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Clinical Advancements in Prosthodontics: Bridging the Gap between Function and Aesthetics

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: closed (30 April 2024) | Viewed by 15822

Special Issue Editors


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Guest Editor
Department of Dental Materials, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, 1081 LA Amsterdam, The Netherlands
Interests: dental implants; dental prosthodontics; finite element analysis; biomechanics; bond strength; fatigue; partial restorations; intraradicular retainer; prosthetic dentistry; fixed and removable prosthodontics; aesthetic dentistry; oral rehabilitation; digital dentistry; CAD/CAM technology; implant-supported dentures; full mouth rehabilitation; occlusion and bite analysis; dental materials for prosthodontics; denture design and fabrication; implant prosthodontics; prosthetic complications and management; maxillofacial prosthetics; prosthodontic treatment planning; prosthodontic maintenance and longevity; dental crowns and bridges; restorative dentistry
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Prosthodontics Unit, Department of Restorative Dentistry and Post-Graduate Program in Oral Sciences, Faculty of Odontology, Federal University of Santa Maria, 1000 Roraima Av., T Street, Building 26F, Santa Maria, Brazil
Interests: prosthodontics; fixed and removable prosthodontics; oral rehabilitation; restorative dentistry; prosthodontic treatment planning; prosthodontic maintenance and longevity; aesthetic dentistry; digital dentistry; CAD/CAM technology; implant-supported prosthetics; full mouth rehabilitation; dental implants; crowns and bridges; denture design and fabrication; prosthetic complications and management; occlusion and bite analysis; dental materials for prosthodontics; biomechanics; bond strength; fatigue
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue, titled "Advancements in Dental Prosthodontics: Bridging the Gap between Function and Aesthetics", delves into the latest breakthroughs and innovations in the field of prosthodontics. This collection of articles presents cutting-edge research and developments aimed at achieving the seamless integration of function and aesthetics in dental restorations.

This Special Issue covers a wide range of topics, including advancements in dental implant technology, both fixed and removable prosthodontics, and the application of digital dentistry and CAD/CAM technology in creating precise and natural-looking dental prostheses. It explores the challenges and solutions associated with achieving optimal oral rehabilitation for patients, taking into consideration factors such as occlusion and personalized analysis.

Moreover, this Special Issue investigates novel dental materials specifically designed for prosthodontic applications, discussing their mechanical reliability, longevity, and performance over time. It addresses the effect of degradation on the mechanical behavior of materials like Y-TZP ceramics, reinforced glass ceramics, and polymers and how grinding techniques may impact their performance.

One significant area explored in this Special Issue is the impact of 3D printing on dental prosthodontics. The use of 3D printing technology has revolutionized the field, allowing for precise and patient-specific dental restorations. This Special Issue features studies on the application of 3D printing in prosthodontic workflows, the development of biocompatible 3D printing materials, and the assessment of the mechanical properties of 3D-printed dental prostheses. Authors are invited to contribute WITH clinical and pre-clinical research, including articles, reviews, systematic reviews, brief reports, case reports, and communications that showcase their findings and insights on the various aspects of dental and medical prosthodontics.

Overall, this Special Issue brings together comprehensive research and insights from leading experts in the field of dental prosthodontics, offering valuable knowledge and advancements that will shape the future of functionally efficient and aesthetically pleasing dental restorations, ultimately improving the quality of life for dental patients worldwide.

Dr. João Paulo Mendes Tribst
Prof. Dr. Gabriel Kalil Rocha Pereira
Guest Editors

Manuscript Submission Information

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Keywords

  • dental ceramics
  • rapid stereolithographic ceramic manufacturing
  • CAD-CAM technologies
  • artificial intelligence digital workflow
  • digital articulator
  • personalized medicine
  • mechanical properties
  • biocompatibility

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Published Papers (9 papers)

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Editorial

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4 pages, 812 KiB  
Editorial
Advancements in Dental Care: The Evolving Landscape of Prosthetic Dentistry
by João Paulo Mendes Tribst, Gabriel Kalil Rocha Pereira and Cornelis Johannes Kleverlaan
J. Clin. Med. 2024, 13(5), 1225; https://doi.org/10.3390/jcm13051225 - 21 Feb 2024
Cited by 1 | Viewed by 3869
Abstract
In the dental field, the specialty of prosthodontics stands out as the frontline of innovation, continually pushing the boundaries to enhance both function and aesthetics for optimal oral rehabilitation [...] Full article
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Research

