O emprego da moldagem digital na prática odontológica - relato de caso / The use of digital molding in dental practice ­ case report

O avanço da tecnologia de digitalização de imagens e desenvolvimento de dispositivos de fresagem possibilitaram a otimização de diversos processos na Odontologia. O emprego do escaneamento intraoral e do sistema CAD-CAM (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) aprimorou a realização de reabilitações protéticas, permitindo a obtenção de peças de alta qualidade em tempo reduzido. O objetivo deste trabalho é relatar um caso de reabilitação de um incisivo central inferior a partir de escaneamento intraoral, com scanner Omnicam (DentsplySirona Charlotte, NC, EUA) e aplicação do sistema CAD-CAM.

The advancement of image digitization technology and the development of milling devices have made it possible to optimize various processes in Dentistry. The use of intraoral scanning and the CAD-CAM system (CAD - Computer Aided Design; CAM - Computer Aided Manufacturing) has improved the performance of prosthetic rehabilitations, allowing the obtaining of high quality parts in a reduced time. The objective of this work is to report a case of rehabilitation of a lower central incisor using intraoral scanning, with an Omnicam scanner (Dentsply Sirona) and application of the CAD-CAM system.

Current trends in digital shade matching - A scoping review.

Shade selection plays an important role in the success of any prosthesis and is largely influenced by technological advancements and societal trends, which emphasize the need for accurate shade selection. This scoping review aims to assess the accuracy of shade matching with any of the digital shade selection methods compared to the conventional method. This review employs PRISMA extension protocols for scoping review and search strategies based on keywords performed in PubMed, Scopus, and Cochrane databases. Two investigators (V.N. and S.B.V.) independently performed screening of the literature electronically in three databases. In vivo and in vitro studies which used digital shade selection methods were included in the study. A total of 29 articles which had used any method of digital shade selection were assessed. This scoping review concluded that the reliability and accuracy of various digital methods were comparable to that of conventional methods. Further research is suggested for the development of standalone, reliable and accurate methods for the use of digital shade analysis.

Developing an AI-based application for caries index detection on intraoral photographs.

This study evaluates the effectiveness of an Artificial Intelligence (AI)-based smartphone application designed for decay detection on intraoral photographs, comparing its performance to that of junior dentists. Conducted at The Aga Khan University Hospital, Karachi, Pakistan, this study utilized a dataset comprising 7,465 intraoral images, including both primary and secondary dentitions. These images were meticulously annotated by two experienced dentists and further verified by senior dentists. A YOLOv5s model was trained on this dataset and integrated into a smartphone application, while a Detection Transformer was also fine-tuned for comparative purposes. Explainable AI techniques were employed to assess the AI's decision-making processes. A sample of 70 photographs was used to directly compare the application's performance with that of junior dentists. Results showed that the YOLOv5s-based smartphone application achieved a precision of 90.7%, sensitivity of 85.6%, and an F1 score of 88.0% in detecting dental decay. In contrast, junior dentists achieved 83.3% precision, 64.1% sensitivity, and an F1 score of 72.4%. The study concludes that the YOLOv5s algorithm effectively detects dental decay on intraoral photographs and performs comparably to junior dentists. This application holds potential for aiding in the evaluation of the caries index within populations, thus contributing to efforts aimed at reducing the disease burden at the community level.

A Review of Contemporary Image Guidance Techniques in Head and Neck Cancer.

BACKGROUND: Traditional head and neck cancer treatment involves open surgery, cytotoxic chemotherapy, and conventional radiotherapy planning. Emerging techniques aim to improve precision and reduce associated toxicity and functional impairment in current practice. This review article describes four such adaptations in image guidance, tailored to next generation therapies. METHODS: This is a review of current literature, including feasibility studies from our cancer center, relating to: saline-aided intra-oral ultrasound-guided retropharyngeal biopsy; intra-oral ultrasound guided trans-oral robotic surgery (TORS); ultrasound-guided injection of "directly injected therapies"; and magnetic resonance imaging-guided radiotherapy. RESULTS: Presented within the context of the wider literature, initial local experience and data indicate good technical outcomes and patient tolerance, and low technical complications in all four image guidance techniques. CONCLUSION: Initial findings suggest a potentially important future role for these four image guidance techniques, on which next generation therapies are reliant. The broader implications on cross-disciplinary collaboration are also explored herein.

