DIGITAL DENTISTRY AND ITS IMPACT ON ORAL HEALTH-RELATED QUALITY OF LIFE.

Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients' oral health and, consequently, their oral health-related quality of life. Both software and hardware approaches attempt to maintain, restore, or optimize a patient's perceived oral health. This article outlines innovations in dentistry and their potential impact on patients' oral health-related quality of life in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.

Monitoring of Erosive Tooth Wear with Intraoral Scanners In vitro.

Intraoral scanners (IOS) have been used to quantify tooth wear, but so far they have not been systematically validated for monitoring of tissue loss. The aim of this in vitro study was to investigate whether progression of tissue loss can be detected with an IOS and whether IOS values agree with those obtained with noncontacting profilometry (PRO) serving as a standard method. Model jaws were mounted in a phantom head positioned in a dental chair. Flattened areas were prepared on the non-load-bearing cusps of the first molars (model teeth; n = 16) in order to fix flat enamel samples with an experimental area and a reference area. After baseline PRO and IOS, the experimental enamel area was stepwise etched with 35% H3PO4 gel (4 × 30 s and 4 × 15 s). After each etching, PRO and IOS was performed and the vertical tissue loss between the reference and experimental areas was measured, each at the same 3 measurement points. Furthermore, cupped cusps were simulated by stepwise preparation of the load-bearing cusps of the model teeth with a spherical diamond bur, and the maximum vertical depth after each preparation step was measured only by IOS. Trios3 (3Shape, Denmark), Carestream CS3600 (Carestream, USA) and an optical profilometer (MicroProf, Fries, Germany) were used to measure the flat areas of the enamel samples, whereas only IOS were used to measure curved surfaces on the load-bearing cupped cusps of the model teeth. The IOS data were analyzed with an external software (GOM Inspect, Germany) and with the respective internal IOS software. PRO revealed a mean (±SD) tissue loss of 17.1 ± 4.7 µm after 30-s etching steps and 10.1 ± 5.1 µm after the 15-s etching steps. IOS and software types were able to detect the progression of tissue loss after each etching step (p ≤ 0.001 each); Bland-Altmann plots revealed good agreement with PRO regardless of the order of tissue loss, and no systematic difference was found. Increasing cupped lesion depths were detected by all IOS, with no significant differences between IOS and analysis methods. IOS were able to detect small amounts of tissue loss under simulated clinical conditions and seem to be a promising tool for monitoring even initial erosive tooth wear.

Elastic deformation of the mandibular jaw revisited-a clinical comparison between digital and conventional impressions using a reference.

OBJECTIVES: Due to the partly strongly differing results in the literature, the aim of the present study was to investigate a possible deformation of the mandible during mouth opening using an intraoral scanner (IOS) and a conventional impression for comparison with a reference aid. MATERIALS AND METHODS: Four steel spheres were reversibly luted in the mandibular (n = 50) with a metallic reference aid at maximum mouth opening (MMO). Two digital impressions (Trios3), at MMO and at slightly mouth opening SMO and a conventional impression (Impregum), were taken as the measuring accuracy of the reference structure was already known. Difference between MMO-SMO for digital impressions and deviations between digital and conventional (SMO) were calculated. Furthermore, the angle between the normal vectors of two constructed planes was measured. Statistical analysis was performed with SPSS25. RESULTS: Deviations for linear distances ranged from -1 ± 3 µm up to 17 ± 78 µm (digital impressions, MMO-SMO), from 19 ± 16 µm up to 132 ± 90 µm (digital impressions, SMO), and from 28 ± 17 µm up to 60 ± 52 µm (conventional impressions, SMO). There were no significant differences for digital impressions (MMO-SMO), and there were significant differences between the conventional and digital impressions at SMO. CONCLUSIONS: Based on the results of the present study, no mandibular deformation could be detected during mouth opening with regard to the digital impressions. The results were rather within the measuring tolerance of the intraoral scanner. CLINICAL RELEVANCE: Based on the present study, no deformation of the mandibular during mouth opening could be observed at the level previously assumed. Therewith related, dental techniques related to a possible mandibular deformation therefore should be reconsidered.

