Special Issue "Digital Dentistry for Oral Health"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: 31 December 2020.

Special Issue Editor

Prof. Dr. Carlo Mangano
Website
Guest Editor
1. Head of Digital Dentistry Unit Research, S. Raffaele Hospital, Milan, Italy
2. Founding member and President elect of Digital Dentistry Society
Interests: 3D Printing; dental implants; bone Regeneration; bioceramics; customized Scaffolds; tissue Engineering
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Special Issue Information

Dear Colleagues,

The Digital Revolution has now fully entered the world of dentistry. Intraoral, desktop, and face scanners, cone beam computed tomography (CBCT), computer-assisted design/computer-assisted manufacturing (CAD / CAM) software, milling units and 3D printers, and new materials represent a great opportunity to improve the quality of our work. Today, we can acquire a whole series of 3D information on our patient, superimposed and combined, and the patient becomes “virtual”. Diagnostic precision reduces errors, and 3D planning of therapies opens the way toward a novel, minimally invasive dentistry that uses compatible and aesthetic materials. The dentist becomes “digital”, where the planning of computer therapies becomes one of the key moments of the profession. In surgery, in prosthesis, in orthodontics, workflows change. Guided surgery allows planning the position of the implants in 3D, on the computer, and transferring it to the patient through the use of static surgical templates, or of dynamic navigation. This allows inserting the implants in the desired position, inclination, and depth, in agreement with the prosthetic rehabilitation project, and in a minimally invasive way (flapless, i.e. without raising a surgical flap). The operation is faster, and the patient's discomfort is reduced. The digital aspect also helps in programming interventions such as the extraction of included teeth, or the removal of cysts. In regenerative surgery, it is now possible to 3D-print customized meshes for bone regeneration, and custom-made bone grafts in synthetic material; finally, it is possible to produce custom-made implants, even for maxillofacial use. In prosthesis, traditional impression with trays and materials is increasingly being replaced by an optical one, obtained with an intraoral scanner. Patients like the optical impression, which eliminates the discomfort of the traditional impression: Intraoral scanners are a communication and marketing tool and make the workflow more efficient. In fact, the files captured with an intraoral scanner are sent by electronic mail to the modern digital laboratory, which is equipped with computer-assisted design/computer-assisted manufacturing (CAD/CAM) software and prototyping machines (milling units and 3D printers), and which designs and realizes various types of restorations, from simple to complex, using highly aesthetic and compatible materials, including monolithic ones, such as zirconia and lithium disilicate. The same orthodontic workflows are transformed, from diagnosis to planning, up to the execution of therapies.

This special issue welcomes research and clinical papers that examine how digital technologies are transforming the world of oral health. We aim to receive and publish systematic and narrative reviews, randomized controlled trials, prospective and retrospective studies, as well as case reports, focusing on the impact of the new digital technologies in dentistry. The main topics for the Special Issue are presented below:

  • Intraoral, desktop, and face scanners and the data acquisition in digital dentistry;
  • CAD software in prosthodontics, surgery, and orthodontics;
  • Guided implant surgery;
  • Monolithic materials in prosthodontics: zirconia and lithium disilicate and their application;
  • CAM, milling units, and 3D printers;
  • 3D-printed dental implants;
  • Custom-made bioceramics for bone regeneration;
  • Custom-made meshes for bone regeneration;
  • Virtual and augmented reality in dentistry;
  • Big data in dentistry

Prof. Carlo Mangano
Guest Editor

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Keywords

  • Intraoral scanners
  • Face scanners
  • CAD/CAM software
  • Guided implant surgery
  • Digital prosthodontics
  • Zirconia
  • Lithium disilicato
  • 3D printing
  • Dental implants
  • Customized scaffolds

Published Papers (17 papers)

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Open AccessArticle
Accuracy of Dynamic Navigation System Workflow for Implant Supported Full Arch Prosthesis: A Case Series
Int. J. Environ. Res. Public Health 2020, 17(14), 5038; https://doi.org/10.3390/ijerph17145038 (registering DOI) - 13 Jul 2020
Abstract
A minimally invasive implant treatment approach for future full arch implant prosthetic rehabilitations of trophic jaws represents a challenge. An optimal implant planning is strongly related with an accurate merge of the prosthetic information and the radiographic data. To comply with that, most [...] Read more.