Comparison of intraoral and extraoral scanners for volumetric assessment before and after caries removal by the ICDAS score: a quantitative analysis.

OBJECTIVE: Aimed to compare the volumetric calculations (VC) of intra-and-extraoral scanners on carious teeth before/after caries removal. MATERIALS AND METHODS: 120 extracted human molars with ICDAS scores of 3, 4, and 5 were included. The teeth were scanned using an extraoral scanner (Ineos-X5, Dentsply Sirona) and three intraoral scanners (IOS) (iTero Element-5D, Align Technology; Primescan, Dentsply Sirona; Trios 4, 3Shape) before-and-after caries removal (CR). Eight Standard Tessellation Language (STL) data of each tooth sample were overlapped in Meshmixer (Autodesk) software for VC. Shapiro-Wilk, Paired Two-Sample T-test, repeated analysis of variance test statistics, and intraclass correlation coefficient (ICC) were used (p < 0.05). RESULTS: In initial VC, a significant difference observed between Ineos-X5 and iTero Element-5D (p < 0.001) and Ineos-X5 and Primescan (p < 0.001), regardless of the ICDAS score. No significant difference observed after CR between Ineos-X5 and iTero Element-5D (p = 0.917), Ineos-X5 and Primescan (p = 0.936), and Ineos-X5 and Trios 4 (p = 0.727) respectively. There was also no difference between the three IOS after CR (p ≥ 0.05), whereas the iTero Element-5D scanner significantly calculated less volume than Primescan and Trios-4 initially (p = 0.003). Maximum ICC was observed between the Ineos-X5 and Primescan in the ICDAS 5 score, before CR (ICC = 1, p < 0.001) and triple comparisons of iTero Element-5D, Primescan, and Trios-4 (ICC = 1, p < 0.001). CONCLUSION: Carious and irregular surfaces might affect the data collection of IOS. CLINICAL RELEVANCE: Intra-and-extraoral data may present negligible differences in the volumetric calculation, depending on the caries status and anatomical properties. These differences and factors may be important for future artificial intelligence networks that simulate the aftermath of caries removal. The IOSs tested in the current study can successfully collect data from irregular, deep and shallow cavities after caries removal.

Chemical analysis and performance evaluation of ClearCorrect® aligners as received and after intraoral use: Implications for durability, aesthetics, and patient safety.

BACKGROUND: Orthodontic treatment with transparent aligners is popular with patients. Any alteration of the plastic material, as subjected to the oral environment, could influence the treatment's durability, the aligner's aesthetic appearance, and the patient's safety. PURPOSE: This study concerns the physicochemical properties of ClearCorrect® aligners before and after intraoral use, focusing on transparency, surface topography, leachable, polymer glass transition temperature, and viscoelastic properties. METHODS: Aligners were collected after two weeks of intraoral use. Unused samples were obtained from the manufacturers. Transparency was measured by UV-visible spectroscopy. Chemical modifications were studied using infrared and Raman spectroscopies. Thermal degradation, glass transition (Tg), and storage modulus (E') were characterized by thermal analysis (DSC, TGA, DMA). Surface morphology and roughness were studied thanks to SEM and AFM. Aligners were immersed in water-based solutions to identify and quantify organic leachable by HPLC chromatography and trace elements by atomic absorption spectroscopy. RESULTS: ClearCorrect® aligners have a three-layer structure (outer PETG/inner PU layers). Slight chemical alterations occurred after aging. There was also no significant evolution in Tg and thermal degradation temperatures and only a minimal evolution of E'. Surface and transparency alterations occurred. A difference in organic compound and trace element release levels between new and used aligners was evidenced, suggesting an intraoral release during use. SIGNIFICANCE: Intra-oral aging mainly impacts the aligner transparency and surface. The leachable study suggests significant ingestion of organic and non-organic compounds by the patient: investigations are needed to assess the impact of the long-term use of trays on patient health.

