INTRODUCTION
Traditionally, the complete denture-making process involves multiple steps, including preliminary impressions, definitive impressions, maxillo-mandibular relationship, trial dentures, insertion of dentures, and post-insertion adjustments, requiring numerous patient visits and several exchanges with a laboratory.1 This multistep procedure can be time consuming and burdensome for patients, clinicians, and laboratory technicians.
Within the field of prosthodontics, digital technologies such as CAD/CAM, 3D printing, 3D milling, and digital scanning have revolutionized the design and production of tooth-borne prostheses and tooth-supported removable partial dentures.2,3 Nonetheless, digital dentistry in the fabrication of tissue-borne prostheses, such as complete dentures or removable partial dentures primarily supported by tissue, remains limited. Current intraoral scanners often struggle to accurately capture the edentulous arch, particularly the mandibular arch, because of the mobility of the soft tissues and a lack of anatomical landmarks.4 Furthermore, even with digital technology, multiple visits are commonly required to gather information on tooth positioning and jaw relationships following intraoral scanning before the laboratory technician can proceed with designing and fabricating the definitive complete dentures.5 Duplicate dentures have emerged as a digital technique to reduce the number of visits for denture fabrication. However, the application of this technique is limited because many patients seeking dentures might not have existing dentures to duplicate, or their existing dentures might not be in the proper shape to duplicate.6
The Easdent system, a patent-pending invention, addresses this challenge by significantly reducing the number of visits required for complete denture fabrication. The Easdent system uses premade 3D printed resin trays with standardized tooth positions and a moldable custom tray material, obtaining teeth positions, maxillo-mandibular relationship, and definitive impressions in a single visit. This innovative method gathers information required for traditional and digital denture fabrication.
This case report describes the Easdent system through the treatment of an 81-year-old male patient with a history of extensive wear of the occlusal surface of complete denture artificial teeth secondary to bruxism. This approach demonstrates the reduction of the dentist’s chairside time, a patient’s dental visits, and laboratory work for digital denture fabrication, representing a significant step forward in the field of prosthodontics.
CASE REPORT
An 81-year-old male presented to a private dental office with a chief complaint of worn-down complete dentures from grinding and needing a new set of dentures. The patient has had his current dentures for less than 2 years and has developed a habit of grinding them during the day since his stroke 18 months ago.
A clinical exam revealed healthy maxillary and mandibular denture supporting tissues, a moderately resorbed maxillary edentulous ridge, and a severely resorbed mandibular edentulous ridge (Figures 1a and 1b). The patient’s complete dentures had poor retention, requiring the use of denture adhesive, with artificial teeth on both dentures severely worn down (Figures 1c and 1d). The occlusal vertical dimension was overclosed and the occlusion was unstable. The patient was offered a new set of complete dentures with porcelain or metal teeth to reduce the occlusal wear, but he abstained from both options, desiring extra sets of dentures with frequent replacement.
Due to severe denture tooth wear, the patient’s existing dentures were not used for making duplicates or recording tooth position or maxillo-mandibular relationships. The Easdent System, developed to record tooth position, definitive impressions, and maxillo-mandibular relationships in a single visit, was used for denture fabrication. This device consists of stock rigid trays (Easdent Trays), moldable material, and a measurement device (Easdent Measure). Available in multiple sizes, Easdent Trays are stock trays with standardly positioned teeth, tissue-supporting frames, and maxillary and mandibular teeth intercuspated at proper occlusion. The moldable material fills the space between the tray and the patient’s soft tissue.
The Easdent Measure, containing 5 functions in 1 device, has a horizontal bar with 2 faces. The top-facing side consists of a plate with a Y-shaped fork and 2 arms, similar to the Fox Plane analyzer that establishes the occlusal plane by aligning Easdent Tray’s maxillary teeth horizontally parallel to the inter-pupillary and ala-tragus lines. The fork measures the distance between retromolar pads to determine the appropriate size of the Easdent Tray. The bottom-facing side of the horizontal bar contains 2 projections and a movable handle that slides along the length of the horizontal bar. When the patient’s jaws are in centric relation and vertical dimension of occlusion (VDO), the distance from the lower border of the nose’s septum to the lower border of the chin is equal to the distance from the outer canthus of the eye to the commissure of the lips.7 Using the shorter projection and movable handle, the VDO can be predetermined. The Easdent Measure device used in this case report was printed using photopolymer resin (Rodin 3D resin Surgical Guide [Pac-Dent]) from the 3D design (Figure 2).