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15 pages, 3000 KiB  
Article
Fiber-Reinforced Composites for Full-Arch Implant-Supported Rehabilitations: An In Vitro Study
by Luisa De Giorgis, Paolo Pesce, Fabrizio Barberis, Alberto Lagazzo, Francesco Pera, Domenico Baldi, Luigi Canullo and Maria Menini
J. Clin. Med. 2024, 13(7), 2060; https://doi.org/10.3390/jcm13072060 - 2 Apr 2024
Viewed by 1088
Abstract
Background: Fiber-reinforced composites (FRCs) have been proposed as an alternative to traditional metal alloys for the realization of frameworks in full-arch implant-supported prostheses. The aim of the present in vitro study was to evaluate the deflection under load of seven prostheses endowed with [...] Read more.
Background: Fiber-reinforced composites (FRCs) have been proposed as an alternative to traditional metal alloys for the realization of frameworks in full-arch implant-supported prostheses. The aim of the present in vitro study was to evaluate the deflection under load of seven prostheses endowed with frameworks made of different materials, including different types of fiber-reinforced composites (FRCs). Methods: A master cast with four implant analogues in correspondence with the two lateral incisors and the two first molars was used to create full-arch fixed prostheses with the same shape and different materials. Prostheses were made of the following different materials (framework+veneering material): gold alloy+resin (Au+R), titanium+resin (Ti+R), FRC with multidirectional carbon fibers+resin (ICFRC+AR), FRC with unidirectional carbon fibers+composite (UCFRC+C), FRC with glass fibers+resin (GFRC+AR), FRC with glass fibers+composite (GFRC+C), and resin (R, fully acrylic prosthesis). Flexural tests were conducted using a Zwick/Roell Z 0.5 machine, and the deflection of the lower surface of the prosthesis was measured in order to obtain load/deflection graphs. Results: Greater rigidity and less deflection were recorded for UCFRC+C and GFRC+C, followed by Ti+R and Au+R. The greatest deformations were observed for resin alone, ICFRC+R, and GFRC+R. The results were slightly different in the incisal region, probably due to the greater amount of veneering material in this area. Conclusions: When used to realize full-arch frameworks, Au and Ti allow for predictable mechanical behavior with gradual deformations with increasing load. UCFRC also demonstrated good outcomes and less deflection than ICFRCs when loaded. The GFRC full-arch framework may be a valid alternative, although it showed greater deflections. Further studies are needed in order to evaluate how different prosthesis designs and material thicknesses might affect the outcomes. Full article
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12 pages, 275 KiB  
Article
Quantification and Influence of IL-1β on Pain and Inflammatory Response after Placement of a Cement–Screw-Retained Restoration
by Lady Arbelaez-Bonozo, Serafín Maza-Solano, María Baus-Domínguez, Raquel Gómez-Díaz, Gonzalo Ruiz-de-Leon-Pacheco, Daniel Torres-Lagares and María-Angeles Serrera-Figallo
J. Clin. Med. 2024, 13(6), 1669; https://doi.org/10.3390/jcm13061669 - 14 Mar 2024
Viewed by 1079
Abstract
Background: The objective of this study was to evaluate the pain and inflammatory response in soft tissues using healing and prosthetic abutments of different diameters and lengths. Methods: The study population was rehabilitated with Astra Tech EV single implants (Dentsply Sirona, Atlantis, Dentsply [...] Read more.
Background: The objective of this study was to evaluate the pain and inflammatory response in soft tissues using healing and prosthetic abutments of different diameters and lengths. Methods: The study population was rehabilitated with Astra Tech EV single implants (Dentsply Sirona, Atlantis, Dentsply Sirona S.A., Barcelona, Spain) of 4.2 and 4.8 millimetres in diameter in the upper and lower maxilla and loaded with custom abutments digitally designed using Dentsply Sirona’s Virtual Atlantis Design software (Atlantis WebOrder, Dentsply Sirona S.A., Barcelona, Spain), version 4.6.5. The custom abutments had a larger diameter than the healing abutments to evaluate for biomarkers through ELISA. Results: Rehabilitations in the mandible and with healing abutments with diameters less than 4.29 mm and rehabilitators with diameters less than 2.18 mm elicited a higher pain and inflammatory response and, in turn, higher interleukin-1β values. Conclusions: Greater inflammation was evident in cases in which healing abutments with reduced diameter were used compared to the same subsequent rehabilitation with prosthetic abutments with larger diameters. Full article
12 pages, 2033 KiB  
Article
Influence of Narrow Titanium Dental Implant Diameter on Fatigue Behavior: A Comparison between Unitary and Splinted Implants
by Rodrigo González Terrats, María Bonnín Liñares, Miquel Punset, Meritxell Molmeneu, José Nart Molina, Vanessa Ruíz Magaz, Matteo Albertini, José María Manero and Javier Gil Mur
J. Clin. Med. 2024, 13(6), 1632; https://doi.org/10.3390/jcm13061632 - 13 Mar 2024
Cited by 1 | Viewed by 1257
Abstract
Background: Scientific literature lacks strong support for using narrow diameter implants (NDI) in high masticatory force areas, especially in molars. Implant splinting in cases of multiple missing teeth reduces lateral forces, improves force distribution, and minimizes stress on implants. However, no studies have [...] Read more.
Background: Scientific literature lacks strong support for using narrow diameter implants (NDI) in high masticatory force areas, especially in molars. Implant splinting in cases of multiple missing teeth reduces lateral forces, improves force distribution, and minimizes stress on implants. However, no studies have evaluated the fatigue load resistance of unitary or splinted implants. Methods: This in vitro study compares five groups of new metal alloy implants, including unitary and splinted implants with varying diameters. Mechanical characterization was assessed using a BIONIX 370 testing machine (MTS, Minneapolis, MN, USA) according to ISO 14801. For each of the five study sample groups, (n = 5) specimens underwent monotonic uniaxial compression at break testing and (n = 15) cyclic loading to determine the maximum force (Fmax) and the fatigue life (LF) values. Scanning electron microscopy (SEM) was employed for the fractographic analysis of the fractured samples. Results: The Fmax values for unitary samples ranged from 196 N to 246 N, whereas the two-splinted samples displayed significantly higher values, ranging from 2439 N to 3796 N. Similarly, the LF values for unitary samples ranged from 118 N to 230 N, while the two-splinted samples exhibited notably higher values, ranging from 488 N to 759 N. Conclusions: The observed resistance difference between sample groups in terms of Fmax and LF may be due to variations in effective cross-sectional area, determined by implant diameter and number. Additionally, this disparity may indicate a potential stiffening effect resulting from the splinting process. These findings have significant implications for dental clinical practice, suggesting the potential use of splinted sets of small-sized NDI as replacements for posterior dentition (premolars and molars) in cases of alveolar bone ridge deficiencies. Full article