Evaluation of the accuracy of digital impressions with different scanning strategies: An in vitro study.

OBJECTIVES: To evaluate the effects of three different scanning strategies on the trueness and precision of optical impressions obtained with four intraoral scanners (IOSs). METHODS: The reference maxillary dental arch model was fabricated using Telio CAD, and the relative reference digital reference cast was obtained using a computer numerical control machine and an optical scanner (E4, 3Shape, Copenhagen, Denmark). Test scans were performed with four different IOSs (TRIOS3, MEDIT i700, CS 3600, and iTero Element 5D) by an experienced operator and three different scanning strategies (S1: manufacturer-recommended, S2: optimal per previous literature, and S3: experimental). The scan duration was recorded for each scan. All scans were converted to standard tessellation language format and imported into Geomagic Control X. The accuracy was measured by absolute deviation/distance between aligned surfaces. for comparison with the reference cast using Initial Alignment and Best Fit Alignment functions. Data of trueness and precision of each IOS and scan duration were statistically compared using analysis of variance for repeated measures and Bonferroni post-hoc test (p<.05). RESULTS: Scans obtained with MEDIT i700 and CS 3600 showed higher trueness with S3 (p<.05). Scans obtained with TRIOS 3, MEDIT i700, and CS 3600 were more precise with S3, whereas those with iTero Element 5D were more precise with S2 (p<.05). Statistically significant differences were found in scan duration between different scan strategies for all IOSs. RESULTS: No significant differences in trueness were found among strategies (S1: 9.98 µm, S2: 11.93 µm, S3: 8.84 µm; p=0.388) in Trios 3 and iTero Element 5D (S1: 12.24µm, S2: 11.53µm, S3: 10.71µm; p= p=0.279). Scanning strategy S3 with MEDIT i700 achieved greater trueness (7.33 µm) than S2 (16.33 µm, p<.05), while no significant difference was noted between S1 (10.44 µm) and S3 (p=0.291). S3 showed the highest trueness (16.28 µm) compared to S2 (24.05 µm) and S1 (24.78 µm, p<.001) for CS 3600, with no difference between S1 and S2 (p=0.457). Trios 3 had higher precision with S2 (22.46 µm) than S3 (31.69 µm, p<.05), and no significant differences between S1 (25.67 µm) and S2/S3 (p>.05). MEDIT i700 with S3 (29.52 µm) was more precise than both S1 (39.52 µm) and S2 (46.24 µm) (p<.001) with no difference between the last two (p=0.302). S2 yielded the highest precision (44.93 µm) compared to S3 (61.81 µm) and S1 (76.53 µm) (p<.001) for CS 3600, with S3 more precise than S1 (p<.001). Similarly, iTero Element 5D showed S2 as the most precise (30.19 µm) compared to S3 (42.80 µm) and S1 (44.45 µm) (p<.05), with no difference between S1 and S3 (p=0.472). Scan durations were shorter for S3 and S1 compared to S2 in Trios 3 (p<.001), and S3 was faster than S1 and S2 for MEDIT i700 (p<.001). CS 3600 scans with S1 were quicker than S2 and S3 (p<.001). For iTero Element 5D, no significant differences were found between S1 and S3 (p=0.511), but S2 was slower than both (p<.001). CONCLUSIONS: Scanning strategies significantly affect the accuracy and scan duration of optical impressions. Overall, scans obtained with S3 showed the best combination of trueness, precision, and scan duration with MEDIT i700. Specifically, S3 provided the best trueness with both the MEDIT i700 and the CS 3600 while the S2 strategy demonstrated the highest precision for most scanners. Overall, the S1 and S3 strategies resulted faster than S2 among the devices evaluated. CLINICAL SIGNIFICANCE: The study's results suggest that the experimental scan strategy may optimize the use of intraoral scanners in clinical practice, potentially leading to more accurate and time-efficient dental impressions.

