Introduction
It has been stated that edentulism is the final result of a multifactorial process comprising biologic and patient-related factors.1,2 Complete edentulism has been decreased in developed countries but it still remains as a significant problem for elderly population that could vary from 15% to 54% of the senior population.3 Removable complete dentures are the least invasive and most affordable option for the prosthodontic rehabilitation of edentulous patients.4 Treatment of edentulous patients with full complete dentures demands many technical steps, in which making accurate impressions is considered one of the essential steps for complete dentures fabrication.5,6Well-fitting removable complete dentures reduce the occurrence of traumatic ulcers and show higher prostheses wearing comfort.7 Denture retention is vital for masticatory function, speech and can provide a good quality of life.8 The traditional techniques for denture fabrication require a higher level of knowledge and skillful manipulation of the materials, which may lead to multiple errors during denture fabrication.9-11 Moreover, the production of complete dentures using conventional techniques and materials such as monomer can cause an allergic reaction to some patients, regardless of the curing method as the residual of monomer has cytotoxic potential.12 Fortunately, all of these problems have become solved following the digital workflow for denture fabrication, because milled resin pucks have very limited unpolymerized monomers,13 dentures are made in highly crosslinked pucks,14 and fabrication time is considerably decreased following fully digital or even a combination of novel and traditional fabrication.15,16 Furthermore, recent studies have claimed higher retention,17,18fit19 of CAD/CAM than conventional denture fabrication.
CAD/CAM dentures can be fabricated within hours, whereas using conventional techniques can take days for production.22 Therefore, the development of novel technologies in dentistry is allowing the clinicians to make restorations in a faster, easier and more accurate manner. New techniques in dentistry have countless applications, and the production of a completely removable prosthesis is one of them.23,24 These novel techniques allow the clinician the options to fabricate complete dentures in office, laboratory or at a centralized production center.25,26 Currently, the practice of making complete removable dentures using subtractive technology is becoming very common, and the literature provides reports following full digital and combination of digital and conventional methods for their production.27-30 However, no clinical reports are showing complex clinical situations with patients presenting atrophic alveolar ridges. Therefore, this report aims to show a combination method of novel and traditional methods for the fabrication of CAD/CAM complete dentures for patients presenting with atrophic alveolar ridges. Moreover, this workflow could be used for clinicians with no access to CAD/CAM technology in their offices.