CAD/CAM versus traditional complete dentures: A systematic review and meta-analysis of patient- and clinician-reported outcomes and costs.

STATEMENT OF PROBLEM: Computer-aided design and manufacturing (CAD/CAM) have been increasingly used to enhance the patient and clinician experiences with removable complete dentures (CDs). Yet, evidence from systematic reviews is lacking to validate the clinical significance of these digital prostheses. PURPOSE: The purpose of this systematic review was to compare CAD/CAM CDs with the traditional ones in terms of patient and clinician-reported outcomes, post-insertion adjustment visits and costs. MATERIALS AND METHODS: An electronic search of four databases [Medline (Ovid), Embase, Scopus and Cochrane CENTRAL; last update: May 2022] was performed to retrieve clinical studies comparing CAD/CAM and traditional CDs. Two independent reviewers screened the articles, extracted data (methods and outcomes) and assessed risk of bias of the included studies. The following outcomes underwent meta-analysis (random-effects model): overall patient and clinician satisfaction, oral health-related quality of life (OHRQoL), number of post-insertion adjustment visits, as well as laboratory and total costs. RESULTS: This review included 11 studies. Meta-analysis revealed that CAD/CAM CDs are comparable to the traditional CDs in terms of overall patient satisfaction and OHRQoL. Clinician-reported data depended on the manufacturing technique: whereas milled CDs performed better than traditional CDs in terms of clinician satisfaction and number of adjustments, 3D printed and traditional CDs were similar. Fabrication of CAD/CAM CDs required significantly less laboratory and overall costs than the traditional CDs. CONCLUSIONS: There is some evidence showing that CAD/CAM CDs are at least comparable to traditional CDs. Further well-designed randomized clinical trials are needed to evaluate the performance of specific CAD/CAM approaches for manufacturing CDs, however.

DIGITAL FABRICATION OF COMPLETE DENTURES, COMPARED TO CONVENTIONAL METHODS, MAY OFFER A MORE COST-EFFECTIVE APPROACH WITH IMPROVED PATIENT OUTCOMES.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Digitally versus conventionally fabricated complete dentures: A systematic review on cost-efficiency analysis and patient-reported outcome measures (PROMs). Tew, In Meei, Suet Yeo Soo, and Edmond Ho Nang Pow.The Journal of Prosthetic Dentistry (2023). SOURCE OF FUNDING: No fund was received. TYPE OF STUDY/DESIGN: Systematic review.

Randomised clinical trial of patient satisfaction with traditional and simplified complete dentures.

To clinically evaluate the patient satisfaction and associated costs of dentures made using a simplified procedure that eliminates assembly on the articulator and dentures made with the conventional technique. Single-blind randomised clinical trial. Forty edentulous patients were randomly divided into 2 groups. One group received dentures made using the conventional method (CG), and the other using a simplified technique (SG) that omits the use of functional impressions (with modelling compound and ZOE impression paste) and an articulator to assemble the models. Overall patient satisfaction was assessed at 3 and 6 months by means of a Numerical Rating Scale (NRS). The comparisons were made using a repeated measures ANOVA (P = .05). No significant differences were found in terms of the satisfaction stated by the patients or the quality of the prosthesis evaluated by a professional among the dentures made using the traditional (n = 17) and simplified (n = 21) techniques. The rehabilitation of an edentulous patient with a simplified technique for the preparation of a total prosthesis is a feasible, more economical alternative and accepted by most patients.

[Evaluation of production and clinical working time of computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays for complete denture].

OBJECTIVE: To compare the technician fabrication time and clinical working time of custom trays fabricated using two different methods, the three-dimensional printing custom trays and the conventional custom trays, and to prove the feasibility of the computer-aided design/computer-aided manufacturing (CAD/CAM) custom trays in clinical use from the perspective of clinical time cost. METHODS: Twenty edentulous patients were recruited into this study, which was prospective, single blind, randomized self-control clinical trials. Two custom trays were fabricated for each participant. One of the custom trays was fabricated using functional suitable denture (FSD) system through CAD/CAM process, and the other was manually fabricated using conventional methods. Then the final impressions were taken using both the custom trays, followed by utilizing the final impression to fabricate complete dentures respectively. The technician production time of the custom trays and the clinical working time of taking the final impression was recorded. RESULTS: The average time spent on fabricating the three-dimensional printing custom trays using FSD system and fabricating the conventional custom trays manually were (28.6±2.9) min and (31.1±5.7) min, respectively. The average time spent on making the final impression with the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually were (23.4±11.5) min and (25.4±13.0) min, respectively. There was significant difference in the technician fabrication time and the clinical working time between the three-dimensional printing custom trays using FSD system and the conventional custom trays fabricated manually (P<0.05). CONCLUSION: The average time spent on fabricating three-dimensional printing custom trays using FSD system and making the final impression with the trays are less than those of the conventional custom trays fabricated manually, which reveals that the FSD three-dimensional printing custom trays is less time-consuming both in the clinical and laboratory process than the conventional custom trays. In addition, when we manufacture custom trays by three-dimensional printing method, there is no need to pour preliminary cast after taking the primary impression, therefore, it can save the impression material and model material. As to completing denture restoration, manufacturing custom trays using FSD system is worth being popularized.

