Is a complete denture made the digital way better than one made the conventional way?

With a conventional complete denture, the work goes through five steps: a preliminary impression, the main impression taken with a custom tray, recording how the jaws sit relative to each other, a try-in with wax teeth, and delivering the denture. In the digital route the steps keep the same names; what carries them changes. The impression is taken with an intraoral scanner or by the conventional method and converted to a digital file through a desktop scanner; the jaw relationship is still recorded in the mouth; the try-in denture is printed on a 3D printer; the final denture's base is either milled from a resin block or 3D-printed. The teeth may be bonded to the base separately, or, in some systems, produced together with the base.

The most discussed side of this workflow is the number of appointments. A systematic review examining 15 studies, published in the Journal of Prosthodontics, reports that the digital workflow needs fewer appointments than the conventional one, but that total treatment time comes out similar in both routes. So coming to the clinic less does not mean the treatment takes less time; part of the work shifts to time without the patient present, into the laboratory and the software. The same review also states that retention is generally found satisfactory in digital dentures, and equal to or better than the conventional denture on some measures.

On satisfaction, the picture is flatter. In the review's own words, most studies find no significant difference between the two methods in patient satisfaction; some studies come out in favour of digital, others in favour of conventional. No difference shows up either in the number of remakes, repairs or post-delivery adjustments. The authors' own words are that it is hard to conclude that a digitally made complete denture consistently gives higher satisfaction than a conventionally made one. Improvements measured on the technical side do not automatically turn into something the patient feels.

The one clear tendency this review does pick out concerns how the base is made. Patients tend to prefer milled digital dentures, while with 3D-printed dentures there is a tendency to favour the conventional denture. The material-side counterpart of this distinction sits in a systematic review and meta-analysis published in Scientific Reports. In data pooled from 21 studies, the flexural strength of 3D-printed denture bases comes out statistically lower than both heat-cured acrylic and milled blocks; the same direction holds for surface hardness. Milled materials' values cluster within a narrow range, while printed ones spread across a very wide range, meaning the result varies from resin to resin.

This meta-analysis's own caveat needs stating too. The variation between studies is high, test standards vary, and most of the research included was done in a laboratory setting. The authors state clearly that long-term clinical studies measuring patient outcomes are limited. So a printed denture showing lower strength in the laboratory does not necessarily mean it will break sooner in the mouth; it is just that we also have no clinical data today showing the opposite.

On cost, another systematic review and meta-analysis in the Journal of Prosthodontics pools five studies, 184 patients and 202 dentures. No statistically significant difference is found between the digital and conventional workflows in the number of appointments, laboratory cost, clinical cost or total cost. The variation between studies is high on every measure; of the five studies included, four carry a moderate risk of bias and one a high risk, and four are retrospective. The authors also note that the investment in equipment and software is not accounted for, and that patient-centred outcomes are not measured at all. Their conclusion is that the two workflows are similar in cost-effectiveness.

The scale of the randomised data is small too. In a cross-over randomised trial published in the Journal of Clinical Medicine, 10 patients use both their digital and their conventional denture in sequence. The average number of appointments comes out at 5.3 for digital and 5.9 for conventional; no significant difference is found between the two groups on an oral-health-related quality of life scale. The stability of the upper denture is rated significantly better in the digital group, while polish quality is rated better in the conventional group. A rule cannot come from a study of 10 patients; this result is a sign of a trend, not evidence.

The digital route's gain is not the same for everyone. The distinction below shows the situations where the difference is felt, and the ones where it disappears.

The sequence below shows the order most commonly used in clinics. As reviews point out, there is no single agreed protocol; the number of steps varies from clinic to clinic.

1. 1

   Impression and scanning

   The surface of the gum and palate is captured with an intraoral scanner. In some clinics a conventional impression is taken and the model is passed through a desktop scanner; both produce a digital file. If there is flabby, mobile tissue, some dentists deliberately prefer the conventional technique, because the position the tissue is recorded in matters there.

2. 2

   Recording the jaw relationship

   How the lower and upper jaw sit relative to each other, and the height of the teeth, is recorded in the mouth. This step is the part that does not go digital; the computer cannot generate this information on its own, and much of the denture's success depends on the accuracy here.

3. 3

   Design, and printing the try-in denture

   Tooth arrangement, lip support and bite are set up in the software. The design is printed as a single piece on a 3D printer and tried in the mouth. Its difference from a conventional wax try-in is that this one feels much closer to the real denture, and it can be tried out while you talk.

4. 4

   Feeding changes made at the try-in back into the file

   During the try-in, work is done on the length of the teeth, the midline, lip support and the bite. Every adjustment made is fed back into the file. In the conventional route, these adjustments made on the wax stayed in the technician's hands; here, they are recorded.

5. 5

   Producing and delivering the final denture

   The base is milled from a resin block or 3D-printed, the teeth are set and the denture is polished. At delivery the bite is checked and any pressure points are relieved. A few adjustment appointments after delivery are normal; reviews find no difference between the two methods in this number.

6. 6

   Finding out whether your case will be solved with a denture or with fixed teeth

   This distinction is decided by the bone in your jaw, and it cannot be stated without an image. If you have a panoramic X-ray or a CBCT scan, send it through the form; the dentist who will carry out the treatment reads the image, and we will reply within 24 hours on whether a denture or fixed teeth on implants is on the table for you. This is a preliminary assessment; the final decision is made after an examination and a CBCT scan.

The production method does not change the real question about the complete denture itself: will the denture rest on the gum, or will support be taken from the bone.

Moving production onto a computer removes some errors while adding new ones. The following are points named in the literature that have a real counterpart in the clinic.

A new complete denture needs a period of getting used to it, whichever way it was made. The sequence below shows the expected general course.

1. The first few days

   Speech changes, saliva increases and pressure is felt at a few points. Starting with soft food and small mouthfuls during this period makes things easier. Sore points are relieved by coming into the clinic, not by filing the denture down at home.

2. Week one and two

   Pressure points are relieved over a few short appointments. Reviews find no difference between digital and conventional dentures in the number of post-delivery adjustments and repairs; so needing a few appointments is not a production fault, it is the expected course.

3. Month one to three

   Chewing settles into a routine and speech returns to normal. Establish the habit of taking the denture out at night during this period; leaving it in overnight is reported as one of the main risk factors for denture-related gum inflammation.

4. Year one and after

   Because the bone underneath keeps resorbing, the denture loosens over time. In the randomised trial in patients with flabby ridges, retention drops by close to a quarter within six months with either method. How often check-ups happen is set by the clinic's follow-up plan.

Neither generalisation, that the digital route is cheaper or that it is more expensive, is supported by today's evidence. You will not find figures here; these are the things to look at when assessing a quote:

Whether the base is milled or printed

This distinction changes both the material's strength and the cost. In the meta-analysis, milled bases give the highest flexural strength and surface hardness values, while printed ones spread across a very wide range. Ask which one the quote specifies.

How the teeth are made

Taking teeth from a ready-made set and bonding them to the base, and producing them together with the base, are different processes. How the result looks and how it wears depend on this choice.

The number of appointments, and whether adjustments are included

Ask from the start whether post-delivery adjustment appointments are included in the price. Reviews find no difference between the two methods in the number of these appointments, so being digital does not mean no adjustment will be needed.

Whether the file is kept

The most concrete practical benefit of the digital route is reproducibility. Find out in writing whether the design file is kept at the clinic, and what route would be followed if you wanted it reproduced in future.