CLINICAL REPORT

A 3D printing replication technique for fabricating

digital dentures
Yukihiro Takeda, DDS, PhD,a Jessica Lau, DMD,b Hesham Nouh, BDS, DSc, MSD,c and
Hiroshi Hirayama, DDS, DMD, MSd

The replication technique is a ABSTRACT

method of fabricating new
Digitally fabricated dentures allow clinicians to provide new prostheses for edentulous patients in
removable complete dentures an efficient manner. One approach uses a replication technique where a prosthesis in need of minor
by using a reasonable, but alterations is used as a basis for the definitive prosthesis. Compared with conventional duplication
imperfect, existing prosthesis techniques, this method allows for the predictable fabrication of accurate dentures in less time and
as the foundation for a new with increased quality. In this clinical report, interim treatment dentures were scanned and 3D
denture.1-3 The replication printed to make a replication denture for fabrication of a digital prosthesis with the replication
technique allows clinicians to technique. (J Prosthet Dent 2019;-:---)
retain those satisfactory fea-
tures while still allowing for modification of the intaglio records are sent to the dental laboratory where definitive
fit, border extension, esthetics, tooth positioning, occlu- dentures are fabricated by using CAD-CAM.7,8 While
sion, and vertical dimension of occlusion. The replication there are a few reports for the replication technique using
technique can be used to address unsatisfactory aspects milling technologies for CAD-CAM dentures,11,12 reports
of the existing denture, making a complete evaluation of with 3D printing are lacking. In this clinical report, certain
the existing denture essential. This process has been desirable features of a patient’s interim treatment den-
facilitated with the introduction of computer-aided tures were preserved by 3D printing a replica to be used
design and computer-aided manufacturing (CAD-CAM) for same-visit definitive impressions and occlusal regis-
in removable prosthodontics.4-8 trations for the fabrication of new digital dentures by
With dental scanners and 3D printers becoming more using the replication technique.
commonplace in dental clinics,9,10 the replication tech-
CLINICAL REPORT
nique is well positioned for treating aging edentulous
populations in a more accurate and efficient manner than A completely edentulous 61-year-old white women with
conventional techniques. This ultimately translates into no systemic disease presented to the Boston University
high-quality prostheses that may reduce the need for Henry M. Goldman School of Dental Medicine with a
adjustment visits and the overall adaptation period. request for new maxillary and mandibular dentures.
Generally, digital dentures are fabricated after Upon clinical examination, the patient was found to have
conventional definitive impressions, and interocclusal a skeletal class II relationship and an enlarged tongue

a
Graduate student, Department of Restorative Sciences and Biomaterials, Division of Postdoctoral Prosthodontics, Boston University Henry M. Goldman School of Dental
Medicine, Boston, Mass.
b
Graduate student, Department of Restorative Sciences and Biomaterials, Division of Postdoctoral Prosthodontics, Boston University Henry M. Goldman School of Dental
Medicine, Boston, Mass.
c
Clinical Associate Professor, General Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, Mass and Director, Predoctoral Prosthodontics &
Restorative Dentistry, Boston University Henry M. Goldman School of Dental Medicine, Boston, Mass.
d
Clinical Professor, Department of Restorative Sciences & Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, Mass; and Director,
Advanced Education Program in Prosthodontics, Advanced Education in Operative Dentistry and Esthetic Dentistry; and Advanced Graduate Study in Digital Dentistry,
Boston University Henry M. Goldman School of Dental Medicine, Boston, Mass.

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Figure 1. Frontal view. A, Pretreatment. B, Treatment denture. C, Uncovering mandibular canine implants.

Figure 2. Fabrication of 3D-printed replication dentures. A, Scanned maxillary treatment denture. B, Scanned mandibular treatment denture.
C, D, Printed replication dentures with supports.

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Figure 3. Definitive impressions and interocclusal record. A, Maxillary
border molding. B, Mandibular border molding. C, Interocclusal record
with definitive impressions.
(Fig. 1A), which would complicate the appropriate den-
ture tooth placement. Interim treatment dentures were
fabricated by using conventional methods with the
neutral zone technique to address the patient’s intoler-
ance to denture tooth positioning that impinged on the
tongue space and interfered with her speech.13 Denture
tooth positioning was finalized based primarily on the
patient’s function within the acquired neutral zone. After
delivery and adjustment of the treatment dentures, the
Takeda et al
3
Figure 4. Conversion to STL files. A, Maxillary intaglio image.
B, Mandibular intaglio image. C, Interocclusal record image.
STL, standard tessellation language.
patient was satisfied with the esthetic, functional, and
speech outcomes but requested increased mandibular
denture retention (Fig. 1B). Therefore, two 3.3-mm SLA
bone-level implants (Institut Straumann AG) were
placed in the areas of the 2 mandibular canines with
bone reduction to fabricate an implant-retained over-
denture. During the healing stage, a tissue-conditioning
material (Hydro-Cast; Henry Schein, Inc) was used to
reline the surgical site every 5 to 7 days. After uncovering
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Figure 5. Preview and biofunctional evaluation dentures. A, Superimposed image of 3D-printed replication dentures and preview design. B, Preview
design frontal view. C, Biofunctional evaluation dentures frontal view. D, Definitive digital dentures frontal view.