Assessing the Impact of IOS Scanning Accuracy on Additively Manufactured Occlusal Splints.

Introduction: Digital workflow and intraoral scanners (IOSs) are used to clinically obtain data for a wide range of applications in restorative dentistry. The study aimed to compare two different IOSs with inexperienced users in the digital workflow of oral split manufacturing. Material and Methods: Anonymous stone models of upper and lower dentate patients were used. Both models were scanned with a desktop 3D scanner 3Shape D2000 to obtain the reference models (STLR). Ten inexperienced operators scanned each model three times with each IOS system (3Shape TRIOS 3 and Carestream CS 3800). Finally, 20 intraoral scanners were randomly chosen from the obtained dataset (10 per IOS system) to design and manufacture 20 nightguards. All the nightguards were scanned. Trueness and precision were calculated and compared between the two IOS systems. Results: All the mean errors both for trueness and precision were below 40 µm, more than acceptable for the design and manufacturing of intraoral devices such as nightguards. All the mean errors (except one) for trueness between the inner part of the nightguards and the upper control model were below 100 µm, less than a printed layer height. For inexperienced operators, both IOSs are suitable for a digital workflow of manufacturing occlusal splints.

An Evaluation of the Accuracy of Digital Models-An In Vitro Study.

BACKGROUND: Intraoral scanning technology has opened new perspectives in dental practice, and combined with CAD/CAM technology, contributes significantly to fabricating high-quality prosthetic restorations. Our in vitro study aims to assess the accuracy of digital models obtained from one laboratory and two less commonly used intraoral scanners by conducting 3D measurements on the digital models obtained. METHODS: An articulated simulator cast was used. Forty-eight scans were performed before and after tooth preparation with each scanner. The Zeiss Inspect software (Version: 2023.3.0.969) was used for measurements in sagittal and transversal planes. The obtained values were compared to reference values resulting from manual measurements. RESULTS: Digital impressions provided discrepancies compared to the reference model. The lowest differences at the A2-L2 (the diagonal dimension of the models from the distal fossa of the second right maxillary molar and the maximum oral convexity of the artificial gingiva at the first left premolar) and the A1-B1 (transversal dimension of the model in the posterior area, from the right second molar's occlusal central fossa to the left second molar central fossa) distances were obtained for the upper models, and at the a1-b1 distance for all the lower models, except the non-prepared models scanned with the intraoral scanners (the discrepancies were not statistically significant). The discrepancies increased with the distance from the starting point of the scan. CONCLUSION: The number and position of prepared teeth can influence the accuracy of the scans. Distortions can appear in the case of multiple preparations. The scanning protocol and calibration must be optimized for the highest accuracy. Furthermore, in vivo studies are necessary to evaluate the clinical applicability of these findings.

Complete Digital Workflow for Manufacturing Presurgical Orthodontic Palatal Plates in Newborns and Infants with Cleft Lip and/or Palate.

Deciding on the implementation or modification of steps in daily clinical care is a nuanced process that demands careful evaluation. This is crucial not only for selecting the most appropriate solution but also for achieving the best treatment outcome. Thus, implementing a workflow for treating cleft lip and/or palate patients with a presurgical orthodontic cleft-covering plate needs to consider objective factors, prioritized from most to least important: safety and quality level, user-friendliness, feasibility, and, finally, efficiency and cost. The goal of this workflow is to integrate CAD/CAM technologies into daily clinical routine to enhance technical and clinical efficiency, reduce the burden of cleft care, and simplify the implementation of these technologies in other facilities. To achieve this, a methodology based on intraoral scanning and additive manufacturing is employed to produce patient-specific passive palatal plates. The approach describes possible pitfalls and their resolution within the routine of a cleft centre, along with an exemplary case scenario. Comparative analysis between the digital workflow and the conventional process demonstrated the digital approach to be safer, higher in quality, more user-friendly, feasible, and cost- and time-effective than the conventional process.

