The Latest in Dentures
The country’s denture market is anticipated to grow from $2.09 billion in 2020 to $3.38 billion in 2028, with a compound annual growth rate of 6.4%, according to Fortune Business Insights.1 Looking beyond this decade, the country’s increasingly aging population will see a significant “turning point” by 2030, according to the United States Census Bureau, when all baby boomers will be more than 65 years old. One in five of the total population will have surpassed retirement age. Later in the 2030s, “older adults will outnumber children for the first time in U.S. history,” according to the bureau.2
In 2020, 40.99 million Americans reported using dentures, according to figures from the U.S. Census data and Simmons National Consumer Survey (NHCS).3
“While the rate of edentulism is going down, the total number of people in need is growing,” said Neil I. Park, DMD, vice president of clinical affairs at Glidewell Laboratories. “It becomes a question of efficiency. Crafting a complete set of dentures can take four to five patient visits. In addition, an increasing number of people are in nursing homes and assisted living, so, as we increase the efficiency of the service, we can serve more of those people.”
The challenge dentists face in providing more service to more people in a shorter amount of time, while also keeping costs low for patients, can be helped with new technology.
“I got tired of telling my patients that Medicaid will cover me to extract 15 teeth, but it won’t cover your dentures,” said Chris Griffin, DDS, FAGD, who runs his dental practice out of northern Mississippi. It is one of the many states that does not offer Medicaid coverage for dentures.4 Griffin says he’s seeing an increase in need for a reduction of price within his patient population. He’s helping provide that price reduction by incorporating more technology in the form of scanners and a specialized 3D printer. Griffin said that, while there is a learning curve with the new technology, “You have to stay at it. The tech is getting better every single day.”
Incorporating a Scanner for Dentures
“Every time you pour a model, there are inherent inaccuracies in the material. The impression material contracts and the dental stone expands. You eliminate that with a digital scan,” said Park. “Scanner technology is rapidly advancing, and we’re at the point where most major brands do a good job for most indications.”
A recent study published in Clinical Oral Investigations found that the accuracy of work done by intraoral scanners (IOSs) “for partially and completely edentulous arches in in vitro settings was high.” Inexperienced operators had a similar rate of accuracy in the scans as the more experienced operators; however, the more experienced operators performed faster scan times.5
“Scanning the gingiva for a set of dentures is probably the most challenging scan a person is going to do in the practice,” Griffin said. When scanning for dentures, dentists must include the unattached gingiva, which moves and impacts the scanning process. “It’s a known fact that digitally scanning gums is far more difficult because unattached gingiva moves. And when you move across a spot with the scanner, the gum isn’t in precisely the same spot. You end up having to use so much time to get the scan right.”
Online courses like those from the Institute of Digital Dentistry and Glidewell can help dentists learn more and improve their work with an IOS.
Whether a dentist performs an intraoral scan in their office or takes traditional impressions and sends them to a lab, digital processes will often become involved in the workflow. “If you work with Glidewell, you’re digital whether you know it or not. If you send us an impression, we’re going to pour a model and scan that model. Or we’ll CT scan your impression directly,” Park said. “Dentists can save money by doing digital scans themselves. [For the analog process,] there are impression material and trays, then you’ve got to mail [the data] to the lab instead of sending it digitally.” When choosing software or a lab, Park says the dentist “needs to work with a lab that is adept and experienced at receiving digital impressions and putting them into production.”
Dentures vs. Implants
Implant-retained and -supported overdentures are also options. Implant-retained overdentures are less expensive because there’s less hardware, according to Park. Implant attachments keep the dentures in place, and the dentures are supported by the jaw, but they are likely removable. Implant-supported overdentures are more expensive because the number of implants needed increases. They function by having the denture be attached to the implants, which support the force of a person’s bite. Implant-supported overdentures are less likely to be removable.
While dentures can be paid for out-of-pocket by many patients, costing $800–$1,500, implant costs vary widely depending on application, according to Griffin. For dentures that snap onto two or four implants and are removable, the cost can range from $5,000 to $10,000, while all-on-X implant cases where the denture is attached to the implants by screws might cost up to $40,000 per arch. “We do a lot of implants. But, many times, people are hesitant to jump in with the cost. Where I live, people are receptive to it, it’s just so much more money,” said Griffin.
Aside from cost, dentures and implants have varying applications that fit a variety of patient conditions. “Complete dentures are the entry-level treatment for patients who have lost all their teeth or whose teeth cannot be saved,” Park said. “For patients who are partially edentulous, some form of implant restoration is typically preferable to dentures. This is because a stable upper denture can usually be made, but a stable lower denture is the bane of any dentist’s existence. Modern implants were developed to treat lower edentulism, so, if a patient can afford it, they’ll be in line to get implants. If not, they’ll be relegated to complete dentures. During the consultation, dentists should offer multiple treatment options, and they can discuss pros and cons of each option.”