(Fig. 1C), treatment dentures were scanned by using a
laboratory scanner (inEos X5; Dentsply Sirona) to
create a standard tessellation language (STL) file
(Meshmixer; Autodesk, Inc). The treatment dentures
were first sprayed with a refractory material (Silicone
Spray; Dentsply Sirona) before attaching an adhesive
positioner (COTISEN; Huanghua Promisee Dental Co,
Ltd) to the polished surfaces of the maxillary and
mandibular dentures. This device was used to rotate
the treatment dentures for 360-degree scanning to
capture all surfaces so that it could be imported to
laboratory software (inLab 16; Dentsply Sirona) and
exported to the Meshmixer software for STL generation
(Fig. 2A, 2B). Support struts were designed in prepa-
ration for 3D printing, and the replication dentures
were printed by using a photopolymerizing resin
(Dental SG V1; Formlabs) in a 3D printer (Form 2;
Formlabs). Printed dentures were washed in a 70%
isopropyl alcohol bath (Form Wash; Formlabs) for 20
minutes, air-dried until the alcohol evaporated, and
polymerized in a glycerin bath at 60  C for 30 minutes
(Form Cure; Formlabs) (Fig. 2C, 2D). Support struts
were then removed, and imperfections were ground
smooth and polished.
The 3D-printed replicated dentures were evaluated in
the patient’s mouth and adjusted as necessary before
border molding with polyvinyl siloxane (PVS) impression
material (GCLT Laboratory Putty; GC America Inc), and
a definitive impression was made with medium- and
light-body PVS impression materials (Aquasil Ultra+;
Dentsply Sirona) (Fig. 3A, 3B). Before removal of the
definitive impressions, the esthetics, occlusion, speech,
occlusal vertical dimension, and function were evaluated
and adjusted as necessary before registering the
occlusion by using an occlusal registration material
(Blu-Mousse Scent-Free SuperFast; Parkell Inc) (Fig. 3C).
The LOCATOR caps (The LOCATOR denture caps;
ZEST Anchors LLC) were removed from the mandibular
definitive impression before scanning the definitive im-
pressions. Maxillary and mandibular replication dentures
scans and a bite scan were performed by using the lab-
oratory scanner and STL files (Fig. 4), and clinical pho-
tographs were sent to the manufacturing center
(AvaDent; Global Dental Science). Preview designs of the
maxillary and mandibular digital dentures were
confirmed, and biofunctional evaluation dentures were
fabricated (Fig. 5). After a clinical confirmation of the
esthetic and functional aspects of the biofunctional

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Figure 6. Definitive digital dentures. A, Maxillary denture intaglio view.
B, Mandibular denture intaglio view. C, Frontal view.
evaluation dentures, definitive dentures were ordered
from the company.
Monolithic definitive dentures were milled from a
monolithic prepolymerized polymethyl methacrylate
(PMMA) resin and sent to the postdoctoral prostho-
dontics clinic for insertion. Both digital dentures were
evaluated with an elastomeric material (Fit Checker
Advanced; GC America Inc) and used to confirm the
appropriate seating of the mandibular digital dentures
with sufficient space for the attachments; no adjustments
Takeda et al
5
were necessary. The LOCATOR caps were then placed
on the mandibular implants for direct pick-up intraorally
with autopolymerizing resin (TOKUYAMA REBASE II;
Tokuyama Dental America Inc). The mandibular digital
denture was then finished and polished before the
prostheses for both arches were delivered (Fig. 6).
DISCUSSION
The treatment dentures were fabricated following con-
ventional denture fabrication techniques. For this patient,
the digital denture replication technique proved to be
advantageous, as the patient had trouble adapting to new
dentures and required specific locations of denture teeth
to allow proper function. Conventionally fabricating a
new set of dentures after implant placement would be
unnecessarily time-consuming while still not fully re-
producing the patient-approved denture tooth position.
Digital fabrication has advantages inherent to its digital
nature, including efficiency, decreased dimensional in-
accuracy, and an STL file that can be modified to alter the
denture and used for future treatment.
Despite the advantages of the replication technique,
this process does come at increased expense, with costs
associated with the laboratory scanner, scanning spray,
and 3D printer. In the future, scanning the existing
denture with a more readily available intraoral scanner
rather than its laboratory counterpart may become
feasible.14
The use of replication dentures facilitates the fabri-
cation of digital dentures made with CAD-CAM, which
has also been reported to be better than conventional
processing methods in several ways. Milled monolithic
prepolymerized PMMA acrylic resin possesses higher
mechanical strength that is not subject to polymerization
shrinkage which would negatively affect denture base
adaptation and accurate tooth position.15-18 With fewer
porosities and surface roughness, these improvements
translate clinically to stronger dentures, with reduced
potential to harbor microorganisms and the resulting oral
infections.19,20 Should the patient require an additional
set of dentures in the future, they can easily be milled,
thanks to digital storage of the denture information.5
This report illustrates the use of scanning and 3D
printing technology for duplicating existing dentures for
the digital denture replication technique. With the inte-
gration of digital technology, this method not only saves
treatment and laboratory time but also provides an ac-
curate and predictable result for definitive digital
dentures.
SUMMARY
Digitally duplicated dentures were predictably and effi-
ciently produced by using the replication technique with
3D scanning and printing. The application of this
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technique may reduce both clinical and laboratory time
based on an accurate diagnosis of the problem and an
understanding of the advantages and limitations of this
technique. Digital replication of dentures allows for
necessary repairs and changes to be made while also
maintaining the desirable features of the existing
dentures.
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Corresponding author:
Dr Yukihiro Takeda
Department of Restorative Sciences and Biomaterials
Division of Postdoctoral Prosthodontics
Boston University Henry M. Goldman School of Dental Medicine
635 Albany Street D307
Boston, MA 02118
Email: yukihiro@bu.edu
Acknowledgments
The authors thank Dr Trevor M. Fujinaka for implant surgery, Jae Choi, CDT, and
Michael Haddad, CDT, for technical support and Dr Peixi Liao for editorial
assistance.
Copyright © 2019 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2019.08.026
Takeda et al