The Dental Edge
Welcome to The Dental Edge, where clinical precision meets a cutting-edge approach to dentistry. In each episode, we bring you conversations with the best and brightest minds in the profession, diving deep into the latest clinical innovations, and the intersection of technology and your practice. Learn from some of the brightest minds in the field as they share invaluable insights to help you elevate your clinical skills and stay ahead in the ever-evolving world of dentistry. If you're a tech-savvy dentist ready to sharpen your edge, you're in the right place.
The Dental Edge
Digital Denture Workflows with Intraoral Scanners
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Digital technology is transforming every corner of dentistry—including complete denture treatment. In this episode, we explore how modern digital denture workflows are helping clinicians streamline procedures, improve communication with laboratory teams, and enhance the patient experience. Discover how intraoral scanning can extend beyond traditional restorative and implant applications to create more efficient, predictable, and collaborative denture workflows. Whether you're already using digital dentistry, or new and looking to maximize the value of your existing technology, this conversation offers valuable insights into the evolving future of removable prosthodontics.
Welcome to the Dental Edge, where clinical precision meets a cutting-edge approach to dentistry. In each episode, we bring you conversations with the best and brightest minds in the profession, diving deep into the latest clinical innovations and the intersection of technology in your practice. Learn from some of the brightest minds in the field as they share invaluable insights to help you elevate your clinical skills and stay ahead in the ever-evolving world of dentistry. If you're a tech-savvy dentist ready to sharpen your edge, you're in the right place.
SPEAKER_02Welcome back, everyone, to the Dental Edge Podcast. We're here to help explain the ever-evolving world of dentistry and answer everyday questions that you might have as dental professionals. Each episode, we aim to delve deeper into fascinating materials that guide dental professionals toward better success as we unpack the clinical cases, technologies, instruments, and the stories behind them. As usual, I'm your host and trusted dental expert, Anna.
SPEAKER_00Hi everyone, Eric here. Anna and I are thrilled to have you with us today. We're here today to share the valuable information and insights brought to you by the amazing partners of dental learning.
SPEAKER_02Today we are getting into something that, well, it fundamentally changes the game for your denture patients. I want you to begin by imagining taking a traditional, newly made denture and looking at it under a high-powered microscope.
SPEAKER_00Oh, it's terrifying once you look closely.
SPEAKER_02Right. To the naked eye, it looks perfectly smooth, it looks polished, but under that lens, it looks like a sponge and is porous. Sure. I mean, it is full of microscopic bubbles, um, tiny little caves and structural voids that are perfectly sized for bacteria to hide in and multiply.
SPEAKER_00Yeah, and that's the reality of traditional analog methods. But imagine a denture surface that looks like solid, impenetrable glass, no bubbles, no voids, and literally no place for bacteria to take hold.
SPEAKER_02This is the denture workflow we'll be looking to unpack today. We're exploring how to utilize intra-oral scanning to create a streamlined digital denture workflow. By the end of our discussion, we aim to help you boost your clinical predictability, dramatically improve your efficiency, and frankly, increase the ROI of your practice.
SPEAKER_00Absolutely, because when you eliminate those microscopic hiding spots, you are well, you're fundamentally changing the patient's daily quality of life. You're virtually eliminating the risk of things like fungal infections and chronic tissue inflammation.
SPEAKER_02Yes, and to guide us to better success, we are reviewing an incredible presentation from Dr. Ronnie Schnell. She has a phenomenal background. She's a clinical professor and the director of pre-doctoral removable prosthetontics at Boston University. Dr. Schnell also has over 42 years of private practice experience at the Classic Smile, a true bank of wisdom and expertise.
SPEAKER_00Yeah, she has completed over 2,000 digitally fabricated denture arches alongside her students.
SPEAKER_02Over 2,000. So it's safe to say she knows dentures' cases well.
SPEAKER_00Right. That volume is critical. I mean, when you oversee thousands of arches, you aren't just looking at theoretical success. You are seeing every possible clinical failure, every weird anatomic anomaly, and every technical glitch.