Microleakage of thin-walled monolithic zirconia and polymer-containing CAD-CAM crowns.

STATEMENT OF PROBLEM: Monolithic restorations facilitate computer-aided design and computer-aided manufacturing (CAD-CAM) processability and provide thin-walled restorations, which require less tooth reduction. For the long-term success of these restorations, their durable sealing is important. However, data in this regard are sparse. PURPOSE: The purpose of this in vitro study was to investigate the microleakage of monolithic complete crowns made from current CAD-CAM materials after mastication simulation. MATERIAL AND METHODS: Sixty-four identical test specimens (crown and tooth) were milled based on corresponding standard tessellation language data sets: one for the crowns and another for the human molar teeth. Four CAD-CAM restoration materials were investigated: 2 polymer-containing materials, Brilliant Crios (BC) and Vita Enamic (VE), and 2 zirconia materials, ultra-high-translucent Nacera Pearl Q³ Multi-Shade (ultraHT) and high-translucent Nacera Pearl Multi-Shade (HT). The crowns were adhesively luted to the CAD-CAM milled human molars with 1 of 3 luting systems: OneCoat7Universal and DuoCem (BC); A.R.T.Bond and DuoCement (VE); or EDPrimer/Panavia F2.0 (ultraHT and HT). The specimens were divided in 2 subgroups, and 2 different mastication simulations were applied: normal function (NF) and bruxism (B). A dye penetration test was used to detect microleakage, and the specimens were sectioned. A digital microscope (Zeiss) was used for analysis and to calculate the percentage of leakage in relation to the height of the tooth. Data were subjected to the Mann-Whitney and Kruskal-Wallis tests (α=.05). RESULTS: Microleakage was identified in all groups. VE reported the highest leakage with a mean of 13.0%, followed by ultraHT (4.8%), HT (3.6%), and BC (3.0%). No significant difference was detected between the 2 simulation programs (normal function and bruxism). However, VE and the zirconia group HT exhibited a significant difference (P<.014), whereas no significant difference was noted among the zirconia groups or the polymer-containing groups BC and VE. CONCLUSIONS: Thin-walled restorations made of CAD-CAM composite resin and zirconia exhibited reduced microleakage compared with the polymer-containing ceramic. Thus, from the specific viewpoint of microleakage, CAD-CAM composite resins and zirconia seem to be suitable materials for thin-walled complete crowns.

A statistical model of the rate-dependent fracture behavior of dental polymer-based biomaterials.

An insight into the fracture behavior of dental polymer-based biomaterials is important to reduce safety hazards for patients. The crack-driven fracture process of polymers is largely stochastic and often dependent on the loading rate. Therefore, in this study, a statistical model was developed based on three-point bending tests on dental polymethyl methacrylate at different loading rates. The fracture strains were investigated (two-parameter Weibull distribution (2PW)) and the rate-dependency of the 2PW parameters were examined (Cramér-von Mises test (CvM)), arriving at the conclusion that there could be a limiting distribution for both quasi-static and dynamic failure. Based on these findings, a phenomenological model based on exponential functions was developed, which would further facilitate the determination of the failure probability of the material at a certain strain with a given strain rate. The model can be integrated into finite element solvers to consider the stochastic fracture behavior in simulations.

Evaluation of Mechanical Versus Manual Root Canal Preparation in Primary Molars-A Comparative In Vitro Study.

The endodontic treatment of primary teeth is to maintain the function of the tooth free of symptoms until its physiological exfoliation. A critical factor for success is how quickly and effectively the root canal preparation can be performed. Therefore, the aim of this comparative in vitro study was to analyze the efficiency of two mechanical root canal preparation systems FM (FlexMaster) and HF (HyFlex EDM) to manual KF (K-file) on extracted primary molars. A total of 45 teeth were divided into three groups (n = 15): KF (#15-35), FM (04#30) and HF (25/~ OneFile). Root canal preparation was performed, and the preparation time was measured. All root canals were non-destructively analyzed by micro-computed tomography in the cervical, middle and apical thirds before and after preparation with regard to the parameters of canal transport (in µm) and centering ratio (0-1). Statistical analysis was performed at a 5% significance level using non-parametric tests. HF caused the lowest canal transport in the apical third (p = 0.008). The centering ratio value of HF was significantly higher in the middle third of the root canals than in the other two groups (p < 0.01). The mean instrumentation time was significantly higher for KF (6.67 min) than for FM (4.69 min) and HF (4.03 min, p < 0.01). HF can be recommended for primary molar root canal treatment.

