Dental implant planning using artificial intelligence: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Data on the role of artificial intelligence (AI) in dental implant planning is insufficient. PURPOSE: The purpose of this systematic review with meta-analysis was to analyze and evaluate articles that assess the effectiveness of AI algorithms in dental implant planning, specifically in detecting edentulous areas and evaluating bone dimensions. MATERIAL AND METHODS: A systematic review was conducted across the MEDLINE/PubMed, Web of Science, Cochrane, and Scopus databases. In addition, a manual search was performed. The inclusion criteria consisted of peer-reviewed studies that examined the accuracy of AI-based diagnostic tools on dental radiographs for dental implant planning. The most recent search was conducted in January 2024. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of the included articles. RESULTS: Twelve articles met the inclusion criteria for this review and focused on the application of AI in dental implant planning using cone beam computed tomography (CBCT) images. The pooled data indicated an overall accuracy of 96% (95% CI=94% to 98%) for the mandible and 83% (95% CI=82% to 84%) for the maxilla in identifying edentulous areas for implant planning. Eight studies had a low risk of bias, 2 studies had some concern of bias, and 2 studies had a high risk of bias. CONCLUSIONS: AI models have the potential to identify edentulous areas and provide measurements of bone as part of dental implant planning using CBCT images. However, additional well-conducted research is needed to enhance the accuracy, generalizability, and applicability of AI-based approaches.

3D Printing/Additive Manufacturing of Single- Implant Overdentures. A Randomized controlled clinical trial.

OBJECTIVES: Mandibular single-implant overdenture is a well-established treatment modality for the management of completely edentulous patients. The use of CAD/CAM printing technology to fabricate complete dentures and overdentures is burgeoning. The trial aimed to clinically evaluate 3D-printed single-implant overdentures and compare outcomes to those of overdentures manufactured using conventional techniques. MATERIALS AND METHODS: A randomized clinical trial (RCT) was designed. Twenty-eight participants were randomly allocated into two equal groups. Participants in the control group received conventionally manufactured single-implant overdentures, while participants in the printed group received digital light processing (DLP) printed single-implant overdentures. An evaluation was conducted to assess the rates of implant survival and success, as well as overdenture survival and success, along with the measurement of maximum biting force (MBF) over a one-year follow-up period. Data was collected and subjected to statistical analysis. Statistical significance was determined using a two-sided p-value with a threshold of less than 0.05. RESULTS: The printed denture group had higher implant survival (100%) and success rates (92.8%) compared to the conventional denture group (85.7% survival, 85.7% success). Overdenture survival and success rates were 100% in the printed group and 78.6% in the conventional group. Both groups showed a significant increase in maximum biting force (MBF) at 3, 6, and 12 months of follow-up (P<0.001). The printed group demonstrated a statistically significant improvement in MBF compared to the conventional group (P<0.001). CONCLUSIONS: 3D-printed mandibular single-implant overdentures may represent an alternative to conventionally fabricated ones.

Clinical assessment of maxillary screw-retained implant prosthesis fabricated from digital versus conventional full- arch implant impression. A randomized controlled clinical trial.

OBJECTIVES: To evaluate the peri-implant marginal bone loss (MBL) and prosthodontic complications of maxillary screw-retained implant prosthesis fabricated from digital versus conventional full- arch implant impression. MATERIAL AND METHODS: 28 participants with edentulous maxillary arches were randomly selected and enrolled in two equal groups; Group I conventional impression group (CIG) and Group II Digital impression group (DIG). All patients were rehabilitated with maxillary screwretained implant prosthesis retained by 6 implants. Peri-implant MBL and prosthodontic complications and were registered at 6, 12, and 24 months (m). Data was collected and statistically analyzed. RESULTS: Regarding the effect of time, there was a statistically significant increase in MBL at 6, 12 and 24 m follow-up periods (P<.001). As for the effect of groups, there was no statistically significant difference in MBL between CIG and DIG at 6, 12 and 24 m where P value was 0.083, 0.087 and 0.133 respectively. Prosthetic complications were recorded 19 times in the conventional group and 12 times in the digital group with no significant difference between both groups (P=.303). CONCLUSION: Digital full -arch implant impression is a reliable impression technique and may represent an alternative to conventional impression technique in the fabrication of maxillary screw-retained implant prosthesis.

Advancements in artificial intelligence algorithms for dental implant identification: A systematic review with meta-analysis.