SPEAKER_02Yeah, exposing herself to the full range of denture cases has allowed Dr. Schnell to figure out what actually works in the slippery, wet, and unpredictable environment of the human mouth. Another interesting fact about her, just to keep in the back of your mind, Dr. Schnell is also a competitive figure skater who went to adult nationals in Lake Placid.
SPEAKER_00So cool. And honestly, even though it sounds corny, she inherently understands concepts like balance, precise edges, and staying upright under pressure. All of that translates surprisingly well to like establishing a perfect occlusal plane.
SPEAKER_02Totally. But before we get into the clinical weeds of scanning and software, we need to set a baseline because there is this really dangerous assumption out there. People think that buying an intra-oral scanner means you're buying a shortcut that just bypasses basic clinical knowledge.
SPEAKER_00Yes, sadly. And that is one of the biggest traps you can fall into. A scanner does not make you a better clinician. It makes a good clinician significantly more efficient.
SPEAKER_02It's like having autopilot on an airplane, right? It's an incredible tool, but you still need to know how to fly the actual plane. Navigate the mouth, right?
SPEAKER_00That is the perfect analogy. You still need a deep understanding of a dental anatomy, the musculature, the occlusion. The digital process accomplishes all those essential biological steps of denture making. It just uses a different vehicle to get there.
SPEAKER_02So instead of analog impression trays and messy physical materials, you're using virtual data to find patient success.
SPEAKER_00Exactly. You are essentially working on a virtual patient on a computer screen. But the biological requirements remain exactly the same. You cannot just scan your way out of a poor understanding of anatomy.
SPEAKER_02It makes total sense. The biology hasn't changed, but the materials certainly have. And going back to that microscope analogy we started with, this is where the digital workflow creates a massive upgrade. Let's talk about the monolithic milled PMMA puck. For anyone who might be newer to the digital side or just used to old school lab processes, what actually is a PMMA puck and why is it so different from traditional acrylic?
SPEAKER_00Well, let's break down the traditional method first. When a lab makes a conventional pack and press denture, or even if they use fluid resin injection, they are mixing a powder polymer with a liquid monomer.
SPEAKER_02Correct. It's a chemical reaction.
SPEAKER_00Exactly, it's chemical. And as that material cures, there is this unavoidable off-gassing process. Gas escapes, the material shrinks slightly, and those escaping gases, well, they leave behind microscopic voids.
SPEAKER_02That's your sponge or porous surface of the denture.
SPEAKER_00Indeed. But a monolithic milled PMMA puck, which stands for polymethyl methacrylate, bypasses that off-gassing phase entirely. It is a solid disk of high-grade resin and it's manufactured industrially under immense controlled heat and massive pressure, all within in a factory setting.
SPEAKER_02So the chemical reaction happens long before it ever reaches the dental lab?
SPEAKER_00Long before the industrial pressure squeezes out every single microbubble and ensures total polymerization. It's essentially a solid block of plastic glass. So when the lab takes your digital scan and uses a milling machine to carve the denture out of that puck, they're exposing a surface that has zero microporosity.
SPEAKER_02And there's actual research backing up how big of a deal this is.
SPEAKER_00Oh, absolutely. Research out of the State University of New York at Buffalo looked specifically at this. They found that because there are no voids, the adherence of candid albicins, you know, the fungus responsible for denturostomatitis and painful sore spots, the adherence is absolutely negligible.
SPEAKER_02That is a massive clinical breakthrough. I mean, you are giving the patient a biohygienic prosthesis.
SPEAKER_00Exactly. They aren't going to come back in six months complaining of burning gums because their dentures become a petri dish for bacteria.
SPEAKER_02And this method of making dentures doesn't absorb stuff either, does it?
SPEAKER_00No, it's significantly more hydrophobic, meaning it absorbs far less saliva and fewer odors over time. Plus, structurally, it is stronger because the base and the teeth can be milled from a singular solid piece of cross-linked material.