EAO consensus conference: economic evaluation of implant-supported prostheses.

OBJECTIVE: There are various alternatives for the management of oral conditions that may lead to or already have lead to partial or full edentulism. Economic evaluations measure the efficiency of alternative healthcare interventions and provide useful information for decision-making and the allocation of scarce resources. MATERIAL AND METHODS: The current English literature dealing with "cost-effectiveness" of dental implant therapy versus different alternative treatment modalities, that is, complete and fixed partial dentures, root canal, and periodontal treatment, has been included in this narrative review. Due to the high heterogeneity within the literature, a meta-analysis could not be conducted. RESULTS: The available evidence from economic evaluations indicated that for the treatment of central incisors with irreversible pulpitis and coronal lesions, root canal treatments were most cost-effective initial treatment options. When initial root canal treatments failed, orthograde retreatments were most cost-effective. When root canal retreatments failed, extractions and replacement with single implant-supported crowns were more cost-effective compared to fixed or removable partial dentures. In the treatment of periodontitis in molars with Class I furcation invasion, non-surgical periodontal therapy was more effective and costed less than implant-supported single crowns. For the replacement of single missing teeth, two evaluations indicated that implant-supported single crowns provided better outcomes in terms of greater quality-adjusted tooth years or survival rates at lower costs compared to fixed partial prostheses. Another economic evaluation found that implant-supported crowns costed more, but provided greater survival rates compared to fixed partial dentures. For the restoration of edentulous mandibles, two evaluations indicated that overdentures retained by two or four implants improved oral health-related quality of life outcomes, but costed more than complete dentures. CONCLUSIONS: To better assess the efficiency of implant-supported prostheses in various clinical conditions, more economic evaluations are needed that follow well-established methodologies in health economics.

Reimbursement systems influence prosthodontic treatment of adult patients.

OBJECTIVE: To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. MATERIALS AND METHODS: Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. RESULTS: Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. CONCLUSIONS: Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Simplified versus traditional techniques for complete denture fabrication: a systematic review.

STATEMENT OF PROBLEM: A number of methods have been described for the fabrication of complete dentures. There are 2 common ways to make conventional complete dentures: a traditional method and a simplified method. PURPOSE: The purpose of this study was to conduct a systematic review to compare the efficiency of simplified and traditional methods for the fabrication of complete dentures. MATERIAL AND METHODS: The review was conducted by 3 independent reviewers and included articles published up to December 2013. Three electronic databases were searched: MEDLINE-PubMed, The Cochrane Library, and ISI Web of Science. A manual search also was performed to identify clinical trials of simplified versus traditional fabrication of complete dentures. RESULTS: Six articles were classified as randomized controlled clinical trials and were included in this review. The majority of the selected articles analyzed general satisfaction, denture stability, chewing ability and function, comfort, hygiene, esthetics, speech function, quality of life, cost, and fabrication time. CONCLUSIONS: Although the studies reviewed demonstrate some advantages of simplified over traditional prostheses, such as lower cost and clinical time, good chewing efficiency, and a positive effect on the quality of life, the reports related the use of different simplified methods for the fabrication of complete dentures. Additional randomized controlled trials that used similar simplified techniques for the fabrication of complete dentures should be performed with larger sample sizes and longer follow-up periods.

Dental technology services and industry trends in New Zealand from 2010 to 2012.

OBJECTIVE: To provide a snapshot of the New Zealand dental technology industry and influencing factors. BACKGROUND: Developing an understanding of the commercial dental laboratory environment in New Zealand can provide insight into the entire dental industry. METHODS: A web-based survey was the primary method for data collection, with separate questionnaires used for dental laboratory owners and dental technician employees. RESULTS: The mean net income for dental laboratory owners in New Zealand was similar to that of the United Kingdom, at $40.50 per hour. Clinical dental technicians are the highest paid employees, with a mean of $33.49 per hour. The mean technical charge for complete dentures was $632.59; including clinical services, it was $1907.00. The mean charge for a porcelain-fused-to-metal (PFM) crown was $290.27. Dental laboratory owners expressed fear about the possibility of losing dental clients to overseas laboratories due to the availability and cheap charge of offshore work. Only 25.4% of dental laboratories surveyed had computer-aided design (CAD) facilities, and even fewer (7.9%) had computer-aided manufacturing (CAM) systems. CONCLUSION: Clinical dental technology appears to be prospering. The dental technology industry appears to be adapting and remains viable, despite facing many challenges.