A minimally invasive implant treatment approach for future full arch implant prosthetic rehabilitations of trophic jaws represents a challenge. An optimal implant planning is strongly related with an accurate merge of the prosthetic information and the radiographic data. To comply with that, most computer aided implantology (CAI) systems require additional steps, as radiographic stents or fiducial markers to overlap digital jaw scans to cone beam computed tomography (CBCT) data. Using dynamic CAI, residual teeth (up to three) make it possible for the merge to avoid new radiographic scans. An additional challenge is the treatment involving immediate implants compared with delayed implants placed into healed bone. As for other static CAI systems, the operator’s experience and the quality of the CBCT data make the planning affordable and secure the entire implants placement procedure. The literature reports accuracies in terms of comparison between placed implants and planned implants, following a double CBCT approach, based on radiographic volume overlapping. Thirteen consecutive future totally edentulous patients (77 implants), divided into two groups (group A: 3–4 teeth traced; group B: 5–6 teeth traced) requiring a full arch implant prosthetic rehabilitation were included in the reported case series. A dynamic CAI was used to plan and to place all implants following all the recommended digital steps. The software used provided a tool (Trace and Place) that made the merge between X-ray views of the residual teeth and their own positions possible. This method definitely registered that teeth positions comply with the required accuracy live check. After implants placement, a post-operative CBCT was taken in order to evaluate the deviations of the achieved implants at coronal, apical, and depth level as well as angular deviations. Statistically significant radiological mean difference between the two groups was found in the coronal position of implants (0.26 mm, p < 0.001), in the apical position of implants (0.29 mm, p < 0.001), in the depth of implants (0.16 mm, p = 0.022), and in the angular deviation (0.7, p = 0.004). The use of the TaP technology for the treatment of the patients with at least three stable teeth that need to be removed for a totally implant prosthetic treatment is a promising technique. The performed accuracy analysis demonstrated that this digital protocol can be used without a loss of accuracy of the achieved implants compared to planned ones. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
Open AccessArticle
Integrated 3D Information for Custom-Made Bone Grafts: Focus on Biphasic Calcium Phosphate Bone Substitute Biomaterials
Int. J. Environ. Res. Public Health 2020, 17(14), 4931; https://doi.org/10.3390/ijerph17144931 - 08 Jul 2020
Abstract
Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca3(PO4)2, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate [...] Read more.
Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca3(PO4)2, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate the inference of the sintering time at peak temperature on transition of β-Ca3(PO4)2 to α-Ca3(PO4)2. This analysis explored, in an innovative way, inferences and correlations between volumetric microstructure, mechanical properties, sintering temperature, and time at peak temperature in order to find the best sintering conditions for biphasic calcium phosphate composites grafted in severe alveolar bone defects. Methods: Sintered biphasic calcium phosphates (30%-hydroxyapatite/70%-tricalcium phosphate) were tested by microCT imaging for the 3D morphometric analysis, by compressive loading to find their mechanical parameters, and by X-ray diffraction to quantify the phases via Rietveld refinement for different sintering temperatures and times at the peak temperature. Data were analysed in terms of statistical inference using Pearson’s correlation coefficients. Results: All the studied scaffolds closely mimicked the alveolar organization of the jawbone, independently on the sintering temperatures and times; however, mechanical testing revealed that the group with peak temperature, which lasted for 2 hours at 1250 °C, showed the highest strength both at the ultimate point and at fracture point. Conclusion: The good mechanical performances of the group with peak temperature, which lasted for 2 hours at 1250 °C, is most likely due to the absence of the α-Ca3(PO4)2 phase, as revealed by X-ray diffraction. However, we detected its presence after sintering at the same peak temperature for longer times, showing the time-dependence, combined with the temperature-dependence, of the β-Ca3(PO4)2 to α-Ca3(PO4)2 transition. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Digital versus Conventional Impression Taking Focusing on Interdental Areas: A Clinical Trial
Int. J. Environ. Res. Public Health 2020, 17(13), 4725; https://doi.org/10.3390/ijerph17134725 - 30 Jun 2020
Abstract
Due to the high prevalence of periodontitis, dentists have to face a larger group of patients with periodontally compromised dentitions (PCDs) characterized by pathologic tooth migration and malocclusion. Impression taking in these patients is challenging due to several undercuts and extensive interdental areas [...] Read more.