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11 pages, 2906 KiB  
Article
Digital Protocol to Record Occlusal Analysis in Prosthodontics: A Pilot Study
by Emanuele Risciotti, Nino Squadrito, Daniele Montanari, Gaetano Iannello, Ugo Macca, Marco Tallarico, Gabriele Cervino and Luca Fiorillo
J. Clin. Med. 2024, 13(5), 1370; https://doi.org/10.3390/jcm13051370 - 28 Feb 2024
Cited by 2 | Viewed by 1993
Abstract
Background: Digital technologies enable the accurate replication of occlusion, which is pivotal for stability in maximum intercuspation and dynamic occlusion. CAD softwares generates standardized occlusal morphologies requiring significant adjustments. The consideration of individual mandibular movements during restoration leads to better functional integration. This [...] Read more.
Background: Digital technologies enable the accurate replication of occlusion, which is pivotal for stability in maximum intercuspation and dynamic occlusion. CAD softwares generates standardized occlusal morphologies requiring significant adjustments. The consideration of individual mandibular movements during restoration leads to better functional integration. This pilot study evaluates the efficacy of a novel, fully digital protocol for occlusal analysis recording in prosthodontics. Methods: Patients needing single or multiple metal-free restorations were included. Teeth underwent horizontal finish line preparation, while restorations on implants were either directly screwed or used multi-unit abutments. A digital impression (Trios 3 Intraoral Scanner) captured the mouth’s elements. Dynamic occlusion was recorded via Patient Specific Motion (PSM). After the placement and functionalization of temporary restorations, subsequent scans included various elements, and CAD software (Dental system) was used for the restoration design. Restorations were milled in monolithic zirconia, pressed from CAD/CAM-milled wax, and sintered. Results: An evaluation of 52 restorations in 37 patients indicated high accuracy in restorations manufactured via the fully digital workflow. Monolithic zirconia was predominantly used. Subtractive (17.3%) and additive (7.7%) occlusal adjustments were mainly chairside. Conclusion: This study underscores the efficacy of meticulous verification measures and a centric contact system in reducing the need for clinical occlusal refinements in prosthetic restorations. Full article
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12 pages, 882 KiB  
Article
Conometric Connection for Implant-Supported Crowns: A Prospective Clinical Cohort Study
by Saturnino Marco Lupi, Dario De Martis, Claudia Todaro, Gaetano Isola, Mario Beretta and Ruggero Rodriguez y Baena
J. Clin. Med. 2023, 12(24), 7647; https://doi.org/10.3390/jcm12247647 - 13 Dec 2023
Viewed by 1257
Abstract
Background: Traditional screw or cemented connections in dental implants present limitations, prompting the exploration of alternative methods. This study assesses the clinical outcomes of single crowns and fixed partial prostheses supported by conometric connections after one year of follow-up. Methods: Twenty-two patients received [...] Read more.
Background: Traditional screw or cemented connections in dental implants present limitations, prompting the exploration of alternative methods. This study assesses the clinical outcomes of single crowns and fixed partial prostheses supported by conometric connections after one year of follow-up. Methods: Twenty-two patients received 70 implants, supporting 33 rehabilitations. Biological responses and prosthodontic complications were evaluated at baseline, 6 months, and 12 months. Results: All implants exhibited successful osseointegration, with no losses or peri-implant inflammation. Marginal bone levels showed minimal changes, well below pathological thresholds. The difference in marginal bone loss (MBL) was −0.27 ± 0.79 mm between T0 and T1, and −0.51 ± 0.93 mm between T0 and T2. No abutment screw loosening or crown chipping occurred. However, coupling stability loss was observed in nine cases. Conclusions: The conometric connection demonstrated successful integration and minimal complications after one year. This alternative shows promise, particularly in simplifying handling and improving marginal adaptation. Further research with larger sample sizes and longer follow-up is warranted for comprehensive validation. Full article
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12 pages, 26349 KiB  
Article
Immediate Loading of Zygomatic Implants Using a Dual Scan Technique
by Mustafa Gseibat, Valerio Sorrentino, Pablo Sevilla, Jesús Peláez and Maria J. Suarez
J. Clin. Med. 2023, 12(23), 7464; https://doi.org/10.3390/jcm12237464 - 1 Dec 2023
Cited by 2 | Viewed by 1551
Abstract
The immediate loading protocol has become increasingly popular due to the progressive growth in demand for a reduction in treatment times. The possibility of applying this protocol would depend on certain important factors. The application of the digital workflow mentioned in the protocol [...] Read more.
The immediate loading protocol has become increasingly popular due to the progressive growth in demand for a reduction in treatment times. The possibility of applying this protocol would depend on certain important factors. The application of the digital workflow mentioned in the protocol guarantees rapidity, precision, and esthetics. This report aims to describe a fully digital workflow using a dual scan impression technique to fabricate immediate fixed complete dentures (FCDs) for zygomatic and standard implants. A 58-year-old female patient requested treatment for her severely atrophic maxilla, and four unrehabilitated implants in the mandible. After proper diagnosis and planification, four zygomatic implants and two standard implants were placed. During the surgery, transmucosal abutments were placed on all implants. After suturing, the positions of the implants were recorded using a stereophotogrammetric technique, creating a standard tessellation (STL) file. In the lower arch, the second phase of the surgery was carried out: the transmucosal abutments were placed, and then the implant positions were recorded in the same way. The soft tissues were rescanned after suturing with an intraoral scanner (IOS), and all STL files were aligned to obtain the virtual final models. The pre-design after virtual modifications was aligned with the definitive models. The provisional prostheses were milled and placed after six hours after the surgery, and the definitive prostheses were placed six months after the surgery. The dual scan technique used obtained a precise fit for both the provisional and definitive FCDs. This technique might be an effective and reliable alternative for the fabrication of immediate and definitive screw-retained FCDs in a completely digital workflow. The time taken for scanning and fabrication was reduced, and the clinician’s and patient’s satisfaction were improved. Full article
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Review