SPEAKER_02So you don't have to worry about teeth popping off?
SPEAKER_00Right. You eliminate the weakest link of a traditional denture, which is that bond between the carded acrylic tooth and the denture base.
SPEAKER_02Okay, so we have this indestructible biohygienic material waiting for us in the milling machine, but that pristine material is absolutely useless if the fit is wrong.
SPEAKER_00100% you hit the nail on the head.
SPEAKER_02So how do we accurately translate the complex dynamic environment of the mouth to the digital software so the machine knows what to mill?
SPEAKER_00Well, this brings us to what Dr. Schnell identifies as the absolute key to simplifying the digital denture workflow. She calls it the reference denture technique. But if you think about the best possible custom tray you could ever ask for to take an impression, it actually already exists. Okay, how does that work? When you need to make a new denture, the hardest part is often capturing accurate initial data without causing the patient severe discomfort.
SPEAKER_02Wait, it's their existing denture?
SPEAKER_00Exactly. It is the patient's current existing denture.
SPEAKER_02It's like going to a tailor, right? Instead of having them measure your body from scratch with a tape measure while you awkwardly wiggle around, you bring them your favorite well-worn suit and say, Hey, make exactly this, but take the waist in half an inch.
SPEAKER_00Yes, the reference denture is that old suit. A fantastic way to visualize it. If their current denture is even reasonably serviceable, you capture your clinical records directly inside of it, much like you would if you were doing a hard reline or a rebase. A patient can bite into an apple without fear, and the wear parameters match or even exceed traditional setups. Not to mention, the color stability is fantastic because there is no porous surface for coffee or wine stains to penetrate.
SPEAKER_02Let's break down those records because we can't assume the software is just going to magically guess the patient's facial structure. What are we physically marking on this reference denture before we even pick up the scanner?
SPEAKER_00You need to establish the midline, the high smile line, and the horizontal plane. You can literally just use a sharpie to draw these lines directly onto the teeth of the old denture once it's in their mouth.
SPEAKER_02Just a standard sharpie. That's amazingly simple. Okay, got it. What comes next?
SPEAKER_00If their lip support is deficient because you know the old flange is worn away, you just add some rope wax or flowable composite right onto the front of the denture to plump the lip back out. Then you verify their vertical dimension of occlusion, their VDO, and you lock in their centric relation or CR. You are basically turning their old denture into a perfect data-rich map.
SPEAKER_02Just to clarify the anatomy side of this map, when we are taking that wash impression on the intagliosurface, you know, the side resting against the gums, what are the absolute critical anatomical landmarks we have to make sure the impression material captures?
SPEAKER_00Well, you must have a clear, distinct capture of the incisive papilla on the maxilla. That is your compass for where the central incisors belong. You also need the hamular notches captured fully, and on the lower, you absolutely must cover the retromolar pads. Those are your non-negotiable landmarks for stability and support.
SPEAKER_02Okay, so once you have that wash impression perfect and you've marked your midline and corrected the lip support, what next?
SPEAKER_00Then you bring in the technology, you take your intra-oral scanner and do a full 360-degree scan of that reference denture while it's outside the mouth.
SPEAKER_02So you're scanning the whole thing?
SPEAKER_00Yep. You scan the cameo side. The polished teeth and gums, they show the world. You scan the Italia wash impression, and then you put the dentures back in the mouth to scan the bite.
SPEAKER_02Wait, hold on. I actually have to push back here.
SPEAKER_00Okay, lay it on me.
SPEAKER_02You are saying we scan the bite with no PVS bite registration material at all, like none. Every dentist relies on that squishy physical material to get a hard confirmation that the bite is locked in.
SPEAKER_00I totally get it. It is the most common fear clinicians have when adopting this workflow.
SPEAKER_02Really? How so?
SPEAKER_00But the reality is that physical bite material introduces far more errors than it solves. Think about what actually happens when you squirt PVS between a patient's arches.