Due to the high prevalence of periodontitis, dentists have to face a larger group of patients with periodontally compromised dentitions (PCDs) characterized by pathologic tooth migration and malocclusion. Impression taking in these patients is challenging due to several undercuts and extensive interdental areas (IAs). The aim of this clinical trial was to analyze the ability of analog and digital impression techniques to display the IAs in PCDs. The upper and the lower jaws of 30 patients (n = 60, age: 48–87 years) were investigated with one conventional impression (CVI) using polyvinyl siloxane and four digital impressions with intraoral scanners (IOSs), namely True Definition (TRU), Primescan (PRI), CS 3600 (CAR), and TRIOS 3 (TIO). The gypsum models of the CVIs were digitalized using a laboratory scanner. Subsequently, the percentage of the displayed IAs in relation to the absolute IAs was calculated for the five impression techniques in a three-dimensional measuring software. Significant differences were observed among the impression techniques (except between PRI and CAR, p-value < 0.05). TRU displayed the highest percentage of IAs, followed by PRI, CAR, TIO, and CVI. The results indicated that the IOSs are superior to CVI regarding the ability to display the IAs in PCDs. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Repeatability of Freehand Implantations Supported with Universal Plastic Sleeves—In Vitro Study
Int. J. Environ. Res. Public Health 2020, 17(12), 4453; https://doi.org/10.3390/ijerph17124453 - 21 Jun 2020
Abstract
Repeatability and precision are major factors which have an influence on final implant treatment results. The aim of this study was to evaluate the repeatability of freehand implant procedures assisted with special plastic sleeves which are placed on the drill to guarantee the [...] Read more.
Repeatability and precision are major factors which have an influence on final implant treatment results. The aim of this study was to evaluate the repeatability of freehand implant procedures assisted with special plastic sleeves which are placed on the drill to guarantee the proper mesiodistal distance from the landmark’s surface. Patient data required for implant treatment, including images of mandibles from CBCT scans and virtual models of soft tissues and teeth, were used to prepare complete virtual models of patient clinical conditions. The models were saved as STL files and 3D printed in five copies. Drilling procedures were done at positions 37, 46 and 47. Each model was scanned with pins in the osteotomies and compared using digital aligning of the models’ surfaces. The average deviation was −1.38 ± 1.4 mm. Average deviations on guide pins placed at position 37 were −0.46 ± 0.59 mm, at position 46 were −1.46 ± 0.88 mm (landmark’s surface of both: distal tooth’s surface), and at position 47 were the highest: −2.69 ± 1.62 mm (landmark’s surface: surface of plastic sleeve). The following conclusion was drawn: Using universal plastic sleeves could improve implant procedure precision especially in the case of partially edentulous patients. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Artificial Intelligence (AI)-Driven Molar Angulation Measurements to Predict Third Molar Eruption on Panoramic Radiographs
Int. J. Environ. Res. Public Health 2020, 17(10), 3716; https://doi.org/10.3390/ijerph17103716 - 25 May 2020
Abstract
The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n [...] Read more.
The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n = 588) and validation (n = 250) of the network. A fully convolutional neural network with ResNet-101 backbone jointly predicted the molar segmentation maps and an estimate of the orientation lines, which was then iteratively refined by regression on the mesial and distal sides of the segmentation contours. Accuracy was quantified as the fraction of correct angulations (with predefined error intervals) compared to human reference measurements. Performance differences between the network and reference measurements were visually assessed using Bland−Altman plots. The quantitative analysis for automatic molar segmentation resulted in mean IoUs approximating 90%. Mean Hausdorff distances were lowest for first and second molars. The network angulation measurements reached accuracies of 79.7% [−2.5°; 2.5°] and 98.1% [−5°; 5°], combined with a clinically significant reduction in user-time of >53%. In conclusion, this study validated a new and unique AI-driven tool for fast, accurate, and consistent automated measurement of molar angulations on panoramic radiographs. Complementing the dental practitioner with accurate AI-tools will facilitate and optimize dental care and synergistically lead to ever-increasing diagnostic accuracies. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Patient-Reported Outcome Measures (PROMs) for Two Implant Placement Techniques in Sinus Region (Bone Graft versus Computer-Aided Implant Surgery): A Randomized Prospective Trial
Int. J. Environ. Res. Public Health 2020, 17(9), 2990; https://doi.org/10.3390/ijerph17092990 - 25 Apr 2020
Abstract
Purpose: To assess patient-reported outcomes measures (PROMs) for two implant placement techniques in cases of sinus bone atrophy (bone graft surgery (BGS) versus computer-aided implant surgery (CAIS)), after surgery and one year later, and to evaluate the clinical success of both treatments. Methods: [...] Read more.
