DENTAL TECHNIQUE

Complete denture fabrication with CAD/CAM

record bases
J. Bryan McLaughlin, DMD, MPHa and Van Ramos, Jr, DDSb

The production of accurate ABSTRACT

record bases is an integral part
One of the primary goals of new materials and processes for complete denture fabrication has been
of complete denture fabrica- to reduce polymerization shrinkage. The introduction of computer-aided design and computer-
1
tion. According to Elder, re- aided manufacturing (CAD/CAM) technology into complete denture fabrication has eliminated
cord bases should adapt to the polymerization shrinkage in the definitive denture. The use of CAD/CAM record bases for complete
basal seat area as the finished denture fabrication can provide a better-fitting denture with fewer postprocessing occlusal errors. (J
denture base, have the same Prosthet Dent 2015;-:---)
border form as the finished
denture, be sufficiently rigid to withstand occlusal many of their insights can be retained with this new
forces, be dimensionally stable, be fabricated so that they material.4-6
may be used as bases for setting up teeth, be able to be Huggett et al7 showed that heat-processed acrylic
fabricated inexpensively, easily, and quickly, and have no resins displayed a general trend of greater polymerization
undesirable color. shrinkage with higher temperatures and shorter pro-
Processed record bases for complete denture fabrica- cessing times. Brewer8 found that most of the error from
tion have been advocated for their ability to provide polymerization shrinkage occurred during the first pro-
benefits in the definitive prosthesis. Langer2 argued that cessing and that the second processing should occur
the use of trial bases that failed to engage soft tissue at 60 C. Morrow et al6 described the process, notably
undercuts and distribute pressure evenly over the entire adding a finish line for the second processing that is
load-bearing mucosa recorded errors that were incorpo- located 2 to 4 mm from the border extension. Other
rated into the final denture. He found that 75% of den- authors have found a small difference between trial bases
tures fabricated from trial bases had occlusal errors of 0.1 and processed record bases.9,10 Disadvantages are addi-
to 0.7 mm, compared with dentures fabricated from tional cost, weakness of the bond between the new
processed record bases, of which only 10% had any and old resin, and difficulty with inadequate interarch
occlusal error and only in the range of 0.1 to 0.2 mm. distance.11
3
Jacob and Yen proposed processed record bases in the Computer-aided design and computer-aided man-
treatment of maxillofacial patients, finding improved ufacturing (CAD/CAM) technology has recently ex-
retention and stability and fewer occlusal errors. panded into the area of complete dentures.12-14 The
Processed bases also have the benefit of allowing bases are milled from prepolymerized acrylic resin cyl-
the provider to check and adjust border extensions and inders that are highly condensed and less porous than
intaglio surfaces over multiple appointments, potentially conventional denture acrylic resin.15 Bidra et al15 describe
leading to fewer adjustments at the delivery of the the anticipated benefits of the new production process
final prosthesis. Other authors have contributed to the as providing better strength and fit and the potential
techniques of fabricating processed record bases, and to harbor fewer microorganisms with fewer resulting

a
Resident, US Army Advanced Education Program in Prosthodontics, Fort Gordon, Ga.
b
Program Director, US Army Advanced Education Program in Prosthodontics, Fort Gordon, Ga.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
Figure 1. Border-molded definitive impression with light-body polyvinyl
siloxane.
Figure 3. Place sharp finish line 2 to 4 mm from borders and at junction
of alveolar ridge and palate on maxillary denture base.
infections. This technology provides an interesting
possibility in the treatment of patients who are suscep-
tible to oral candidiasis and could be added to the
treatment regimens already described.16 One current
CAD/CAM system (Avadent; Global Dental Science) is
designed to record all necessary information at the first
visit, delivering the definitive prosthesis at the second
visit.17 However, the 2-appointment process does not
allow the provider to verify the occlusal vertical dimen-
sion, lip support, the maxillomandibular relationship, the
incisal edge position, or the mandibular occlusal plane.15
The use of CAD/CAM record bases provides the op-
portunity to overcome these drawbacks, evaluate tooth
position intraorally, and receive patient feedback while
maintaining the benefits of this new technology.
