The National Dental Centre Singapore (NDCS) has developed a new smart digital workflow known as SmartRPD, aimed at significantly improving fitting accuracy and reducing treatment time for patients requiring metal-base removable partial dentures (RPDs).
Conventional fabrication of metal-based RPDs relies on manual metal casting, which is inefficient due to labour intensiveness and technique sensitivities. This often results in poor fitting of RPD and unsatisfactory outcomes. The new SmartRPD workflow integrates intra-oral scanning, automatic design, and 3D printing, transforming the process of the production of RPDs into an automated and streamlined workflow.
“The innovative workflow marks a strategic move towards enhancing our service operation, offering efficient, precise, and patient-centric RPD fabrication through digitalisation and automation. This seamless process streamlines workflows, reduces patient visits, enhances satisfaction, and minimises reliance on labour and technical resources,” said lead principal investigator assistant professor Dr Yu Na, NDCS.
Since 2020, NDCS has been collaborating with A*STAR’s Institute of High Performance Computing (IHPC) on the development of SmartRPD. IHPC developed computational geometry algorithms to analyse patient-specific dental scans and generate 3D models of the RPD frameworks. This user-friendly modelling process requires minimal input from dentists, automating customisation and streamlining manufacturing through 3D printing.
“Our goal was to develop a dental software that enhances efficiency of custom RPD, allowing dentists to focus on more important tasks,” said principal scientist Dr Lim Chi Wan, IHPC.
This initiative received joint support from Temasek, which provided the initial philanthropic funding to enable research and technology development for proof-of-concept; Temasek Foundation, which provided additional funding for the later stages to establish key platforms and processes for clinical workflows, communications and 3D printing of the RPDs; and the Singapore Ministry of Health through the National Medical Research Council (NMRC) Office, MOH Holdings which supported the clinical team in evaluating clinical efficacy.
The future of SmartRPD in an ageing population
During a media briefing on 13 Sep, NDCS shared how SmartRPD can help address the rising demand for RPDs by an ageing population in the years ahead with its improved productivity and resource utilisation.
A 2017 community survey1 found that 69% of elderly aged 65 and above wear dentures. Of this figure, nearly two-thirds of seniors have severe tooth loss and 3% of seniors have no teeth. On average, only 11 teeth remain among seniors in the community. In contrast, a healthy dentition requires at least 20 functional teeth.
Singapore’s ageing population indicates an increase in dental care needs, including the potential demand for RPDs, which typically require replacement every 5-10 years. In 2020, the annual demand for RPDs in Singapore was estimated at 40,000, which may continue to increase as 24% of the population is projected to be 65 and above by 2030.
The pilot clinical trial of the new digital workflow saw a satisfaction rating of 95% from dentists and demonstrated increased productivity for clinicians. Between 2020 to 2023, multiple trials involved 33 NDCS clinicians, five private dentists, and 90 patients who participated in the scan, digital design, and 3D print workflow.
“The current practice for the end-to-end production of RPDs has a lot of scope for improvement in terms of the efficiency, precision and manpower usage. Adoption of the SmartRPD will result in a better-quality throughput, as well as help address the shortage in denture production,” said clinical associate professor Goh Bee Tin, CEO, NDCS. “With SmartRPD, patients can look forward to a better treatment experience, faster turnaround time and better fitting dentures. Our end goal is that it will improve the oral health, appearance and overall quality of life for patients.”
NDCS will be moving to the next stage to secure clinical validation of SmartRPD from this year. This will involve an additional 300 patients and 40 clinics.
Plans to license this technology are also underway. NDCS is currently in discussions with potential industry partners to commercialise this technology. In addition, NDCS is also leveraging its specialist training programme to familiarise general dentists and specialists with the new technology, to ensure seamless integration of SmartRPD into clinical practice.
At the media briefing, NDCS presented a patient-case from the clinical trial which reported assuring feedback to the quality and patient experience with the new device and workflow. The patient wanted to redo her upper dentures as they no longer fit due to the extraction of two teeth and joined the SmartRPD clinical trial in Nov 2023 for upper denture fabrication with NDCS dentist Dr Phang Zi Ying.
“I have been wearing dentures since I was 18, and this is my fourth and best fitting one by far. My old dentures used to be uncomfortable and sometimes caused pain when eating, but with these new ones fabricated using the SmartRPD workflow, I can chew properly and enjoy my food thoroughly because they fit properly. Additionally, I was able to receive my dentures quickly and conveniently, with less physical trips to the dentist needed. I am sure this new technology will be appreciated by other elderly patients like me who would also like to receive well-fitting dentures in a timely manner,” said the 65-year-old patient, Lim Soon Lian.
“Tooth loss is a highly prevalent problem among our growing elderly population, and without adequate treatment, can lead to poor nutrition, chronic diseases, and other health problems. NDCS has developed an innovative solution that improves fit accuracy of partial dentures, reduces waiting time and patient visits to the dentist, and broadens affordable access to partial dentures. The Temasek Foundation is very heartened to support this meaningful work and catalyse its integration into routine clinical use,” said Ms Heng Li Lang, head, Climate & Liveability, Temasek Foundation.
References
1. Dental health status of community-dwelling older Singaporeans: Findings from a nationally representative survey, Gerodontology, Mar 2017, Chiu et.al
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