SPEAKER_02Oh, right, because there's literally a layer of rubber between their teeth.
SPEAKER_00First, you introduce film thickness. Even the very best bite registration material has a physical volume that artificially holds the jaws apart. It actually increases the vertical dimension.
SPEAKER_02Oh man, and then you get the case back from the lab and you have that classic nightmare scenario. It fit perfectly on the stone models, but when you put the wax try-in into the patient's mouth, the bite is open by like two millimeters.
SPEAKER_00Exactly. And second, patients instinctively bite differently when there is a foreign squishy substance on their teeth. They slide forward, they shift laterally.
SPEAKER_02What's the digital process for the bite?
SPEAKER_00You have the patient bite down into their natural, comfortable tooth-to-tooth contact at the correct VDO you already established. They're biting on their own hard acrylic teeth, so their proprioception is totally natural. Then you simply slide the scanner into the vestibule and scan the buckle surfaces of the teeth locked together.
SPEAKER_02Wow, so no film distortion, no material buildup?
SPEAKER_00Exactly. The physical records often fail to rekey properly when the lab technician tries to mount them on a mechanical articulator. With an intra-oral scanner, you eliminate all of those middleman variables.
SPEAKER_02That makes total sense. You are completely removing the physical middleman that causes all the distortion.
SPEAKER_00Right, and no mounting plaster expanding. The software captures the precise spatial data at the exact vertical dimension. It is profoundly more accurate.
SPEAKER_02Because in the analog world, this is the wax try-in phase. And we all know the anxiety of the wax try-in. It's delicate. Um, it melts if the room is too warm, the patient accidentally bites down too hard and shoves an incisor into the wax space, and boom, your perfect setup is ruined.
SPEAKER_00Okay, so we've scanned the reference denture inside and out, we've captured the byte digitally, we hit send, and all that data goes to the lab. What happens when the case comes back for verification?
SPEAKER_02Ah, this is my favorite part.
SPEAKER_00The biofunctional try-in or BTI.
SPEAKER_02The BTI, what is it?
SPEAKER_00In the digital world, we do not use delicate wax. The BTI is a fully functional monolithic trial denture. It is entirely printed or milled out of a rigid PMMA resin. Usually it's in a uniform, monochromatic tooth shade, so you could focus strictly on form and function rather than getting distracted by the final aesthetics.
SPEAKER_02So it is a solid, durable prototype. But how do you evaluate it clinically? Because with wax, the whole point is that if the midline is canted, I can just warm up a spatula, melt the wax, and physically twist the tooth until it's straight. If this BTEI is a solid piece of plastic, how am I making adjustments?
SPEAKER_00Welcome to the secret weapon of the digital workflow. You evaluate it exactly like you would a final denture insertion, but with the freedom to be, well, aggressive. You put it in the mouth and check the tissue side using pressure indicating pace to look for heavy spots. And what if it's loose? You check your border extensions to see if they're overextended or falling short. You check your occlusion with articulating paper, evaluate phonetics, verify the incisal edges, the VDO, the midline, the lip support, all of it. And here is where the paradigm shifts. You are not afraid to physically attack this monolithic try-in.
SPEAKER_02Wait, you mean I can literally take a high-speed handpiece to it? It sounds like treating the BTI as a living, breathing, rough draft.
SPEAKER_00That is exactly what you are doing. It's like doing live action editing directly in the mouth. If the vertical dimension is too long and they're clicking their teeth when they speak, you take an acrylic burr and just grind the occlusal surfaces down until the speech clears up. If you need more buckle cord or to whiten their smile, you literally bond flowable composite directly onto the side of the trial denture. If the retention isn't quite right and it's rocking slightly, you just relieve the intake surface with a burr, fill it with a light body wash material, and take a new impression right inside the BTI. You physically force that trial denture to look and function exactly how you want the final expensive milled denture to be.
SPEAKER_02And because it's just a cheap printed prototype, there's no panic if you mess it up. But how does the lab know what I did? Do I have to write out a massive prescription detailing every little spot I ground down?
