Limitations of Digital Dentures

• Despite rapid advancements, the design and fabrication of digital complete dentures continue to present several technical and clinical challenges. Designing an esthetic digital denture remains time-intensive and requires proper data integration, technical expertise, and clinical judgment compared with fixed restorations.⁵²

• In addition, CAD software for designing removable restorations is less advanced than that for fixed prostheses. While ongoing developments are improving usability, current systems still require significant manual input.⁵²

• A key limitation of computer-aided design (CAD) lies in the manipulation of three-dimensional objects on two-dimensional screens, making accurate assessment of spatial relationships and occlusion challenging. Although virtual articulators are available, their effectiveness remains constrained by this interface limitation.⁵²

• Achieving optimal esthetics is another concern, as digital workflows have limitations in replicating the detailed gingival characterization obtained with conventional techniques. Consequently, digital dentures are often perceived as less esthetic compared to conventional complete dentures.⁵²

• Digital denture materials are largely limited to PMMA, with 3D-printed materials showing inferior mechanical properties, while milled materials, though stronger, are more time-consuming and expensive.⁵²

From a clinical workflow standpoint, several additional limitations persist

• Adjustments and relines associated with IOS use: When the IOS is used to record the denture-bearing tissues, relines and repeated adjustments of the intaglio surface and borders are needed to achieve an optimal fit of the digital prostheses.³⁰

• Suboptimal esthetics due to elimination of try-in: Several digital protocols advocate the elimination of try-in procedures to save time and cost as they permit virtual evaluation of patient esthetics.⁵³ However, the prostheses may not have the desired result when placed in the patient’s mouth thereby resulting in patient dissatisfaction and treatment failure.

• Learning curve: Fabrication of digital complete dental prostheses requires specialized clinical training and there is a learning curve attached to it. To achieve a successful outcome, the dental practitioner needs to invest time and effort in assessing digital previews and should also actively participate in electronic communication with the laboratory.²⁴

• Impossible to digitally register the interocclusal records: It is currently impossible to digitally register the interocclusal records (for patients without existing dentures) and challenging to record digital functional impressions, thus the full digital workflow for the complete denture rehabilitation remains questionable.^30-35

• Inability to balance digital dentures: It is not possible to balance digital dentures during the designing phase of denture fabrication.

• Relining challenges: 3D-printed denture bases relined with chairside materials tend to exhibit more adhesive failures, whereas milled and conventionally processed bases more often show cohesive or mixed failure patterns.^54,55

Emerging Trends in Digital Denture Workflows

Recent advancements emphasize the integration of three-dimensional (3D) facial scans with intraoral data to improve occlusal plane orientation, midline determination, and esthetic planning.^56,57 The combination of facial scanning, intraoral scanning, and electronic facebow records enables the development of physiologically accurate prosthetic setups,while also reducing the number of clinical visits.^56,57

Artificial intelligence (AI) is increasingly being integrated into digital denture workflows to automate prosthetic design, validate scan data, and align prostheses with facial esthetics.⁵⁸ AI can support multiple stages of the workflow, including automated identification and delineation of anatomical landmarks and impression boundaries in digital scans, as well as virtual tooth arrangement. Furthermore, AI integration may facilitate patient-specific workflow customization and seamless coordination across digital steps, contributing to reduced chairside time and fewer clinical visits.