“What should be recommended depends on the patient,” continued Park. “An implant-retained overdenture still puts pressure on the bone, which, for patients with extensive bone loss, puts pressure on the nerve, so it may not be tolerable. In those cases, the patient will need an implant-supported overdenture to take the pressure off the bone. The patient will also be able to generate more biting force with an implant-supported overdenture.”
Printing Dentures in the Office
While it is not yet widespread practice for dentists to print their own dentures in their offices, effectively becoming their own labs, some dentists have begun doing so. Griffin began 3D printing in 2013, and he’s only seen improvements in the software and the hardware. He is now exclusively making the dentures for his patients.
“When a patient used to come in needing dentures, they’d have been in pain and really fearful. I would have to tell them the fastest we can get you dentures is two weeks, but more likely it will be three or four weeks,” Griffin said. “Now, a person comes in, and I’ll tell them we might not be fast enough to do it the same day, but we can get started today with the digital scans, and we can get you your dentures this week. It makes them feel that they can deal with the pain for a few more days. It’s faster, cheaper and better.”
With the software plan he has, the cost to print is $25, compared to several hundred dollars from a lab. The price corresponds to one or both arches at the same time with no additional charge for both.
The 3D printing equipment costs around $20,000, and, as printing is hundreds of dollars per denture cheaper than sending a scan or impression to a lab, Griffin says the money spent on the printer should be recouped in two months or less. He creates models, dentures and implant surgical guides with the same printer he purchased in 2020. He also recently created The 3D Printing Association for Dentists (3dpa.org).
“I think digital dentistry has come to a point where we need an auxiliary who is committed to the digital side. I took one of my best employees and gave her that role, and she’s kind of our in-house auxiliary,” Griffin said.
Replacing Dentures
A denture may need to be replaced, according to The American College of Prosthodontists, if a dentist notices one or more of these red flags: if it has been more than five years since the denture was created, if it has degraded, if the teeth supporting it have been lost (in the case of partial dentures), if the patient no longer can tolerate the device, or if there is chronic inflammation around the denture.6
“A denture is something you wear in your mouth all day long. And, if it’s a material that is porous, you’ll have bacteria working their way in, which over time weakens the denture material,” Park said. “One of my hopes is that we will have denser materials that will be less absorbent and provide less of an opportunity for microbes to colonize.”
A recent study in the Journal of Pharmacy and BioAllied Sciences examined why dentures break, and it found breakage most commonly occurs either due to a patient dropping them or from activity inside the mouth while in use. Defects in how the denture was created in the lab can also contribute to the problem. A thin denture base, inclusions like plaster or air bubbles within the material, and deep scratches that predispose the denture to fracture are all reasons that cause conditions for breakage.7
One other big advantage for Griffin’s practice using 3D printing is that it is easy to replace broken or missing dentures. “Now we can print them and get them ready in a day,” he said. “There are no repairs; you just need to print a new one, and it just costs $25.”
Dan Kolen is a freelance writer and media producer based in Chicago. To comment on this article, email impact@agd.org.
References
1. “Dentures Market Size, Share & COVID-19 Impact Analysis, By Type (Complete, and Partial), By Usage (Removable and Fixed), By End User (Dental Hospitals & Clinics, Dental Laboratories, and Others), and Regional Forecast, 2021-2028.” Fortune Business Insights, August 2021, fortunebusinessinsights.com/dentures-market-103337. Accessed 12 July 2022.
2. Vespa, Johnathan, et al. “Demographic Turning Points for the United States: Population Projections for 2020 to 2060.” United States Census Bureau, February 2020. Report no. P25-1144, census.gov/library/publications/2020/demo/p25-1144.html. Accessed 12 July 2022.
3. “U.S. Population: Do You Use Dentures?” Statista Research Department, 23 June 2022, statista.com/statistics/275484/us-households-usage-of-dentures/. Accessed 12 July 2022.
4. “Does Medicaid Cover Dentures?” Help Advisor, 26 April 2022, helpadvisor.com/medicaid/dentures. Accessed 12 July 2022.
5. Schimmel, Martin, et al. “Accuracy of Intraoral Scanning in Completely and Partially Edentulous Maxillary and Mandibular Jaws: An In Vitro Analysis.” Clinical Oral Investigations, vol. 25, no. 4, 2021, pp. 1839-1847.
6. Tuminelli, Frank J., et al. "Position Statement: Frequency of Denture Replacement." American College of Prosthodontists, 20 Oct. 2015, prosthodontics.org/assets/1/7/The_Frequency_of_Denture_Replacement_Position_Statement.pdf. Accessed 13 July 2022.
