digital denture workflows: hybrid techniques, reference denture technique, and biofunctional try in (BTI)

lecture given 9/16/2026

digital denture

a removable complete denture created with automation by using CAD, CAM, and CAE instead of conventional processes; a removable partial denture may also be digitally fabricated

CAE

computer aided engineering

its the software to simulate and analyze designs before you make them

allows you to run finite elemental analyses on dentures, bars, and implants, model occlusion load paths and base deformation, test design changes virtually before printing/milling

pros of CAD/CAM complete dentures

fewer clinical appointments and reduced chairside time

better fit and stronger prepolymerized denture bases

less residual monomer and less tooth movement during fabrication

digital records can be stored and reused

easier and faster replacement denture fabrication

what are limitations of CAD/CAM complete dentures?

learning curve for clinicians and techniques

may require clinical remount and occlusal adjustment

initial outcomes depend on operator experience

limited evidence for 3D printed denture resins compared with milled PMMA

what is the workflow for conventional complete dentures?

primary impression

final impression

jaw relation- VDO/CR records

wax try in- esthetics/phonetics

delivery + early adjustments

usually 5 visits

digital complete denture workflow

hybrid- base with wax rims

reference denture- impression and records

to digital design, BTI, and final CAD/CAM denture

hybrid denture digital workflow

start with new clinical records

conventional impressions and MMR are obtained first, then transferred into the digital workflow

use when- no acceptable existing denture, or major changes in VDO, CR, esthetics, tooth position, or contours

reference denture

start with existing denture

the existing denture serves as the clinical reference to preserve or transfer useful information into the digital workflow

use when- existing denture is acceptable or can be corrected, pt is satisfied with most tooth position, VDO, and denture form

workflow for hybrid denture

conventional impressions (or existing denture) scan

MMR → digitize

CAD tooth setup + base design, manufacture by milling or 3D printing

try in may be printed before the final

delivery + early adjustments

2-4 visits

workflow for reference denture

scan existing denture + reline scan

MMR + digital articulator

try in may be printed before the final

print/mill try in and/or final denture- digital files scored for future remake/duplicate

usually 2-3 visits

what pts are reference dentures best suited for?

generally satisfied with their current denture

need replacement because of wear, aging, or loss of fit

need selective corrections, such as poor fit or border extension

geriatric or medically compromised pts for whom fewer appts are preferred

complete dentures, implant-supported overdentures, and full-arch restorations

pts at high risk of denture loss/damage

what clinical information is transferred from the existing denture during a reference denture workflow?

VDO, esthetics and phonetics, jaw relationship, occlusal plane, tooth position and arch form

what are contraindications for reference denture technique?

risk of carrying over errors like poor esthetics, occlusion, or VDO

major corrections

severe ridge resorption- may not provide reliable records if the ridges are severely resorbed or unstable

what makes an acceptable reference denture?

somewhat intact- no broken base, chipped, or missing teeth

occlusion may show normal wear but avoid excessively worn prosthesis

plane of occlusion should be generally acceptable

borders should be well extended and not more than 5mm short

base must be stable and free of exessive rocking

mandibular denture should cover both retromolar pads

maxillary denture should cover the tuberosities

midline should be acceptable in relation to the face

cleaned of all adhesives

what are the clinical advantages of reference denture workflow?

fewer appts

predictable outcomes

digital integration

evaluation- functional try in allows evaluation

what is a biofunctional try in?

a fully functional teeth try in

milled out of monolithic PMMA puck or printed (printed fractures more easily)

great to verify function, occlusion, phonetics, and esthetics (tooth shade)

modify the BTI by grinding or adding material if necessary

what are the advantages of BTI?

accuracy- can assess retention with 100% certainty

pt can take home for prototype or spare

can be adjusted to proper VDO, esthetic, and phonetic

can be used for radiographic or surgical templates

can be used as reference denture technique

preserves a digital record

what are the disadvantages of BTI?

messy to adjust

afraid to adjust

teeth cannot be moved

another step added compared to 2 visit dentures

increased accuracy from intermaxillary record

cost? (to charge or not to charge, that is the question)

t/f BTI try in evaluation is the same as denture insertion steps

true! assess and try in each BTI separate and together

check borders and flanges, intaglio and post dam, esthetics and phonetics, occlusal plane, VDO, occlusion, and CR

posterior palatal seal

evaluate extension and coverage of hamular notches and disto-buccal undercuts

evaluate peripheral seal, BTI retention, thickness, and gag-reflex/swallowing

when checking esthetics and phonetics, what needs to be checked?

midline

smile line

buccal corridor

occlusal plane

check VDR/VDO

phonetic/labiodental speaking space

what sound can you use to evaluate smile line and buccal corridor?

/e/

low smile line

exposure of less than 75% of the upper anterior teeth without the gum being visible

average smile line

exposure of 75-100% of the upper anterior teeth and only the interproximal gingiva

high smile line

exposure of the entire clinical crown and a contiguous band of gingival tissue

what sound should you use to evaluate tooth exposure at rest/occlusal length of anterior teeth?

/m/ or emma

at age 30, what amount of max and mand teeth showing is esthetically pleasing?

3mm max

0.5mm mand

at age 70, what amount of max and mand teeth showing is esthetically pleasing?

0mm max

3mm mand

what sounds should you use to evaluate incisal length and profile?

/f/ and /v/

how much freeway space should a pt have?

2-3mm

what can cause an open bite?

heel interference

t/f a bite record should not be perforated

false! you want it to be so that VDO is not changed

what will the software do if there are no teeth in contact at CR?

increase VDO