TECHNIQUE
1. Make diagnostic impressions and diagnostic
casts.
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
Figure 2. Digital preview of CAD/CAM record base.
Figure 4. Block out undercuts in intaglio of denture base and fabricate
remount casts.
2. Make custom impression trays (Triad Trutray;
Dentsply Intl).
3. Border mold with green modeling plastic impres-
sion compound (Impression Compound; Kerr
Corp) and make a definitive impression with light-
body polyvinyl siloxane impression material
(Extrude Light Body; Kerr Corp) (Fig. 1). Do not
use polysulfide impression material because the
impression will be scanned at the Avadent
laboratory.
4. Draw the location and extent of the posterior
palatal seal on the impression with a marker.
Indicate the depth of tissue displacement in the
notes section of the prescription form. Select pre-
scriptive features, including natural rugae, poste-
rior palatal seal, complete buccal roll, name
engraving, color, and acrylic resin material on the
laboratory prescription form. Mail the definitive
impressions to the laboratory for scanning and
design. A digital preview is provided before milling
(Fig. 2).
McLaughlin and Ramos
- 2015
Figure 5. Record landmarks and make maxillomandibular records.
5. When the CAD/CAM denture bases are returned,
engrave a sharp finish line 2 to 4 mm from
the borders with a #8 round bur (SS White). On
the palatal surface of the maxillary record base,
place the margin at the junction of the alveolar
ridge and the palate (Fig. 3). At a subsequent stage,
wax will be applied up to the finish line, and
eventually acrylic resin will be processed to this
line.
6. Fabricate remount casts by blocking undercuts
with laboratory putty (Reprosil VPS; Dentsply
Caulk). Embed objects such as paper clips in the
putty to aid in retention to the stone. Ensure that
the putty does not cover the borders of the record
base or the palate of the maxillary record base.
7. Pour stone into blocked-out record bases to
fabricate remount casts (Modern Materials Lab-
stone; Heraeus Kulzer) (Fig. 4). Take care not to
allow the stone to cover too much of the cameo
surface of the border extensions, or the denture
base could become locked in. Once set, ensure that
all borders of the record bases and palate of the
maxillary record base rest firmly against stone and
that the record bases are stable when vertical and
lateral pressure is applied.
8. Fabricate occlusion rims with wax (NeoWax;
Dentsply Intl) using traditionally accepted di-
mensions and techniques.18
9. Evaluate and adjust the occlusion rims. Record
necessary landmarks and make maxillomandibular
and protrusive records (Blu-Mousse; Parkell Corp)
(Fig. 5).
10. Make a facebow recording and mount it on an
articulator using low expansion stone (Mounting
Stone; Whip Mix Corp).
11. Set anterior teeth and evaluate them in the pa-
tient’s mouth. Evaluate the intaglio and border
McLaughlin and Ramos
3
Figure 6. Pour stone directly into intaglio surface of denture and
complete investment and flasking.
extensions and make adjustments. Make a new
centric relation record if necessary.
12. Remount the mandibular cast with new centric
relation and protrusive records.
13. Set the remaining teeth in wax.
14. Evaluate the esthetics, intaglio, and border exten-
sions. Verify the tooth position in the patient’s
mouth.
15. Complete the waxing process by waxing to the
finish line.
16. Pour stone (Modern Materials Labstone; Heraeus
Kulzer) directly into the intaglio surface of the
denture base and complete the investment and
flasking (Varsity; Whip Mix Corp) procedure
(Fig. 6). Place in a boil-out tank (Labormat SD;
Dreve) at 70 C.