Size 4 maxillary and mandibular Easdent Trays (Figures 3a and 3b) were selected from preprinted trays by using Photopolymer resin (TR01 [SHINING 3D Dental]). Light-polymerized pink custom tray material was placed on the maxillary and mandibular Easdent Trays on the intaglio surface (Light Cure Custom Tray Material [Henry Schein, Zahn Laboratory Division]) (Figures 3c and 3d). To keep the unpolymerized tray material from contacting soft tissue, the tray material was covered by plastic sheets cut from dental curing light sleeves (Pinnacle Complete Curing Light Sleeve [Kerr TotalCare, Kerr]) (Figure 4). The maxillary Easdent Tray containing tray material was adjusted into the desired position in the patient’s mouth. The teeth of the maxillary Easdent Tray were aligned with the patient’s facial midline, and the occlusal plane was aligned horizontally parallel to the inter-pupillary line and ala-tragus lines using the Easdent Measure (Figure 5). The incisal edge position was adjusted based on aesthetics and phonetics (Figure 6). The tray material was light polymerized in the maxillary Easdent Tray using a light polymerizing unit (Triad 2000 Light Curing Unit [Dentsply Sirona Prosthetics]) for 3 minutes.
Additional tray material was added at the periphery and covered with plastic again. Using finger pressure, the tray material was adapted along the vestibules, and the borders were molded through various lip movements. The tray material was polymerized again, creating the maxillary custom tray with the correct tooth position (Figure 7). Frenum areas were relieved, and additional border molding was performed with heavy-body polyvinyl siloxane impression material (Correct Plus Bite Superfast [Pentron]) before making the definitive impression with extra light-body polyvinyl siloxoane impression material (Genie PVS X-light Body, Standard Set [Sultan Healthcare]) (Figure 8).
While the maxillary device was stabilized in the patient’s mouth, the mandibular Easdent Tray containing tray material was covered with a plastic sheet and inserted into the patient’s mouth. Mandibular teeth were intercuspated with maxillary teeth to achieve the desired occlusal relationship, and the patient was guided into centric relation at the predetermined VDO (Figure 9). After attaining the desired mandibular tooth position and maxillo-mandibular relationship, the same technique was performed to create the mandibular custom tray and final impression (Figure 10). A centric relation record was made using Correct Plus Bite Superfast (Figure 11). Shade A2 and the Easdent Tray teeth mold were selected for the patient’s denture teeth. The maxillary and mandibular definitive impressions, together with the teeth, were scanned using an intraoral scanner (Aoralscan 3 [SHINING 3D Dental]) outside the mouth. The interocclusal record was scanned in the patient’s mouth for additional accuracy to prevent extra occlusal registration material from introducing errors.
The .STL files from the digital scans were sent to a dental laboratory to fabricate digital dentures. The dental laboratory designed the dentures using dental design software (3Shape Dental System Premium [3Shape]) and sent back 3D printed trial dentures made with photopolymer resin (TR01). Trial dentures indicated proper teeth position and maxillo-mandibular relationship. Definitive dentures were 3D printed by using photopolymer resin (printodent GR-17.1 [pro3dure medical]) for denture teeth and photopolymer resin (printodent GR-14.2 [pro3dure medical]) for the denture base. The dentures fit well, and no adjustments were required (Figure 12).
DISCUSSION
This case report presents a novel approach to fabricating dentures that substantially reduces the number of required patient visits while maintaining or improving the quality of final prostheses. Traditional denture fabrication typically involves at least 5 patient visits, including preliminary impressions, definitive impressions, jaw relation records, try-in, and final insertion. The process can be lengthy and uncomfortable for the patient, and there are multiple opportunities for errors, such as inaccuracies in jaw relation records or in processing.