The Mechanical Properties of Orthodontic Aligners of Clear Aligner After Intraoral Use in Different Time Periods.

OBJECTIVE: Although the technique of orthodontic aligners has risen in popularity, their mechanical properties have not been thoroughly investigated. The aim of this study was to evaluate the mechanical properties of the orthodontic aligners Clear Aligner after intraoral use for 7, 10 and 14 days, and to compare them with as-received aligners (0 days). It was also sought to examine the properties of the unprocessed raw material (polyethylene glycol terephthalate) used to manufacture these aligners. MATERIALS/METHODS: Thirty-two aligners by four patients were evaluated and studied at 0, 7, 10, 14 days of use. Each aligner was divided into three segments (two posterior and one anterior), which resulted in 96 samples. Also, 16 samples of unprocessed material were studied. For all samples, elastic modulus, ultimate tensile stress (UTS) and yield stress were calculated by conducting tensile testing. Additionally, material hardness was tested. The two-tailed Mann-Whitney test was performed, having set the level of significance at p = 0.05. RESULTS: Analysis of the measurements indicated a statistically significant decrease in elastic modulus between days 0 and 14 of use, of UTS between days 0 and 7, 7 and 10, and of yield stress between days 0 and 7. For hardness, in every period, posterior segments demonstrated significantly higher values than anterior segments. All properties of the unprocessed material were statistically significantly higher than the processed samples. CONCLUSIONS: The unprocessed material presented significant differences in every property tested in comparison to the processed aligners. The processed material showed further deterioration over time during use. The present study provides evidence that thermoforming and ageing affect the mechanical properties of the aligners.

The Effect of Image Count on Accuracy in Digital Measurements in Dentistry.

Objective: This study investigated how the number of images collected for digital measurements in dentistry affects accuracy compared with traditional methods. Methods: A Frasaco maxillary model was scanned using a SHINING 3D AutoScan-DS-MIX dental 3D scanner to create an STL file. The maxilla was molded 10 times using polyvinyl siloxane (Zhermack Elite HD+) to produce plaster models, which were scanned with the same reference scanner to generate 10 STL files. The Frasaco model was scanned 10 times, capturing images in intervals of 800-1000, 1000-1200, and 1200-1500 using a 3Shape TRIOS 3 intraoral scanner, creating additional STL files. These were analyzed with reverse engineering software. Results: The most accurate measurements were obtained using 1200-1500 images. Conventional impression techniques performed significantly worse. There was a significant difference between the groups Digital 1200-1500 and Plaster (p < 0.001) and between Digital 800-1000 and Plaster (p = 0.007). No significant difference was found when the digital groups were compared among themselves. There was also no significant difference between the Plaster and Digital 1000-1200 groups. To compare precision values that were normally distributed across three or more methods, a one-way ANOVA was used. Trueness values that were not normally distributed with three or more methods were compared employing the Kruskal-Wallis test. Conclusions: Different image counts affect digital measurement accuracy. The most accurate measurements were obtained when collecting 1200-1500 images. Conventional impression techniques were shown to perform significantly worse than digital impression.

Manual Hair Removal for Intraoral Flaps: a Simple Practice for Professional Education and Patient Cancer Care.

After resection of malignant tumors of the head and neck, reconstructions are commonly performed using surgical free flaps. In non-irradiated patients, hair may continue to grow at the reconstruction site after surgery, causing undesirable effects such as difficult to maintain oral hygiene, food and saliva accumulation, halitosis, dysphagia, moral distress, and impact on intimacy and sexuality. Until a standardized laser therapy protocol is available, manual depilation is an option that should not be underestimated to improve the patient's quality of life and available to every oral healthcare team. This case illustrates a simple practice that contributes to improving patients' quality of life and oral health in an interprofessional way.