A randomized trial on simplified and conventional methods for complete denture fabrication: cost analysis.

PURPOSE: This study aimed to quantify the costs of complete denture fabrication by a simplified method compared with a conventional protocol. MATERIALS AND METHODS: A sample of edentulous patients needing conventional maxillary and mandibular complete dentures was randomly divided into group S, which received dentures fabricated by a simplified method, and group C, which received conventionally fabricated dentures. We calculated direct and indirect costs for each participant including unscheduled procedures. This study assessed 19 and 20 participants allocated into groups S and C, respectively, and comparisons between groups were conducted by the Mann-Whitney and Student's t-test (α = 0.05). RESULTS: Complete denture fabrication demanded median time periods of 173.2 and 284.5 minutes from the operator for groups S and C respectively, and 46.6 and 61.7 minutes from the dental assistant (significant differences, p < 0.05). There was no difference between groups regarding postinsertion adjustments. Group S showed lower values for costs with materials and time spent by patients than group C during the fabrication stage, but not during adjustments. CONCLUSIONS: The median direct cost of complete denture treatment was 34.9% lower for the simplified method. It can be concluded that the simplified method is less costly for patients and the health system when compared with a conventional protocol for the rehabilitation of edentulous patients.

Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures.

PURPOSE: To assess and compare patient satisfaction and oral health-related quality of life (OHQOL) in patients treated with implant-supported overdentures and complete implant fixed prostheses. MATERIALS AND METHODS: From a database of patients who had undergone implant treatment over a 6-year period, a study population of 62 patients was identified; every patient had at least four implants placed in one edentulous arch and was restored with either an overdenture or a fixed prosthesis. Patients were examined and a self-administered, structured multiple-response questionnaire, including the Oral Health Impact Profile-14 measurement tool and a patient satisfaction survey, was used to evaluate patient-centered treatment outcomes. RESULTS: Generally, patient satisfaction was very high in both the implant overdenture and fixed prosthesis groups, although the subjects in the overdenture group, who had mostly maxillary prostheses, reported significantly lower overall satisfaction and lower satisfaction with chewing capacity and esthetics. In just three categories--cost, satisfaction with treating doctor, and ability to perform oral hygiene measures--the fixed prosthesis group was less satisfied than the removable overdenture group, but the difference was not significant. Similarly, the overall OHQOL was high, although patients receiving a fixed prosthesis demonstrated significantly lower psychologic discomfort and psychological disability compared to the overdenture group. CONCLUSIONS: Among all patients who had similar numbers of implants placed, those who received an implant overdenture were less satisfied and had lower OHQOL than the patients who had a fixed prosthesis. Since patient and dentist preferences influenced the type of prosthesis provided, it is likely that subjective, patient-related factors are major determinants of satisfaction and treatment outcomes.

A feasibility study on laser rapid forming of a complete titanium denture base plate.

This work attempted to integrate the technologies of computer-aided design and computer-aided manufacture (CAD/CAM) and laser rapid forming (LRF) for the fabrication of the titanium plate of a complete denture. By the combination of laser scan and reverse engineering software, the standard triangulation language (STL)-formatted denture base plate was finally designed and sliced into a sequence of numerical controlled codes. The titanium (Ti) complete denture plate was finally built, layer-by-layer, on the LRF system. To evaluate the quality of fit, a virtual adaptation test that measured and compared the profiles of the laser free formed denture plate and those of the edentulous plaster cast had been conducted, and the mean deviation was found to be 0.34 mm. After traditional dental finishing techniques, a complete denture with a Ti base plate was then made and judged to be acceptable. The CAD/CAM/LRF system is a potential candidate and a new platform for the design and manufacture of custom-made Ti denture plates and restorations.

Efficient resource use in simplified complete denture fabrication.

PURPOSE: Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures-the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality. MATERIALS AND METHODS: Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis. RESULTS: The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes. CONCLUSIONS: The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.

Budgetary Impact of Oral Rehabilitation With Complete Dentures: An Economical Evaluation From São Paulo State, Brazil.

OBJECTIVE: To develop a budgetary impact analysis regarding the possibility of offering complete upper and lower dentures to an eligible population of elderly people (above 65 years) in the São Paulo state, Brazil. METHODS: The proportion of eligible population was calculated by assessing the prevalence of edentulous (upper and lower arch) and by defining the eligible group (public health system users). The budgetary impact analysis was designed under the following scenario: 5-year time horizon (2018-2022), prospect of municipal expenses with prostheses, and additional progressive incorporation of technology (upper and lower dentures) at an annual rate of 10%, 15%, 20%, 25%, and 30%. Sensibility analysis was performed in 3 different situations (reference, more pessimistic, and more optimistic) based on the calculation of spending through assessed demand and epidemiological demand. RESULTS: The municipal cost for each denture, already discounted the value transferred by the union for this procedure, was R$50.97. The incremental impact on the budget measured by the epidemiological demand relative to assessed demand was approximately R$59 141 510 over 5 years, meaning an impact of 0.08% (0.01% more optimistic; 0.13% more pessimistic) of the "medium and high complexity care" budget and 0.09% (0.03%-0.14%) of the primary care budget. CONCLUSION: The budgetary impact of increasing the oral rehabilitation with complete dentures for elderly population in the São Paulo state is low relative to the expenses with primary or specialized care budgets. In addition, incorporation of denture rehabilitation would be feasible, according to the financial availability and priorities of each municipality.