7. Kumari, Ranjna, and Suman Bala. “Assessment of Cases of Complete Denture Fracture.” Journal of Pharmacy and BioAllied Sciences, 13 Nov. 2021, ncbi.nlm.nih.gov/pmc/articles/PMC8687013/#ref12. Accessed 12 July 2022
In 2020, 40.99 million Americans reported using dentures, according to figures from the U.S. Census data and Simmons National Consumer Survey (NHCS).3
“While the rate of edentulism is going down, the total number of people in need is growing,” said Neil I. Park, DMD, vice president of clinical affairs at Glidewell Laboratories. “It becomes a question of efficiency. Crafting a complete set of dentures can take four to five patient visits. In addition, an increasing number of people are in nursing homes and assisted living, so, as we increase the efficiency of the service, we can serve more of those people.”
The challenge dentists face in providing more service to more people in a shorter amount of time, while also keeping costs low for patients, can be helped with new technology.
“I got tired of telling my patients that Medicaid will cover me to extract 15 teeth, but it won’t cover your dentures,” said Chris Griffin, DDS, FAGD, who runs his dental practice out of northern Mississippi. It is one of the many states that does not offer Medicaid coverage for dentures.4 Griffin says he’s seeing an increase in need for a reduction of price within his patient population. He’s helping provide that price reduction by incorporating more technology in the form of scanners and a specialized 3D printer. Griffin said that, while there is a learning curve with the new technology, “You have to stay at it. The tech is getting better every single day.”
Incorporating a Scanner for Dentures
“Every time you pour a model, there are inherent inaccuracies in the material. The impression material contracts and the dental stone expands. You eliminate that with a digital scan,” said Park. “Scanner technology is rapidly advancing, and we’re at the point where most major brands do a good job for most indications.”
A recent study published in Clinical Oral Investigations found that the accuracy of work done by intraoral scanners (IOSs) “for partially and completely edentulous arches in in vitro settings was high.” Inexperienced operators had a similar rate of accuracy in the scans as the more experienced operators; however, the more experienced operators performed faster scan times.5
“Scanning the gingiva for a set of dentures is probably the most challenging scan a person is going to do in the practice,” Griffin said. When scanning for dentures, dentists must include the unattached gingiva, which moves and impacts the scanning process. “It’s a known fact that digitally scanning gums is far more difficult because unattached gingiva moves. And when you move across a spot with the scanner, the gum isn’t in precisely the same spot. You end up having to use so much time to get the scan right.”
Online courses like those from the Institute of Digital Dentistry and Glidewell can help dentists learn more and improve their work with an IOS.
Whether a dentist performs an intraoral scan in their office or takes traditional impressions and sends them to a lab, digital processes will often become involved in the workflow. “If you work with Glidewell, you’re digital whether you know it or not. If you send us an impression, we’re going to pour a model and scan that model. Or we’ll CT scan your impression directly,” Park said. “Dentists can save money by doing digital scans themselves. [For the analog process,] there are impression material and trays, then you’ve got to mail [the data] to the lab instead of sending it digitally.” When choosing software or a lab, Park says the dentist “needs to work with a lab that is adept and experienced at receiving digital impressions and putting them into production.”
Dentures vs. Implants
Implant-retained and -supported overdentures are also options. Implant-retained overdentures are less expensive because there’s less hardware, according to Park. Implant attachments keep the dentures in place, and the dentures are supported by the jaw, but they are likely removable. Implant-supported overdentures are more expensive because the number of implants needed increases. They function by having the denture be attached to the implants, which support the force of a person’s bite. Implant-supported overdentures are less likely to be removable.
While dentures can be paid for out-of-pocket by many patients, costing $800–$1,500, implant costs vary widely depending on application, according to Griffin. For dentures that snap onto two or four implants and are removable, the cost can range from $5,000 to $10,000, while all-on-X implant cases where the denture is attached to the implants by screws might cost up to $40,000 per arch. “We do a lot of implants. But, many times, people are hesitant to jump in with the cost. Where I live, people are receptive to it, it’s just so much more money,” said Griffin.
Aside from cost, dentures and implants have varying applications that fit a variety of patient conditions. “Complete dentures are the entry-level treatment for patients who have lost all their teeth or whose teeth cannot be saved,” Park said. “For patients who are partially edentulous, some form of implant restoration is typically preferable to dentures. This is because a stable upper denture can usually be made, but a stable lower denture is the bane of any dentist’s existence. Modern implants were developed to treat lower edentulism, so, if a patient can afford it, they’ll be in line to get implants. If not, they’ll be relegated to complete dentures. During the consultation, dentists should offer multiple treatment options, and they can discuss pros and cons of each option.”