A feasibility study on the use of an intraoral optical coherence tomography system for scanning the subgingival finish line for the fabrication of zirconia crowns: An evaluation of the marginal and internal fit.

OBJECTIVES: This study aimed to evaluate the marginal and internal fit of zirconia crowns were fabricated using scan data from an intraoral optical coherence tomography (OCT) scanner and an intraoral scanner (IOS) for scanning the subgingival finish line. METHODS: An extracted maxillary left central incisor was prepared for a zirconia crown. The prepared tooth was placed in artificial gingiva, created using silicone with a refractive index similar to that of the tooth, ensuring a subgingival depth of 0.50 to 0.70 mm from the labial finish line. Scanning data were obtained from four types of models as follows. (1) CAD reference model (CRM) excluding the gingiva and scanned using a laboratory scanner. (2) IOS group excluding the gingiva (IOS only, IOSO group). (3) IOS group with scanned attached artificial (IOS with gingiva, IOSG group). (4) OCT post-processed data of the subgingival finish line and IOSG data (OCT group). Zirconia crowns were fabricated based on these data, and their marginal and internal fit were evaluated using the silicone replica technique. Statistical analyses were conducted using one-way and two-way ANOVA (α = 0.05). RESULTS: The OCT group exhibited a significantly smaller marginal gap than the IOSG group (P < 0.05). The marginal fit of the OCT group did not significantly differ from that of the CRM group (P > 0.05). The IOSG group exhibited a significantly larger chamfer gap, while both the IOSG and OCT groups had significantly larger axial gaps. Furthermore, the OCT group showed a significantly larger incisal gap (P < 0.05). CONCLUSIONS: An intraoral OCT system can enhance the fabrication accuracy of zirconia crowns by achieving superior marginal fit for crowns with subgingival finish lines. CLINICAL SIGNIFICANCE: The use of an IOS for subgingival finish lines without gingival displacement cords may result in a suboptimal marginal fit. However, integrating OCT technology can effectively address this issue, leading to improved clinical outcomes.

Effect of scanning strategies on trueness and time efficiency of digital impression on paediatric models.

BACKGROUND: Various scanning methods aim to reduce intraoral scanner errors, yet no specific approach targets paediatric patients. AIM: Evaluate continuous (C) and noncontinuous (NC) scanning patterns' impact on the trueness and duration of paediatric digital impressions. DESIGN: A standard pedodontic typodont model was scanned with a Trios 4 Move+ IOS using four scanning strategies. C1 and C2 followed continuous scanning from the right molars, with different directions. NC1 scanned noncontinuously from the right molar, with breaks every four teeth. NC2 began at the right primary incisor, with breaks after every three teeth. Each scan, performed five times by one researcher, was timed. Industrial scanning provided reference data. Deviations were analyzed using the MIXED procedure. RESULTS: NC1 had higher deviations in the lower jaw, whereas C1 and NC1 showed higher deviations in the upper jaw (p < .001). C1 had significantly higher deviations in the upper jaw than the lower jaw (p = .041). NC2 had the longest scanning time in both upper and lower jaws (p = .002). CONCLUSION: Paediatric digital impressions benefit from starting at the anterior and incorporating breaks, although this increases scanning time.

Ultrasonography-Guided Dental Implant Surgery: A Feasibility Study.