17. Separate the casts and complete wax removal
(Fig. 7). Use a cotton roll to apply monomer
(Lucitone Liquid; Dentsply Intl) to the denture
surface that will receive the new acrylic resin. This
should be done multiple times, and the monomer
should be rubbed onto the surface. Mix the acrylic
resin (Characterized Lucitone; Dentsply Intl) and
pack the denture under compression. Place it in a
processing tank (Typ 5506; KaVo Dental) and raise
the temperature to 70 C for 6 hours. Remove from
tank, deflask, section, and remove stone. Trim and
polish the dentures.
18. Return the dentures to the remount casts and
make any necessary occlusal adjustments. Adjust-
ments should be minimal.
19. Deliver the dentures, adjusting the intaglio, border
extensions, and occlusion (Fig. 8). Intaglio and
border adjustments should be minimal because
adjustments have been made at the 2 earlier ap-
pointments. Occlusal adjustments should also be
minimal.2
THE JOURNAL OF PROSTHETIC DENTISTRY
4 Volume
Figure 7. After wax elimination, mix acrylic resin and pack denture under pressure. Place in processing tank and raise temperature to 70 C for 6 hours.
Figure 8. Deliver dentures. Adjustments should be minimal.
DISCUSSION
A potential concern for clinicians attempting this tech-
nique may be the distortion of the record bases during
THE JOURNAL OF PROSTHETIC DENTISTRY
- Issue -
the second processing. This concern should be alleviated
both by reviewing the literature and the material prop-
erties of the CAD/CAM record bases. Al-Hanbali et al19
compared heat-processed acrylic resin bases to
microwave-processed acrylic resin bases after 2 poly-
merization cycles and found that both exhibited some
shrinkage, with the microwave-processed bases showing
less shrinkage. Polukoshko et al20 found that heat-
processed acrylic resin record bases showed only 0.01
to 0.03 mm of shrinkage and was related to the volume of
added acrylic resin. This amount of shrinkage was not
deemed clinically relevant. Yeung et al21 studied the
temperature and dimensional change of definitive record
bases during a second processing by using thermocou-
ples incorporated into the resin. They found that the
temperature of the base matched that of the water bath,
ruling out excessive temperature increase from the
exothermic polymerization reaction as a source of
distortion. The measured linear dimensional change after
a second processing was 0.12%, which was not clinically
McLaughlin and Ramos
- 2015
significant. Ellis et al22 conducted a subjective study of
heat-processed definitive record bases after a second
processing. Using a visual analog scale the clinician and
patient evaluated retention, support, and stability before
and after the second processing. They found that
approximately half of the dentures showed no change,
one third improved, and one fifth deteriorated. Of those
that deteriorated, none warranted the relining or
remaking of the denture, leading the authors to conclude
that the benefits of the definitive record base outweigh
the risks of loss of retention, support, and stability.
Fenlon et al23 evaluated whether heat-processed acrylic
resin record bases distorted after a second processing.
They found that 50% of the bases had linear distortion
measured between 2 points of 50 mm or less and that
90% of the bases had distortion of 160 mm or less. This
was deemed clinically insignificant.
This technique may not be appropriate for patients
with abnormal maxillomandibular relationships. In pa-
tients with limited interarch space, the clinician would
need to reduce the teeth or reduce the record base.
SUMMARY
The use of CAD/CAM record bases for complete denture
fabrication makes it possible to take advantage of the
benefits of this new technology while avoiding some of
its drawbacks, all while maintaining control of the
important details of the prosthesis. The elimination of
polymerization shrinkage in the record base, the mini-
mization of polymerization shrinkage while processing
teeth to the base, and the reduction of error in the
occlusal records result in a complete denture that has an
intimate fit to the underlying mucosa and minimal
occlusal errors.
REFERENCES
1. Elder ST. Stabilized baseplates. J Prosthet Dent 1955;2:162-8.
2. Langer A. The validity of maxillomandibular records made with trial and
processed acrylic resin bases. J Prosthet Dent 1981;45:253-8.
3. Jacob R, Yen T. Processed record bases for the edentulous maxillofacial pa-
tient. J Prosthet Dent 1991;65:680-5.
