. A digital preview was reviewed. If corrections were required, it was communicated with AvaDent through email or phone calls. Upon approval of the digital preview, the CAD-CAM monolithic dentures were milled. Standard denture protocols were followed for the insertion visit and subsequent post-insertion visits. The patients evaluated 12 clinical variables using the Visual Analogue Scale at 0-months (baseline) and at 12-months following insertion. The following variables were used: Retention (“Tightness”), Stability (“Absence of rockiness”), Support/Absence of food underneath the denture, Esthetics/Cosmetics, Finish/Appearance, Occlusion/Bite and chewing ability, Speech sounds/Ability to speak normally, Extensions/Bulkiness, Tissue health/Absence of discomfort or sore spots, Projection of the upper lip, Treatment time, and Overall evaluation/ “Overall prosthesis satisfaction” The collected data were then statistically analyzed.
Results: Of the 20 subjects, 14 patients were evaluated at the 12 month follow up. Three subjects self-withdrew due to patient dissatisfaction. Another 3 patients were lost to follow up. All 14 patients rated the studied clinical outcomes as good to excellent at baseline and at 1-year recall. Improvements in ratings were seen from baseline to 12 months in the following outcomes: extensions/bulkiness, occlusion/bite or chewing ability, Tissue health/Absence of discomfort or sore spots, finish/appearance, speech sounds, treatment time, and overall evaluation.
Conclusions: Within the limitations of this study, the patient-centered outcomes for CAD-CAM dentures fabricated using a 2-visit protocol in patients with existing complete dentures was evaluated as good to excellent by patients, using a visual analog scale. The patient evaluations showed minimal differences from baseline and at 1-year evaluation. However, speech, absence of sore spots, and total treatment time showed a statistically significant improvement in VAS ratings. Finally, patients classified as philosophical by House Classification provided the most favorable ratings in patient satisfaction for CAD-CAM dentures.
Though the 2-visit complete denture is a viable treatment option, clinicians should recognize the need for careful patient selection, learning curve in the clinical steps as well as the laboratory aspect of designing the CAD-CAM denture. Furthermore, the additional time and effort, spent off-chairside by clinicians to analyze and approve digital previews, should be weighed against chair-side time spent on the esthetic try-in procedure, which requires an additional visit.
Farrell, Kimberly A., "Prospective Cohort Pilot Study on CAD-CAM Complete Denture for the Edentulous Patients: Patient Centered Outcomes" (2015). Master's Theses. 795.
Dr. Avinash Bidra