STATEMENT OF PROBLEM: The evidence regarding the application of artificial intelligence (AI) in identifying dental implant systems is currently inconclusive. The available studies present varying results and methodologies, making it difficult to draw definitive conclusions. PURPOSE: The purpose of this systematic review with meta-analysis was to comprehensively analyze and evaluate articles that investigate the application of AI in identifying and classifying dental implant systems. MATERIAL AND METHODS: An electronic systematic review was conducted across 3 databases: MEDLINE/PubMed, Cochrane, and Scopus. Additionally, a manual search was performed. The inclusion criteria consisted of peer-reviewed studies investigating the accuracy of AI-based diagnostic tools on dental radiographs for identifying and classifying dental implant systems and comparing the results with those obtained by expert judges using manual techniques-the search strategy encompassed articles published until September 2023. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to assess the quality of included articles. RESULTS: Twenty-two eligible articles were included in this review. These articles described the use of AI in detecting dental implants through conventional radiographs. The pooled data showed that dental implant identification had an overall accuracy of 92.56% (range 90.49% to 94.63%). Eleven studies showed a low risk of bias, 6 demonstrated some concern risk, and 5 showed a high risk of bias. CONCLUSIONS: AI models using panoramic and periapical radiographs can accurately identify and categorize dental implant systems. However, additional well-conducted research is recommended to identify the most common implant systems.

Clinical influence of digital vs analog impressions in all-on-4 implant prostheses: a randomized controlled trial.

AIM: To compare the clinical outcomes of conventional and digital implant impressions in all-on-4 mandibular implant prostheses. MATERIALS AND METHODS: Fifty-six participants were randomly stratified into two control groups (Axial Conventional Impression Group [ACIG] and Tilted Conventional Impression Group [TCIG]), and two test groups (Axial Digital Impression Group [ADIG] and Tilted Digital Impression Group [TDIG]). Conventional pick-up and digital impressions were made for each group, respectively. Participants in ACIG and ADIG received four axial implants, and those in TCIG and TDIG received two anterior axial and two distal tilted implants. All participants received all-on-4 mandibular prostheses and maxillary complete dentures. Implant survival, prosthetic complications, and marginal bone loss were recorded at 6, 12, and 24 months. Data were statistically described in terms of mean ± standard deviation. RESULTS: After 24 months, the implant survival rate was 100%. A significant difference in bone loss was shown between ACIG and ADIG at 6, 12, and 24 months, with P = 0.647, 0.821, and 0.505, respectively. An insignificant difference in bone loss was shown between TCIG and TDIG at 6 ,12, and 24 months, with P = 0.671, 0.935, and 0.687, respectively. No significant difference was shown in prosthodontic complications between all groups throughout the follow-up period. CONCLUSIONS: The digital impressions showed clinically better implant survival, stable peri-implant marginal bone level, and reasonable prosthodontic complications. The present study represents a steppingstone and proof of concept that supports the routine clinical use of digital impressions, especially in a post-COVID-19 world.

Clinical evaluation of implant overdentures fabricated using 3D-printing technology versus conventional fabrication techniques: a randomized clinical trial.

AIM: To evaluate the oral health-related quality of life (OHRQoL) of patients rehabilitated with conventional or 3D-printed implant overdentures. MATERIALS AND METHODS: A randomized clinical trial (RCT) was designed. Twenty-eight completely edentulous participants were randomly allocated into two equal groups. All participants received two implants with ball attachments. Participants in the control group were rehabilitated with conventionally manufactured polymethyl methacrylate (PMMA) maxillary complete dentures (CDs) and mandibular implant overdentures, while those in the intervention group received digital light processing (DLP)-printed photopolymerizable PMMA maxillary CDs (NextDent) and mandibular implant overdentures. Follow-up appointments were scheduled at 3, 6, and 12 months where Oral Health Impact Profile 19 (OHIPEDENT19) data were used to assess the OHRQoL of the participants. Denture retention was measured using a digital force gauge device. RESULTS: The OHRQoL values were significantly higher (less improvement) in the conventional overdenture group at 6 months (P = 0.02) and 12 months (P = 0.04). A statistically significant difference was found between the mean retention values of the conventional and 3D-printed overdenture groups. For all the follow-up periods, the mean retention values were higher for the 3D-printed overdenture group (P = 0.001). CONCLUSION: 3D-printed overdentures may represent an alternative to conventionally fabricated ones. This study represents a stepping stone and proof of concept that support the potential future use of 3D-printed dentures.

Single vs 2 Implants on Peri-implant Marginal Bone Level and Implant Failures in Mandibular Implant Overdentures: A Systematic Review With Meta-analysis.