Cost-effectiveness analysis of two impression methods for the fabrication of mandibular complete dentures.

OBJECTIVES: To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods. METHODS: A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness. RESULTS: The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction. CONCLUSIONS: The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001). CLINICAL SIGNIFICANCE: The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful1.

Clinical Teaching of Prosthodontics in Undergraduate Courses in a German Dental School: Patients, Visits, Efforts, and Incentives.

It is unknown what disadvantages are faced by patients deciding for a prosthodontic treatment by inexperienced students. Commonly, the related extra effort and time are compensated by cost reduction of treatment fees. Thereby, the dental schools subsidize treatments to teach clinical prosthodontics. The aim of this study was to clarify the benefits to patients as well as the efforts of the dental school. Data collected from three courses in a dental school in Germany were patient gender, age, occupation, zip code, number of visits, scope of treatment including costs, financial discount, and remaining copayment. Travel costs were calculated based on zip code. Balance of travel costs and treatment discount was defined as financial benefit. The results showed that 185 patients (95 male) aged 32 to 82 years (median=58) were treated with fixed restorations (FR, n=110), telescopic dentures (TD, n=87), complete dentures (CD, n=17), or other (RD, n=3). The mean number of visits was 11 for FR, 12 for TD, and 9 for CD. Single distance to the clinic ranged from 0.6 to 65 miles (median=12). Total costs of prosthodontics were reduced by 19% on average. The mean financial benefit was 429 USD (median=298, min=-482, max=4025). The financial benefits were found to differ widely, including additional expenditures of patients. Participation, travel burden, and copayment did not depend on age, gender, or occupation. The financial benefit was relativized because students needed at least twice the sessions of a dentist. As a result, the financial efforts of dental schools are significant and compromise a cost-covering education.

Relationships between price and two components of quality of dental services.

Failure to account for differences in service attributes can lead to biased estimates and erroneous inferences regarding relationships between price and quality in studies of the dental care delivery system. This study examined relationships between prices of several common dental procedures and two components of the structure and process dimensions used in quality of care assessments. Results from ordinary least squares regression analysis demonstrated a significant positive relationship between price and an index of technical quality for two restorative services provided by general practitioners, even when controlling for market area characteristics. Additional analyses revealed that prices charged by general practitioners for specific services typically were lower on average and demonstrated greater variation than those charged by specialists for the same procedures. These findings highlight the need to consider service differentiation, including quality variation, in empirical studies involving the pricing of dental services.

How to maintain quality in economy dentures.

A method for constructing custom dentures using minimum time at the chair is described. Efficiency with this or any technique is gained only through experience. Although there are many ways of achieving the same goal, the basic principles of sound prosthodontic procedures must be followed for the service to be professionally acceptable.

Guidelines for professional quality dentures for the financially disadvantaged.

The purpose of this project was to evaluate and report on the timing of procedures involved in complete denture service based on criteria for assessment of quality and to determine the effectiveness of a model of such a delivery system in terms of success of treatment and reduction of cost. It can be concluded that the denture care system may and can be used as a model to provide the base line reference to compare with other denture care delivery systems; the use of criteria for assessment of quality is not only efficient, but is also practical; and a complete denture treatment service of the quality defined by the criteria developed for this model can be provided to patients.

The qualitative assessment of complete dentures produced by commercial dental laboratories.

Comprehensive criteria and simple methods of assessment have been developed for the evaluation of complete dentures supplied by commercial dental laboratories. One hundred laboratories in England and Wales were selected by random sampling. A single identical complete denture case was sent from general practice addresses to each of the selected laboratories and each of the laboratory stages evaluated according to specific criteria. This paper is concerned only with the evaluation of the finished dentures. Half of the cases were treated as NHS cases and half as 'private' cases. The private cases were further subdivided into those where details were left to the laboratory and those where detailed instructions were given for all stages of denture construction. Wide variations were found in both the quality and cost of complete denture laboratory work. Evaluation of some key features of finished dentures suggests that the quality of work was superior for the private cases in which detailed instructions were given to the laboratory. Even for the private (specified) cases, however, important faults were found in a number of cases.