SPEAKER_00Once you've marked it up, ground it down, added composite, and taken your new wash impression, you just pick up your intra-oral scanner again. You just rescan the modified BTI. You take a new buckle byte scan with the new vertical dimension you established, and you send that new digital file back to the lab. Their software overlays your new scan onto the original design and it perfectly mimics those exact physical changes. The lab then mills the final PMMA puck based on that highly customized clinically proven blueprint. The predictability is just off the charts. That level of control is a game changer.
SPEAKER_02Let's look at some advanced scenarios because we know dentistry is rarely a perfectly textbook referenced denture case. We've talked a lot about patients who already have a denture we can use. What about a fully identilous patient who lost their denture, or maybe it's completely unusable?
SPEAKER_00Right, starting from scratch.
SPEAKER_02Yeah, scanning a dent tape patient is one thing. The teeth give the scanner plenty of geometric shapes to stitch the images together. But how do you manage scanning fully identilous arches where the tissues are shiny, wet, mobile, and completely lack landmarks?
SPEAKER_00That is the big clinical hurdle, and it was a crucial question from the original presentation. We have to be honest about the limitations of optical scanners. Scanners capture soft tissue mucostatically, meaning they capture it at rest.
SPEAKER_02Exactly. They take a picture of the tissue exactly as it sits at rest.
SPEAKER_00Now, this is actually fantastic for the crest of the ridge, especially if they have flabby, unsupported tissue, because you aren't compressing and distorting that delicate tissue with heavy, thick compression material.
SPEAKER_02Right. But the borders of a denture aren't static. They move when the patient speaks or chews.
SPEAKER_00Precisely. Scanners struggle immensely to capture mucodynamic functional borders accurately. Think about the physical act of getting a bulky scanner wand into the vestibule. You have to take your finger or a mirror and pull the patient's cheek far out of the way just to see the tissue.
SPEAKER_02Yeah, you really have to yank it.
SPEAKER_00The moment you pull that cheek, you have wildly overextended the tissue fold. If the lab simply prints a denture based on that direct pulled intra-oral scan, the flanges will be massively overextended. The denture will literally pop out the second the patient smiles.
SPEAKER_02So how do you fix the overextension? We know the scanner is great for the flabby ridge, but terrible for the deep borders. Do we just go back to analog alginate?
SPEAKER_00No, you combine the best of both worlds, and this is where the DEX's software workflow provides a brilliant solution. You create a custom tray or a record base, and you take a physical wash impression, focusing heavily on border molding.
SPEAKER_02So doing it old school for a second?
SPEAKER_00Right. You have the patient pucker, smile, swallow, capturing those dynamic functional borders perfectly in the physical material. Then you take that impression out of the mouth and you scan it with your intra-oral scanner. The software allows you to take the scan of those perfect physical borders and literally stitch or layer that data right over the direct optical scan you took of the patient's uncompressed palate.
SPEAKER_02That is incredible software engineering. You are creating a hybrid, you are keeping the uncompressed static tissue scan for the delicate ridge, and you're merging it with the dynamic muscle-molded physical border for the vestibule.
SPEAKER_00Yes, the clinical term is a muco-selective digital impression. You are selecting the optimal state for each specific type of tissue and combining them into one perfect digital file.
SPEAKER_02Okay, what about immediate dentures? If someone is coming in with a failing dentition and they need full clearance and immediate placement, how does digital play into that? Because I imagine taking analog impressions over mobile periodontally involved teeth is just a nightmare for the patient.
SPEAKER_00Yeah, it is a total nightmare. Patients with severe periodontal disease are terrified that the alginate or the PVS is going to accidentally extract their loose teeth when you pull the tray out. Digital workflows were absolutely made for immediate dentures because you eliminate that physical pulling entirely. Furthermore, when a patient is partially dentate, those remaining natural teeth act as perfect obstacle landmarks so the scanner never gets lost. It stitches the images together incredibly fast.