OBJECTIVE: To evaluate the feasibility of ultrasound-image-based computer-assisted implant planning and placement. MATERIALS AND METHODS: Intraoral scans, cone-beam computerized tomography (CBCT), and ultrasound (US) scans with a custom positioning device were acquired in nine patients. Prosthetic-driven surgical guides were planned and fabricated based on ultrasound images and intraoral scans. Implants were then placed. Postoperative implant position was obtained intra-surgically by intraoral scan. Aside from the ultrasound-based plan, conventional implant planning was performed by the same operator on a pre-surgical CBCT for comparison. Linear deviations between ultrasound and CBCT-planned implant positions were measured and compared with the intra-surgical implant position, and the position deviations between two consecutive plannings were performed on the same CBCT by the same operator. The linear deviation between the 3D scan surface of the edentulous region and the ultrasonographic soft tissue profile segmentation was also assessed with reverse-engineering software. Means, standard deviations, and root mean square differences (RMSD) were calculated for every variable. RESULTS: All the ultrasound-planned implants were successfully placed, and no complications were recorded. The mean deviations in angles, shoulders, and apexes were 5.27 ± 1.75° (RMSD: 5.53°), 0.92 ± 0.26 mm (RMSD: 0.95 mm), and 1.41 ± 0.61 mm (RMSD: 1.53 mm), respectively, between the US and CBCT-planned implants; 2.63 ± 0.43° (RMSD: 2.66°), 1.16 ± 0.30 mm (RMSD: 1.19 mm), and 1.26 ± 0.27 mm (RMSD: 1.28 mm) between the planned implant and intra-surgically recorded positions; and 2.90 ± 1.36° (RMSD: 3.18°), 0.65 ± 0.27 mm (RMSD: 0.70 mm), and 0.99 ± 0.37 mm (RMSD: 1.05 mm) between two consecutive CBCTs planning performed by the same operator. The mean deviation between the 3D surfaces of model scans and ultrasound-derived soft tissue profile in the edentulous area was 0.19 ± 0.08 mm. CONCLUSIONS: Ultrasound-guided implant surgery represents a feasible non-ionizing alternative to conventional static guided implant surgical protocols for implant placement in sites with favorable characteristics.

Three-Dimensional Planimetry Assessment of Dental Plaque-Covered Area Reduction after Rinsing with 0.2% Sodium Hypochlorite Solution as Part of a Guided Biofilm Therapy® Protocol-Pilot Longitudinal Study.

Background/Objectives: Less often employed as a rinsing solution for controlling oral biofilms, NaOCL was used in oral rinses at various concentrations in steps 1 and 4 of periodontal therapy. The aim of this study was to quantitatively evaluate the biofilm-disruptive properties of a 0.2% NaOCl solution in standardized oral rinses using dedicated plaque-disclosing agents and 3D scanning methods in patients undergoing the regular Guided Biofilm Therapy® protocol. Methods: Eight patients with at least 20 teeth present evenly distributed between the two arches were included. After 24 h of refraining from oral hygiene, dental arches were stained with a disclosing agent, the subjects rinsed for 20 s, clinical photographs and 3D scans were performed, subjects rinsed again for 20 s, photographs and 3D scans were performed again, and then the GBT® protocol was resumed as usual. Data representing areas covered with dental plaque were acquired using the "Medit Scan for Clinics" software and then underwent a post-processing and rendering process. The outcome variable was the percent reduction in the plaque-covered areas. Results: For the upper jaw, the estimated mean percent reduction in the biofilm-covered area was 39.65%, while for the mandible, it was 38.26%. The analysis of individual photographs revealed changes in the plaque-covered areas and reductions in the color intensity of the residual plaque-covered areas under identical lighting conditions. Conclusions: When analyzed using 3D intraoral scanning, the 0.2% NaOCl rinsing solution seems to be a clinically efficient disruptor/dissolvent of the oral biofilm, both when integrated into modern protocols of periodontal therapy like GBT® and for home self-care.

Ageing-Related Macrophage Polarisation in the Trigeminal Ganglion Enhances Incisional Intraoral Pain.