The Easdent system, described in this case report, eliminates several of these steps by combining the tasks of recording the tooth positions, maxillo-mandibular relationship, and definitive impressions into a single visit. The use of premade resin trays with standard tooth positions, combined with a light-polymerized custom tray material, not only reduces the number of visits required but also minimizes the potential for errors that can occur during the traditional multistep process. The digital workflow also allows for easy replication of dentures, ensuring that patients are able to receive replacements quickly, and with consistent quality.
The digital workflow in prosthodontics has demonstrated several advantages over conventional techniques, including increased precision, reproducibility, and patient comfort.2,3 In this case report, digital scans of the Easdent impressions and interocclusal records were sent to a laboratory for the fabrication of digital dentures. The patient’s experience illustrates the system’s effectiveness in providing a comfortable, efficient, and high-quality dental solution.
CONCLUSION
The Easdent system represents a significant advancement in complete denture fabrication, simplifying the traditional multistep process into a single clinical visit without compromising the quality of the final prostheses. The successful use of the Easdent system, combined with the high-quality fit of the digital dentures, suggests that this method could become a new standard in denture fabrication. Further research and clinical trials are recommended to validate these findings across a broader patient population and explore the full potential of digital dentures in combination with innovative systems such as the Easdent System.
REFERENCES
1. Zarb GA, Hobkirk J, Eckert S, et al. Prosthodontic Treatment for Edentulous Patients: Complete Dentures and Implant-Supported Prostheses. 13th ed. Mosby; 2012.
2. Watanabe H, Fellows C, An H. Digital technologies for restorative dentistry. Dent Clin North Am. 2022;66(4):567–90. doi:10.1016/j.cden.2022.05.006
3. Chochlidakis KM, Papaspyridakos P, Geminiani A, et al. Digital versus conventional impressions for fixed prosthodontics: A systematic review and meta-analysis. J Prosthet Dent. 2016;116(2):184–90.e12. doi:10.1016/j.prosdent.2015.12.017
4. Rasaie V, Abduo J, Hashemi S. Accuracy of intraoral scanners for recording the denture bearing areas: a systematic review. J Prosthodont. 2021;30(6):520–39. doi:10.1111/jopr.13345
5. Rasaie V, Abduo J. Current techniques for digital complete denture fabrication. Int J Comput Dent. 2022;25(2):181–99. https://pubmed.ncbi.nlm.nih.gov/35851356/
6. Yoda N, Abe M, Yamaguchi H, et al. Clinical use of duplicate complete dentures: A narrative review. Jpn Dent Sci Rev. 2024;60:190–7. doi:10.1016/j.jdsr.2024.05.005
7. Emam NM. Correlation between nose-to-chin distance and other measurements used to determine occlusal vertical dimension. Cureus. 2024;16(5):e60443. doi:10.7759/cureus.60443
ABOUT THE AUTHOR
Dr. Zhu is a part-time clinical assistant professor at the Restorative Department of Rutgers School of Dental Medicine and a full-time private practice owner in New Jersey. She is the inventor of Easdent Tray and Easdent Measure is offering the system at cost to interested dentists. She can be reached at zhuhu1@sdm.rutgers.edu.
Ms. Zhang is a third-year candidate in the DDS/MPH dual degree program at Columbia University College of Dental Medicine, expected to graduate in 2027. She can be reached at bree101zhang@gmail.com.
Dr. Yousef is a board-certified prosthodontist and vice chair of the Restorative Department of Rutgers School of Dental Medicine. She can be reached at aboyouss@sdm.rutgers.edu.
Dr. Morgano is a board-certified prosthodontist and chairman of the Restorative Department of Rutgers School of Dental Medicine. He can be reached at smm519@sdm.rutgers.edu.
Dr. Elkassaby is a board-certified prosthodontist and director of digital dentistry at Rutgers School of Dental Medicine. She can be reached at hte9@sdm.rutgers.edu.
Disclosure: Dr. Zhu is the inventor of Easdent Tray and Easdent Measure. She has no financial interest in any other companies mentioned in this article and received no compensation for writing this article. Drs. Elkassaby, Yousef, and Morgano, and Ms. Zhang, report no disclosures.