Purpose: To assess patient-reported outcomes measures (PROMs) for two implant placement techniques in cases of sinus bone atrophy (bone graft surgery (BGS) versus computer-aided implant surgery (CAIS)), after surgery and one year later, and to evaluate the clinical success of both treatments. Methods: Sixty patients with bone atrophy in the posterior maxilla and in need of implant placement were randomly assigned to two groups, and in accordance with the case report form (CRF), 30 were treated with BGS and 30 with CAIS. Immediately after treatment and one year later, PROMs were assessed, and the clinical success of both treatments was evaluated. Results: No significant differences were found between BGS and CAIS with regard to the following: loss of implants (p = 492); patient recommendation (p = 210); duration of surgery (p = 987); pain on the intervention day (p = 512); pain in the week after intervention (p = 299); and complications in the stage of surgery (p = 1.00). Similarly, at one year, no differences were found with regard to the following: pain around implant (p = 481); infection of implants (p = 491); abnormal radiographic imaging (p = 226); occurrence of undesirable events (p = 1.00); loss of one of the implants (p = 1.00); plaque detection (p = 1.00); bleeding on probing (p = 236); and presence of keratinized mucosa (p = 226). However, a significant difference was found among BGS and CAIS with regard to the number of consultations (p = 0001); number of implants placed (p = 033); and treatment difficulty (p = 0369). Significant differences were found for peri-implantitis (p = 0481) and radiology of craterization (p = 020) in clinical examination at the first year. Conclusion: Treatment difficulty and number of consultations were higher for BGS than for CAIS, as well as peri-implantitis and bone craterization at one year, indicating significant differences between the two treatments. However, there were no statistically significant differences between BGS and CAIS regarding the other PROMs, at placement and after one year. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis
Int. J. Environ. Res. Public Health 2020, 17(7), 2449; https://doi.org/10.3390/ijerph17072449 - 03 Apr 2020
Abstract
This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and [...] Read more.
This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
New Intraoral Scanner-Based Chairside Measurement Method to Investigate the Internal Fit of Crowns: A Clinical Trial
Int. J. Environ. Res. Public Health 2020, 17(7), 2182; https://doi.org/10.3390/ijerph17072182 - 25 Mar 2020
Abstract
To measure the internal fit of the computer-aided designed/computer-aided manufactured (CAD/CAM) crowns, a new scanner-based chairside approach was investigated in patients, and the results were compared to the established silicone replica technique and a digital laboratory replica method. Thirty full-coverage crown preparations were [...] Read more.
To measure the internal fit of the computer-aided designed/computer-aided manufactured (CAD/CAM) crowns, a new scanner-based chairside approach was investigated in patients, and the results were compared to the established silicone replica technique and a digital laboratory replica method. Thirty full-coverage crown preparations were included. Based on a digital impression with an intraoral scanner (IOS, Trios 3), three CAD/CAM measurement copings (‘COM’, resin composite; ‘ZIR’, zirconium dioxide; ‘NPA’, non-precious alloy) were fabricated for each tooth preparation. The internal fit of the measurement copings was analyzed with three different evaluation methods: IOS-based digital approach (D-IOS), digital replica method with laboratory software (D-GOM), and conventional silicone replica technique (CV-SR). The congruence between the determined target parameter of the 80-µm cement space and the actual measured internal gap was investigated. Statistical analysis was performed by ANOVA (p-value < 0.05). No significant difference was determined between the three evaluation methods. However, significant differences were observed for the three coping materials (p-value < 0.05), the single measurement position (marginal, axial, and occlusal fit) (p-value < 0.05), and the interaction between the coping material and the measurement position (p-value < 0.05). COM revealed the smallest internal gap, followed by ZIR and NPA. Regardless of the coping material, the occlusal gap was higher than the axial and marginal gaps. Furthermore, only the internal gaps of the marginal area almost matched the target parameter of 80-µm for the cement space. D-IOS is effective for measuring internal fit of single crowns in different clinical settings. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Histologic, Histomorphometric, and Clinical Analysis of the Effects of Growth Factors in a Fibrin Network Used in Maxillary Sinus Augmentation
Int. J. Environ. Res. Public Health 2020, 17(6), 1918; https://doi.org/10.3390/ijerph17061918 - 15 Mar 2020
Abstract
This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either [...] Read more.