OBJECTIVE: Although macrophage polarisation in the trigeminal ganglion (TG) is crucial in orofacial pain hypersensitivity, the effect of ageing-related changes and their involvement in intra-oral nociception remains unclear. We assessed the effect of ageing-related macrophage polarisation in TG on intra-oral mechanical pain hypersensitivity following palatal mucosal incision using senescence-accelerated mice (SAM)-prone8 (SAMP8) and SAM-resistant 1 (SAMR1). MATERIALS AND METHODS: Mechanical head-withdrawal reflex threshold (MHWRT) of the palatal mucosa was measured for 21 days after palatal mucosal incision. On days 3 and 14, the abundance of Iba-1-immunoreactive (IR) cells, CD11c-IR cells (pro-inflammatory macrophages (M1)), C-C motif chemokine ligand 2 (CCL2)-IR M1-macrophages, CD206-IR cells (anti-inflammatory macrophages (M2)) and transforming growth factor-ß (TGF-ß)-IR M2-macrophages in the TG was analysed. The effect of continuous intra-TG administration of CCL2-neutralising antibody or recombinant-CCL2 on MHWRT was examined. RESULTS: Incision-induced decrease in MHWRT was enhanced in SAMP8 compared with that in SAMR1. On days 3 and 14, the number of CCL2-IR M1-macrophages in TG was increased in SAMP8 compared with that in SAMR1. CCL2-neutralising antibody suppressed, whereas recombinant-CCL2 increased pain hypersensitivity in SAMP8. CONCLUSIONS: Mechanical pain hypersensitivity after oral mucosal injury is potentiated and sustained by age-related enhancement of CCL2 signalling via M1-macrophage hyperactivation in TG.

Oral screening of dental calculus, gingivitis and dental caries through segmentation on intraoral photographic images using deep learning.

OBJECTIVE: Intraoral photographic images are instrumental in the early screening and clinical diagnosis of oral diseases. In addition, people have been trying to apply artificial intelligence to these images. The purpose of this study is to investigate and evaluate a deep learning system designed to segment intraoral photographic images for the detection of dental caries, dental calculus, and gingivitis, and to assess the degree of dental calculus based on the overall features of the tooth surface and gingival margin. MATERIAL AND METHODS: This cross-sectional study collected 3,365 oral endoscopic images, randomly distributed in training datasets (2,019 images), validation dataset (673 images), and test dataset (673 images). The training set and verification set images are manually labeled. An oral endoscopic image segmentation method based on Mamba (Oral-Mamba) and an intelligent evaluation model of dental calculus degree were proposed, achieving the segmentation of two types of oral diseases, namely gingivitis and dental caries, as well as the segmentation of dental calculus regions, and the intelligent evaluation of the degree of dental calculus. RESULTS: Oral-Mamba demonstrated high accuracy in segmentation, with accuracy rates for gingivitis, dental caries, and dental calculus at 0.83, 0.83, and 0.81, respectively. In particular, these rates surpassed those of the U-Net model in IoU, accuracy, and recall metrics. Furthermore, Oral-Mamba runs 25% faster than U-Net.The accuracy of degree classification in the intelligent evaluation model of dental calculus degree is 85%. CONCLUSION: The proposed deep learning system is expected to be used for the detection of two types of oral diseases and dental calculus, and the degree judgment of photographic images from an intraoral camera. This system offers a practical method to assist in the oral screening of dental caries, dental calculus, and gingivitis, providing benefits such as intuitive use, time efficiency, cost-effectiveness, and ease of deployment.

Fabrication of three implant-supported crowns using a digital workflow: a case report.

Accurate working impression is an essential requirement for the fabrication of implant prosthesis, and digital impressions have recently become more popular. In this case report, a completely digital workflow is introduced for the fabrication of three single-unit screw-retained implant crowns on the posterior maxilla by a dental student, under supervision. This approach involved the use of an intraoral scanner to capture a digital impression of the three implants and their surrounding mucosa, the opposing arch, and occlusion. The use of intraoral scanners and digital impressions illustrated an efficient and patient-friendly method of capturing the necessary data to fabricate a well-fitted prothesis. The aim of this case report is to examine a fully digital approach in the production of multiple single-unit implant crowns.