BACKGROUND: As a consensus, the 2-implant supported overdentures (ODs) are considered as the first choice of treatment for the edentulous mandible. In the same context, there is increased evidence supporting the use of single-implant OD. The aim of any design is to preserve the remaining structures and allow the longevity of the treatment. OBJECTIVES: To evaluate the impact of single implant vs 2 implants on the peri-implant marginal bone loss (MBL) and number of implant failures in mandibular implant overdentures. METHODS: A literature search of electronic databases (PubMed and Cochrane) was performed up to March 2016 and complemented by hand search. Randomized clinical trials (RCTs) that evaluated MBL and number of implant failures relative to single-implant mandibular overdenture (MOD) were selected. The review and meta-analysis were performed using meta-analytic statistical package and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. FINDINGS: Five RCTs met the inclusion criteria for systematic review and qualitative synthesis. The observation period ranged from 12 months to 5 years in the selected RCTs. The comparison included in the meta-analysis is single- vs 2-implant MODs. Pooled data revealed that single-implant MODs significantly decreased the MBL (mean difference: 0.27, 95% confidence interval: 0.20-0.34, P < .0001, I2 = 0%) and number of implant failures (risk ratio: 3.26, 95% confidence interval: 1.18-8.97), P = .02; I2 = 0%). CONCLUSIONS: Single-implant MOD was found to be better than 2-implant MOD in terms of MBL and number of implant failures. However, this result should be interpreted with caution due to limited number of analyzed studies with different loading protocols and short follow-up period.

Single Implant-Retained Mandibular Overdentures: A Literature Review.

The absence of teeth, known as edentulism, poses considerable obstacles in prosthodontic care and greatly affects a person's well-being. Conventional complete dentures frequently lead to problems like instability and insufficient retention, especially in the lower jaw. Fortunately, the introduction of dental implants has transformed the way we approach edentulous patients, as they now offer support and enhanced retention for removable prostheses, thus revolutionizing their treatment. While a consensus exists on using two implants for retaining mandibular overdentures, the associated cost may be prohibitive for economically disadvantaged individuals. As a solution, the concept of single implant-retained mandibular overdentures has emerged, catering to individuals with limited financial resources and complete tooth loss. This review explores the efficacy and suitability of the single implant overdenture approach, along with an overview of treatment options for edentulous patients, including traditional dentures, tooth-supported overdentures, and implant-supported overdentures. The preservation of bone, improvements in functional abilities, and psychological benefits associated with overdentures are discussed. Moreover, various classifications and prosthetic options for implant overdentures, specifically for mandibular cases, are presented. This literature review aims to provide a comprehensive understanding of possible treatment options and focus on the single implant-retained mandibular overdenture approach and its implications in prosthodontic rehabilitation for edentulous patients.

Palatal vault configuration and its influence on intraoral scan time and accuracy in completely edentulous arches: a prospective clinical study.

PURPOSE: The aim of this prospective clinical study was to compare the influence of palatal vault forms on accuracy and speed of intraoral (IO) scans in completely edentulous cases. MATERIALS AND METHODS: Based on the palatal vault form, participants were divided into three equal groups (n = 10 each); Class I: moderate; Class II: deep; Class III: flat palatal vault. A reference model was created for each patient using polyvinylsiloxane impression material. The poured models were digitized using an extraoral scanner. The resultant data were imported as a solid CAD file into 3D analysis software (GOM Inspect 2018; Gom GmbH, Braunschweig, Germany) and aligned using the software's coordinate system to determine its X, Y, and Z axes. Five digital impressions (DIs) of maxilla were captured for each patient using an intraoral scanner (TRIOS; 3Shape A/S, Copenhagen, Denmark) and the resultant Standard Tessellation Language (STL) scan files served as test models. Trueness was evaluated by calculating arithmetic mean deviation (AMD) of the vault area between reference and test files while precision was evaluated by calculating AMD between captured scans to measure repeatability of scan acquisition. The scan time taken for each participant was also recorded. RESULTS: There was no significant difference in trueness and precision among the groups (P = .806 and .950, respectively). Average scan time for Class I and III palatal vaults was 1 min 13 seconds and 1 min 37 seconds, respectively, while class II deep palatal vaults showed the highest scan time of 5 mins. CONCLUSION: Palatal vault form in edentulous cases has an influence on scan time. However, it does not have a substantial impact on the accuracy of the acquired scans.

Botulinum toxin and occlusal splints for the management of sleep bruxism in individuals with implant overdentures: A randomized controlled trial.