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15 pages, 901 KiB  
Review
The Potential of Nano-Based Photodynamic Treatment as a Therapy against Oral Leukoplakia: A Narrative Review
by Angela Angjelova, Elena Jovanova, Alessandro Polizzi, Simona Santonocito, Antonino Lo Giudice and Gaetano Isola
J. Clin. Med. 2023, 12(21), 6819; https://doi.org/10.3390/jcm12216819 - 28 Oct 2023
Cited by 5 | Viewed by 1969
Abstract
Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be classified as any other definable lesion with the risk of progressing into malignancy. Despite the advancements in conventional therapy, the rates of malignant transformation remain notably high, affecting 4.11% [...] Read more.
Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be classified as any other definable lesion with the risk of progressing into malignancy. Despite the advancements in conventional therapy, the rates of malignant transformation remain notably high, affecting 4.11% of adults, due to the difficulty of accurate diagnosis and indistinct treatment. Photodynamic therapy (PDT), being a minimally invasive surgical intervention, employs a variety of factors, including light, nano-photosensitizers (PSs) and oxygen in the management of precancerous lesions. PDT faces limitations in administering photosensitizers (PSs) because of their low water solubility. However, these challenges could be effectively resolved through the incorporation of PSs in nanostructured drug delivery systems, such as gold nanoparticles, micelles, liposomes, metal nanoparticles, dendrimers and quantum dots. This review will give an overview of the different innovative PS approaches in the management of premalignant lesions, highlighting the most recent advancements. From a clinical perspective, it is expected that nanotechnology will overcome barriers faced by traditional therapeutics and will address critical gaps in clinical cancer care. Full article
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Other