This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either beta-tricalcium phosphate (β-TCP) or MPM grafts (10 sinuses each). Six months postsurgery, specimens were obtained with a trephine bur prior to implant placement in 39 cases. Volumetric changes in sinus augmentation were analyzed between 1 week (T-I) and 6 months (T-II) postsurgery. Histomorphometric and histological analyses of biopsy samples revealed mean new bone percentages of 35.40% ± 9.09% and 26.92% ± 7.26% and residual graft particle areas of 23.13% ± 6.16% and 32.25% ± 8.48% in the MPM and β-TCP groups, respectively (p < 0.05). The mean soft-tissue areas in the MPM and β-TCP groups were 41.48% ± 8.41% and 40.83% ± 8.86%, respectively (p > 0.05). Graft reductions between baseline and 6-months postprocedure in the β-TCP and MPM groups were 17.12% ± 13.55% and 14.41% ± 12.87%, respectively, with significant graft volume reduction observed in both groups (p < 0.05) while there is no significant difference between MPM and β-TCP groups (p > 0.05). Thus, MPM, representing growth factors in a fibrin network, increases new bone formation and has acceptable volume stability in MSL procedures Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Perceptions of Dentists and Non-Professionals on Some Dental Factors Affecting Smile Aesthetics: A Study from Vietnam
Int. J. Environ. Res. Public Health 2020, 17(5), 1638; https://doi.org/10.3390/ijerph17051638 - 03 Mar 2020
Abstract
Aim: It is important to meet the aesthetic expectation regarding the smile concept of both dentists and non-professionals after treatment is complete. Therefore, the study aims to evaluate the effects of altered displays in incisors, gingival margin, and other smile-related-factors on dentists’ [...] Read more.
Aim: It is important to meet the aesthetic expectation regarding the smile concept of both dentists and non-professionals after treatment is complete. Therefore, the study aims to evaluate the effects of altered displays in incisors, gingival margin, and other smile-related-factors on dentists’ vs. non-professionals’ aesthetics perceptions. Materials and method: We altered the features of 42 digital smile photographs to generate the changed displays in incisors, gingival margin, and other smile-related-factors. Then, these altered photographs were presented to 51 dentists and 51 non-professionals, and each picture was rated by each participant with a visual analog scale ranging from 0 (very ugly) to 100 (very beautiful). Results: We found that the alterations in incisors, gingival margin, and other factors affected studied groups’ aesthetic perception of smile. The ugly smile threshold rated by both groups for crown length of maxillary central incisors was 2.0 mm. This threshold was 2.5 mm for dentists, with moving the gingival margin of maxillary lateral incisors to the incisal ridge. The ugly thresholds for other smile-related-factors were different between studied groups; for example, the ugly thresholds for gingival exposure levels were 3 and 4mm for dentists and non-professionals, respectively. Thus, our data indicate that altered displays in incisors, gingival margin, and other smile-related-factors affected perceptions of both studied groups on smile aesthetics, but dentists tended to feel more refined than non-professionals. Dentists and non-professionals had significantly different aesthetic perceptions of the alteration of the gingival exposure level. Conclusion: Both dentists and non-professionals’ perceptions should be fully considered during orthodontic and prosthodontic treatment to achieve optimum aesthetic results. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
Comparative Analysis of the Reproduction Accuracy of Main Methods for Finding the Mandible Position in the Centric Relation Using Digital Research Method. Comparison between Analog-to-Digital and Digital Methods: A Preliminary Report
Int. J. Environ. Res. Public Health 2020, 17(3), 933; https://doi.org/10.3390/ijerph17030933 - 03 Feb 2020
Abstract
Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording [...] Read more.
Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording of Gothic arch angle. Methods: To determine the reproduction accuracy of the centric relation of jaws, we examined 5 patients with intact dentition in a prosthetic dentistry clinic (first class in Angle’s system). For each method, 20 registrations of the centric jaw relation were carried out by one operator. The breaks between definitions were 30 minutes. A total of 400 CR recording operations were carried out (400 records of CR). In order to study the reproducibility of CR determination methods, 200 recorded mandible positions were analyzed by means of an analog-to-digital method (a macro kit Canon 650D, Canon 60 mm macro IS USM f2.8, Canon macro ring MR-14 EX and the computer program Adobe Photoshop) to assess the first occlusal contact obtained in the CR of jaws, while the other 200 were analyzed by means of a digital method (the computer program Avantis for 3D modeling, Prime as a laboratory 3D scanner (DOF), and Trios as an intraoral scanner (3Shape)) to assess the spatial position of the mandible in the CR. Statistical analysis was carried out using STATISTICA-10. In all statistical analysis procedures, the critical significance level p was assumed to be 0.05. Results: In the study of the data by means of the computer program Avanti 3D, the reproducibility of the mandible position in the CR reached 0.119 ± 0.012 mm for frontal deprogrammer, 0.225 ± 0.028, p ≤ 0.05 for bilateral manipulation by Dawson P.E., 0.207 ± 0.02, p ≤ 0.05 for leaf gauge, and 0.120 ± 0,013, p ≤ 0.05 using an intraoral device for recording the Gothic arch angle. The analog-to-digital method showed an identical tendency for reproduction of the mandible position. Conclusions: The digital analysis we made using the Avantis 3D program showed, with high confidence, that the maximum reproducibility of the CR position was reached by using our own design frontal deprogrammer and the device for recording Gothic arch angle. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessArticle
An Experimental Strategy for Capturing the Margins of Prepared Single Teeth with an Intraoral Scanner: A Prospective Clinical Study on 30 Patients
Int. J. Environ. Res. Public Health 2020, 17(2), 392; https://doi.org/10.3390/ijerph17020392 - 07 Jan 2020
Cited by 1
Abstract
Purpose: To present an experimental strategy for successfully capturing the margins of prepared single teeth with an intraoral scanner (IOS). Methods: The protocol was as follows: (1) an intraoral impression was captured with an IOS, without taking care of the visibility [...] Read more.
Purpose: To present an experimental strategy for successfully capturing the margins of prepared single teeth with an intraoral scanner (IOS). Methods: The protocol was as follows: (1) an intraoral impression was captured with an IOS, without taking care of the visibility of the margins; (2) a partial analog impression was taken by means of a 3D-printed custom tray filled with polyvinylsiloxane light, after the removal of a retraction cord; (3) the hollow portion of the analog impression, with the preparation margins clearly visible, was scanned extraorally with the same IOS; (4) the scan of the analog impression was imported into computer-assisted-design (CAD) software, where its normals were inverted; (5) the scan with inverted normals was registered on the first intraoral scan, and replaced it; (6) the technician designed the final restoration, which was fabricated and delivered for application. The study outcomes were: (1) the marginal adaptation of the final crown; (2) the quality of interproximal contacts; and (3) the quality of occlusal contacts. Results: Thirty patients (18 males, 12 females; mean age 51.3 ± 11.6 years) were selected for this study. All these patients were restored with a monolithic translucent zirconia crown, fabricated following the aforementioned protocol. The clinical precision and the marginal adaptation of the crowns were optimal, interproximal contact points were perfect, and the only necessary adaptations were occlusal, with some minor precontacts that had to be polished. Conclusions: The present protocol seems to be compatible with the fabrication of clinically precise zirconia crowns. Further studies are needed to confirm these results. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessEditor’s ChoiceArticle
Reliability of a Virtual Prosthodontic Project Realized through a 2D and 3D Photographic Acquisition: An Experimental Study on the Accuracy of Different Digital Systems
Int. J. Environ. Res. Public Health 2019, 16(24), 5139; https://doi.org/10.3390/ijerph16245139 - 16 Dec 2019
Cited by 7
Abstract
Aims: The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors [...] Read more.
Aims: The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors want to verify the reliability of different models obtained with different techniques and machines. Methods: 12 patients that needed aesthetic restorative treatment were enrolled in the study. All the patients underwent recording data of the height and width dental elements 1.1, 1.2, and 1.3 size using different technologies and comparing 2D with 3D methods. A T test was then applied in order to verify whether there was a statistically significant difference between the measurements obtained, comparing the different tools data (Emerald, TRIOS, Photogrammetry and DSS (Digital Smile System)) with the reference values. Results: No significant differences emerged in the measurements made with the different scanners (Trios 3Shape ®, Planmeca Emerald ®) and photogrammetry. Therefore, what should be underlined regarding the 2D measurements is the speed and simplicity compared to all 3D techniques, so this work can help to better define the field of application and the limits connected to 2D techniques, giving a good window of the technique. Conclusions: The low number of patients is not sufficient to provide statistically significant results, but the digital planning future prospects seem to be promising. This study results highlighted how a photogrammetric scanner for dental arches would only have a much smaller shooting field size and greater accuracy. Despite these considerations, the photogrammetric facial scanner provided excellent results for the measurement of individual teeth, showing a great versatility of use. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessCase Report
Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report
Int. J. Environ. Res. Public Health 2020, 17(8), 2693; https://doi.org/10.3390/ijerph17082693 - 14 Apr 2020
Abstract
Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top [...] Read more.
Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessProtocol
An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 2: The Restoration of Molar Incisor Hypomineralization in Children
Int. J. Environ. Res. Public Health 2020, 17(5), 1499; https://doi.org/10.3390/ijerph17051499 - 26 Feb 2020
Cited by 1
Abstract
Until recently, the treatment for molar incisor hypomineralization (MIH) mainly included interim restorations such as resin restorations and stainless-steel crowns. These require replacement after adolescence. The use of intraoral scanners (IOS) has opened a new venue for restoring MIH teeth, by reducing the [...] Read more.
Until recently, the treatment for molar incisor hypomineralization (MIH) mainly included interim restorations such as resin restorations and stainless-steel crowns. These require replacement after adolescence. The use of intraoral scanners (IOS) has opened a new venue for restoring MIH teeth, by reducing the challenge of dealing with uncooperative children’s behavior and enabling tooth structure preservation and long-lasting restoration. We present an innovative treatment approach for children with MIH, using a digital workflow with IOS and CAD-CAM (computer-aided design and computer-aided manufacturing) fabrication of the restoration. The overall protocol involves a thorough diagnostic phase throughout treatment planning, which takes into consideration the child’s behavior and the parent’s cooperation and compliance. Initial preparation consists of inhalation sedation if needed, an effective local anesthesia, and the use of a rubber dam. Removal of all areas of enamel and dentin porosity is essential, and the tooth/teeth must be appropriately prepared to accommodate inlays or onlays for molars and labial veneers for incisors. IOS impressions are taken, including scanning of the prepared tooth and its antagonist, scanning of the bite, and CAD-CAM preparation of the restoration. Next is restoration, cementation, and follow up. Digital workflow provides definitive restorations in young patients due to the high accuracy of the scanning. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessProtocol
An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 1: The Restoration of Endodontically Treated Molars in Children
Int. J. Environ. Res. Public Health 2020, 17(4), 1364; https://doi.org/10.3390/ijerph17041364 - 20 Feb 2020
Cited by 1
Abstract
Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) [...] Read more.
Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1–2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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Open AccessCase Report
Full Digital Workflow for the Treatment of an Edentulous Patient with Guided Surgery, Immediate Loading and 3D-Printed Hybrid Prosthesis: The BARI Technique 2.0. A Case Report
Int. J. Environ. Res. Public Health 2019, 16(24), 5160; https://doi.org/10.3390/ijerph16245160 - 17 Dec 2019
Abstract
Purpose: To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an implant-supported 3D-printed hybrid prosthesis (an acrylic resin complete fixed dental prosthesis supported by implants). Methods: In edentulous cases, [...] Read more.
Purpose: To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an implant-supported 3D-printed hybrid prosthesis (an acrylic resin complete fixed dental prosthesis supported by implants). Methods: In edentulous cases, the physiological mandibular position should be determined before the immediate loading procedures. In some cases, the use of interim removable prostheses for a few weeks could be useful to test the new occlusion in centric relation and to verify the prosthetic project. When the correct intermaxillary relationships are achieved, it is difficult to transfer them from the provisional to the final prostheses, as impressions or scans of edentulous arches do not have reference points for intermaxillary records. This paper presents a complex case and the technique used to transfer information from a complete denture to an implant-supported prosthesis with a digital workflow. A prosthetic stent has been used to scan the edentulous mandibular arch and to record the intermaxillary relation. Results: The delivery of the hybrid implant-supported prostheses was carried out with no problems and minimal occlusal adjustments. The patient was extremely satisfied with the treatment and the situation remained stable at the 1-year follow up. Conclusions: The approach described in the present article predictably maintains prosthetic information and allows the delivery of a final implant-supported restoration with the same occlusal relationship as the one tested with the provisional diagnostic dentures. Full article
(This article belongs to the Special Issue Digital Dentistry for Oral Health)
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