McLaughlin and Ramos
5
4. Graser GN. Completed bases for removable dentures. J Prosthet Dent
1978;39:232-6.
5. Villa H. Double-processing technique for complete dentures. J Prosthet Dent
1969;22:500-5.
6. Morrow R, Rudd K, Eissmann H. Dental laboratory procedures: complete
dentures. Vol 1. St Louis: C. V. Mosby; 1980:122-8.
7. Huggett R, Brooks SC, Bates JF. The effect of different curing cycles on the
dimensional accuracy of acrylic resin denture base materials. Quintessence
Dent Technol 1984;8:365-71.
8. Brewer A. Prosthodontic research in progress at the school of aerospace
medicine. J Prosthet Dent 1963;13:49-69.
9. Schoen P, Stewart J. The effect of temporary bases on the accuracy of centric
jaw relationship records. J Prosthet Dent 1967;18:211-6.
10. Yarmand M, Gehl D. Laboratory and clinical study on a permanent type base
for transferring interocclusal records. J Prosthet Dent 1971;25:497-505.
11. Bailey LR. Permanent-type base for transferring records to an articulator.
Dent Clin North Am 1964;Nov:623-8.
12. Infante L, Yilmaz B, McGlumphy E, Finger I. Fabricating complete dentures
with CAD/CAM technology. J Prosthet Dent 2014;111:351-5.
13. Goodacre CJ, Garbacea A, Naylor WP, Daher T, Marchack CB, Lowry J. CAD/
CAM fabricated complete dentures: concepts and clinical methods of
obtaining required morphological data. J Prosthet Dent 2012;107:34-46.
14. Kattadiyil MT, Goodacre CJ, Baba NZ. CAD/CAM complete dentures: a review
of two commercial fabrication systems. J Calif Dent Assoc 2013;41:407-16.
15. Bidra AS, Taylor TD, Agar JR. Computer-aided technology for fabricating
complete dentures: systematic review of historical background, current status,
and future perspectives. J Prosthet Dent 2013;109:361-6.
16. Giannini PJ, Shetty KV. Diagnosis and management of oral candidiasis.
Otolaryngol Clin N Am 2011;44:321-40.
17. Global Dental Science LLC. AvaDent Digital Dentures. Available at: http://
www.avadent.com. Accessed December 20, 2014.
18. Jamieson CA. A modern concept of complete dentures. J Prosthet Dent
1956;6:582-92.
19. Al-Hanbali E, Kelleway JP, Howlett JA. Acrylic denture distortion following
double processing with microwaves or heat. J Dent 1991;19:176-80.
20. Polukoshko KM, Brudvick JS, Nicholls JI, Smith DE. Evaluation of heat-cured
resin bases following the addition of denture teeth using a second heat cure.
J Prosthet Dent 1992;67:556-62.
21. Yeung KC, Chow TW, Clark RKF. Temperature and dimensional changes in
the two-stage processing technique for complete dentures. J Dent 1995;23:
245-53.
22. Ellis JS, Read GE, Thomason JM. A subjective study of dimensional stability
of permanent acrylic resin complete denture bases after a second curing cycle.
Eur J Prosthodont Rest Dent 2004;12:105-8.
23. Fenlon MR, Juszczyk AS, Rodriguez JM, Curtis RV. Dimensional stability of
complete denture permanent acrylic resin denture bases; a comparison of
dimensions before and after a second curing cycle. Eur J Prosthodont Rest
Dent 2010;18:33-8.
Corresponding author:
Dr J. Bryan McLaughlin
228 E Hospital Rd
Tingay Dental Clinic Building 320
Fort Gordon, GA 30905
Email: james.b.mclaughlin1.mil@mail.mil
Acknowledgment
The authors thank the United States Army Dental Corps for the funding of patient
treatment and laboratory materials.
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
THE JOURNAL OF PROSTHETIC DENTISTRY