SPEAKER_02Aesthetically, I assume having the natural teeth scanned gives the lab a massive head start.
SPEAKER_00The design software has a feature to biocopy the patient's exact natural teeth. If the patient actually likes the shape and arrangement of their natural incisors, but they're just losing them to bone loss, the software duplicates the exact morphology of those teeth for the final denture.
SPEAKER_02So they don't look like they got a generic set of piano key dentures here?
SPEAKER_00Exactly. They look like they still have their own smile.
SPEAKER_02And if their natural teeth are a disaster, like what if they have massive spacing or the occlusal plane has collapsed?
SPEAKER_00The software can morph them. You tell the lab, hey, keep the general shape of the central incisors so it looks natural to their face, but close that three millimeter diastema, bring the overjet back two millimeters, and level the occlusal plane.
SPEAKER_02That's amazing.
SPEAKER_00And speaking of the lab, this workflow fundamentally changes your relationship with your technician. They are no longer just a passive receiver of stone models, they are an active digital partner.
SPEAKER_02Right, because they are the ones driving this incredibly complex CADCAM software. What is the biggest mistake you see clinicians make when communicating with the lab in this digital space?
SPEAKER_00Sending naked STL files with zero context. A digital scan of teeth tells the technician absolutely nothing about the patient's face. The key to predictable success is sending comprehensive visual data. You must send photos.
SPEAKER_02Photos and data reference points are so important.
SPEAKER_00Vital. Send a full-face photo of the patient resting, a full-face photo with a huge exaggerated smile, and a photo with retractors in place. If you're doing a reference stenture, take a photo of the patient wearing it. The software allows the technician to overlay your 3D digital scan directly onto the 2D photograph of the patient's face. When they can see the patient's eyes, their interpupillary line, and their lips, they can design the perfect aesthetic setup on the very first try.
SPEAKER_02It really is a collaborative effort. You are giving the lab the architectural blueprints and the photos act as the landscaping. When you put all these pieces together, the indestructible biohygienic milled PMMA material, the streamlined reference denture technique, the live action editing of the biofunctional try-in, and the ability to selectively merge tissue scans, you are looking at a fundamentally more predictable, less stressful way to practice dentistry.
SPEAKER_00You really are. And if we connect this to the bigger long-term picture of your practice, here is something truly fascinating to consider regarding the life cycle of a patient.
SPEAKER_02Okay, what's that?
SPEAKER_00What if the immediate digital denture you designed today becomes the exact perfectly archived digital blueprint for that same patient's complex implant restoration 10 years down the line?
SPEAKER_02Wait, really?
SPEAKER_00Yeah, you have their vertical dimension, their ideal tooth position, their lip support, their midline all permanently saved in the cloud. The digital record never degrades. It doesn't chip, it doesn't get lost in a storage closet. It just sits there waiting to be used as the perfect mathematically precise foundation for their next phase of comprehensive care.
SPEAKER_02That is a wild thought. You aren't just making a prosthesis for today. You are archiving their ideal anatomy for the rest of their life. You've essentially created a permanent digital backup of their smile, ready to be recalled with a click of a button. Thanks for tuning in for today's episode of the Dental Edge Podcast. We'd like to give another thank you to Dr. Ronnie Schnell and our CE supporters at DEXIS for sharing valuable insights into maximizing the success of intraoral scanners for your denture workflow.
SPEAKER_00We've reviewed the clinical steps involved for complete dentures using intraoral scanning devices. We've explained how this workflow improves communication between dental labs and patients, and we've seen how implementing a digital denture workflow can improve the ROI at your practice.
SPEAKER_02Now that we have better knowledge of a streamlined digital denture workflow, you can help your next denture case with precise clinical efficiency and confidence. To check out her original presentation, please visit www.dentalearning.net. The incredible partners of dental learning provide great conversations and CE resources to really help your practice evolve and stay informed. Listen in next time for more great episodes of the Dental Edge Podcast. We're thrilled to be your number one source for the latest and greatest in modern dentistry.