“What should be recommended depends on the patient,” continued Park. “An implant-retained overdenture still puts pressure on the bone, which, for patients with extensive bone loss, puts pressure on the nerve, so it may not be tolerable. In those cases, the patient will need an implant-supported overdenture to take the pressure off the bone. The patient will also be able to generate more biting force with an implant-supported overdenture.”
Printing Dentures in the Office
While it is not yet widespread practice for dentists to print their own dentures in their offices, effectively becoming their own labs, some dentists have begun doing so. Griffin began 3D printing in 2013, and he’s only seen improvements in the software and the hardware. He is now exclusively making the dentures for his patients.
“When a patient used to come in needing dentures, they’d have been in pain and really fearful. I would have to tell them the fastest we can get you dentures is two weeks, but more likely it will be three or four weeks,” Griffin said. “Now, a person comes in, and I’ll tell them we might not be fast enough to do it the same day, but we can get started today with the digital scans, and we can get you your dentures this week. It makes them feel that they can deal with the pain for a few more days. It’s faster, cheaper and better.”
With the software plan he has, the cost to print is $25, compared to several hundred dollars from a lab. The price corresponds to one or both arches at the same time with no additional charge for both.
The 3D printing equipment costs around $20,000, and, as printing is hundreds of dollars per denture cheaper than sending a scan or impression to a lab, Griffin says the money spent on the printer should be recouped in two months or less. He creates models, dentures and implant surgical guides with the same printer he purchased in 2020. He also recently created The 3D Printing Association for Dentists (3dpa.org).
“I think digital dentistry has come to a point where we need an auxiliary who is committed to the digital side. I took one of my best employees and gave her that role, and she’s kind of our in-house auxiliary,” Griffin said.
Replacing Dentures
A denture may need to be replaced, according to The American College of Prosthodontists, if a dentist notices one or more of these red flags: if it has been more than five years since the denture was created, if it has degraded, if the teeth supporting it have been lost (in the case of partial dentures), if the patient no longer can tolerate the device, or if there is chronic inflammation around the denture.6
“A denture is something you wear in your mouth all day long. And, if it’s a material that is porous, you’ll have bacteria working their way in, which over time weakens the denture material,” Park said. “One of my hopes is that we will have denser materials that will be less absorbent and provide less of an opportunity for microbes to colonize.”
A recent study in the Journal of Pharmacy and BioAllied Sciences examined why dentures break, and it found breakage most commonly occurs either due to a patient dropping them or from activity inside the mouth while in use. Defects in how the denture was created in the lab can also contribute to the problem. A thin denture base, inclusions like plaster or air bubbles within the material, and deep scratches that predispose the denture to fracture are all reasons that cause conditions for breakage.7
One other big advantage for Griffin’s practice using 3D printing is that it is easy to replace broken or missing dentures. “Now we can print them and get them ready in a day,” he said. “There are no repairs; you just need to print a new one, and it just costs $25.”
Dan Kolen is a freelance writer and media producer based in Chicago. To comment on this article, email impact@agd.org.
References
1. “Dentures Market Size, Share & COVID-19 Impact Analysis, By Type (Complete, and Partial), By Usage (Removable and Fixed), By End User (Dental Hospitals & Clinics, Dental Laboratories, and Others), and Regional Forecast, 2021-2028.” Fortune Business Insights, August 2021, fortunebusinessinsights.com/dentures-market-103337. Accessed 12 July 2022.
2. Vespa, Johnathan, et al. “Demographic Turning Points for the United States: Population Projections for 2020 to 2060.” United States Census Bureau, February 2020. Report no. P25-1144, census.gov/library/publications/2020/demo/p25-1144.html. Accessed 12 July 2022.
3. “U.S. Population: Do You Use Dentures?” Statista Research Department, 23 June 2022, statista.com/statistics/275484/us-households-usage-of-dentures/. Accessed 12 July 2022.
4. “Does Medicaid Cover Dentures?” Help Advisor, 26 April 2022, helpadvisor.com/medicaid/dentures. Accessed 12 July 2022.
5. Schimmel, Martin, et al. “Accuracy of Intraoral Scanning in Completely and Partially Edentulous Maxillary and Mandibular Jaws: An In Vitro Analysis.” Clinical Oral Investigations, vol. 25, no. 4, 2021, pp. 1839-1847.
6. Tuminelli, Frank J., et al. "Position Statement: Frequency of Denture Replacement." American College of Prosthodontists, 20 Oct. 2015, prosthodontics.org/assets/1/7/The_Frequency_of_Denture_Replacement_Position_Statement.pdf. Accessed 13 July 2022.
7. Kumari, Ranjna, and Suman Bala. “Assessment of Cases of Complete Denture Fracture.” Journal of Pharmacy and BioAllied Sciences, 13 Nov. 2021, ncbi.nlm.nih.gov/pmc/articles/PMC8687013/#ref12. Accessed 12 July 2022