14 pages, 5805 KiB  
Technical Note
Soft Tissue Retraction Maneuver in Cone Beam Computed Tomography Prior to Crown-Lengthening Procedure—A Technical Note
by Paulina Adamska, Marcin Stasiak, Wojciech Dąbrowski, Dorota Pylińska-Dąbrowska, Łukasz Jan Adamski, Adam Zedler, Ewa Kozłowska and Michał Studniarek
J. Clin. Med. 2024, 13(13), 3668; https://doi.org/10.3390/jcm13133668 - 24 Jun 2024
Cited by 2 | Viewed by 870
Abstract
Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the [...] Read more.
Background: An accurate determination of the biological width and the relationship of the cemento-enamel junction with the border of the alveolar bone is crucial during a clinical crown-lengthening (CCL) procedure. The aim of this study was to present a technical note about the retraction techniques in cone beam computed tomography (CBCT) prior to CCL, highlighting the significant enhancement in procedural accuracy and predictability that these techniques offer. Methods: Clinical and radiological examinations should be performed before a CCL procedure. It is necessary to determine the length of the tooth crowns, the periodontal pockets’ depth, and the phenotype of the gingiva. The ideal CBCT examination should be performed with soft tissue retraction. This can be achieved using retractors or cotton rolls. Results: Retraction of the lips, cheeks, and tongue allows one to assess the marginal gingiva, the cemento-enamel junction, and the alveolar bone. A detailed plan of the CCL procedure, which involves retraction, ensures both the aesthetic appeal and the achievement of a newly defined gingival zenith, enhancing the overall visual harmony. Conclusions: Compared with conventional radiographic imaging, the soft tissue retraction maneuver in CBCT prior to CCL surgery offers an effective approach to the evaluation and diagnosis of soft and hard tissue. This is because of the detailed planning of the aesthetic CCL procedure. Such an approach leads to superior aesthetic outcomes in dentistry, contributing to the advancement of aesthetic dentistry through a harmonious blend of art and science. Full article
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