BACKGROUND: The available treatment options fail to provide definitive or curative management for bruxer patients rehabilitated with implant overdentures (OD). The data regarding Botulinum toxin (BTX) injection as a management strategy for bruxism remains unclear. This randomized, single-blinded, control-group, pretest-posttest prospective trial evaluated the occlusal guard and Botox injections (BTX) effectiveness in managing sleep bruxism (SB) in subjects whose one of the edentulous arches had been restored with the implant-supported OD. METHODS: Forty-two patients diagnosed with definite bruxism were selected, all of which had implant-retained ODs opposing natural dentition. The participants were allocated randomly to three equal groups. Participants in group I (control group) were instructed to remove the OD at night; group II was managed with conventional occlusal stents. Those in group III were given BTX injections. New ODs were constructed for all groups, and all ball attachments were replaced with a new nylon cap. A baseline assessment (one month of OD insertion) of patient satisfaction and sleep quality was conducted, and then again at 3, 6, 9, and 12 months of treatment. Subjective sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). Patients' satisfaction was evaluated using Temporomandibular disorders/numeric scales (TMD/NS). Prosthodontic (mechanical) complications were recorded during the follow-up period. RESULTS: Group III showed a statistically significant improvement in patient satisfaction and sleep quality compared to the other two groups at 3, 6, 9, and 12 months follow-up period ( P  = 0 0.001, 0.0001, 0.0013, and 0.0001 respectively). Regarding prosthodontic (mechanical) complications, the highest number of events was revealed in the control group. CONCLUSIONS: BTX and occlusal appliances effectively improve patient satisfaction and sleep quality of Bruxer patients rehabilitated with single arch implant overdentures.

Implant splinting in mandibular overdentures: a systematic review with meta-analysis of randomized clinical trials.

OBJECTIVES: To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated with mandibular implant overdentures. METHOD AND MATERIALS: A literature search of electronic databases (PubMed and Cochrane Central Register of Controlled Trials [CENTRAL]) was performed, with the last search conducted in July 2019. Randomized controlled trials with at least a 12-month follow-up period were selected. The review and meta-analysis were performed in accordance with PRISMA guidelines. Two comparisons were included in the meta-analysis: (1) Two-implant supported ball versus two-implant supported bar mandibular overdenture; (2): Two- versus four-implant supported bar mandibular overdenture. RESULTS: Six randomized controlled trials fulfilled the inclusion criteria and were included in a quality assessment and meta-analysis. Pooled data revealed a nonsignificant difference in marginal bone level (I2 = 0%; P = 1; mean difference = 0.00; 95% CI -0.37 to 0.37) and implant failures (P = .24; risk ratio = 6.07; 95% CI 0.30 to 121.33) when two-implant ball overdentures were compared to two-implant bar overdentures. Similarly, there was no significant difference in marginal bone level (I2 = 59%; P = .59; mean difference = -0.16; 95% CI -0.73 to 0.41) or implant failures (I2 = 0%; P = .36; risk ratio = 2.03; 95% CI 0.45 to 9.16) when two- versus four-implant bar overdentures were compared. CONCLUSION: Based on the findings of the meta-analysis, there is no influence of implant splinting on peri-implant marginal bone level and implant failures for completely edentulous patients rehabilitated with mandibular implant overdentures. However, this result should be interpreted with caution due to the limited number of analyzed studies, most of them considered at unclear risk of bias. Well-designed randomized controlled trials with follow-up periods of at least 5 years are highly recommended to establish evidence with regard to the influence of implant splinting on mandibular overdentures.

Impact of Removable Partial Denture Type on Patient Satisfaction and Abutment Survival Rate-RCT.

BACKGROUND: Patient's satisfaction and the preservation of abutments is the most important outcomes that the clinician seeks during fabrication of any dental treatment, especially when it is concerned with removable prosthodontic rehabilitation. AIM: The present study evaluates three different Removable Partial Denture (RPD) types restoring mandibular class II modification I edentulous cases with regards to patient's satisfaction and abutments survival. METHODS: Forty-two partially edentulous patients were divided into three groups (Group I rehabilitated with Vitallium RPD, Group II rehabilitated with Vitallium RPD where the modification area restored with the surveyed bridge, Group III rehabilitated with Thermopress RPD). The patients were followed up for twenty-four months. Using a questionnaire, prosthodontic maintenance required was documented at the delivery and after 3 months. RESULTS: There was a significant difference regarding patient satisfaction for group III (P-value <0.05) while for groups I and II there was a non-significant difference (P-value >0.05). Regarding the survival rate, there was a non-significant difference between the three groups (P-value >0.05) at the end of twenty-four months of follow up. CONCLUSION: Patient satisfaction and abutment survival were better with Thermopress RPD than conventional Vitallium RPD or Vitallium RPD with a surveyed bridge restoring the modification area. Although a non-statistically significant difference was found in the survival rate of abutments between groups, a clinically important result was revealed as no abutments failures were reported in the Thermopress group.