The Influence of Using Different Types of Scan Bodies on the Transfer Accuracy of Implant Position: An In Vitro Study.

PURPOSE: To assess the absolute linear distances of three different intraoral scan bodies (ISBs) using an intraoral scanner compared to a conventional impression in a common clinical model setup with a gap and a free-end situation in the maxilla. MATERIALS AND METHODS: An implant master model with a reference cube was digitized using x-ray computed tomography and served as the reference file. Digital impressions (TRIOS, 3Shape) were taken using three different ISB manufacturers: NT Trading, Kulzer, and Medentika (n = 10 per group). Conventional implant impressions were taken for comparison (n = 10). The conventional models were digitized, and all models (digital and conventional) were superimposed with the reference file to obtain the 3D deviations for the implant-abutment-interface points (IAIPs). Results for linear deviation (trueness and precision) were analyzed using pairwise comparisons (P < .05; SPSS version 25). For precision, a two-way factorial mixed ANOVA was used. RESULTS: The deviations for trueness (mean) ± precision (SD) of the IAIPs ranged as follows: FDI region 14 = 0.106 ± 0.050 mm (Medentika) to 0.134 ± .026 mm (NT Trading); region 16 = 0.108 ± 0.046 mm (conventional) to 0.164 ± 0.032 mm (NT Trading); region 24 = 0.111 ± 0.050 mm (conventional) to 0.191 ± 0.052 mm (Medentika); region 26 = 0.086 ± 0.040 mm (conventional) to 0.199 ± 0.066 mm (Kulzer). There were significant differences for trueness between all digital and conventional impression techniques. For precision, only two significant differences in two implant regions (14, 24) were observed. CONCLUSION: Longer scanning paths resulted in higher deviations of the implant position in digital impressions. Due to algorithms implemented in the software, errors resulting from the different scan bodies may be reduced during the alignment process of the IOS in clinical practice.

Is the assumption of linear elasticity within prosthodontics valid for polymers? -An exemplary study of possible problems.

As shown in previous studies within other scientific fields, the material behavior of polymethyl methacrylate (PMMA) is viscoelastic-viscoplastic. However, in dental biomaterial science it is mostly considered as linear elastic or elastic-plastic. The aim of the present study was to evaluate, whether the assumption of elastic or elastic-plastic material behavior for PMMA is a practicable simplification or a potential source of error, especially considering clinical loading conditions. Telio-CAD was tested in three-point bending tests with different test velocities to examine the material behavior at different initial loading rates. Additionally, a dynamic-mechanical-thermal-analysis at different frequencies and temperatures was used. Here, a significant influence of loading rate and temperature as well as stress relaxation and creep were observed. To describe the rate-dependency of the elastic modulus, a new model was created, from which the elastic modulus can be calculated with a given strain rate. This model was validated using linear elastic finite element analysis.

Accuracy of four different intraoral scanners according to different preparation geometries.

PURPOSE: To evaluate the accuracy (trueness and precision) achievable with four intraoral scanners (IOSs) and different preparation geometries. MATERIALS AND METHODS: A model of a maxillary arch with different preparation geometries (onlay, inlay, veneer, full-crown) served as the reference master model (RMM). The RMM was scanned 10 times using four commonly used IOSs (Trios 2 [TR], 3Shape; Omnicam [OC], Dentsply Sirona; True-Definition [TD], 3M ESPE; and Primescan [PS], Dentsply Sirona). Scans were matched using a 3D measurement software (Inspect 2019, GOM) and a best-fit algorithm, and the accuracy (trueness and precision) of the preparation types of the scanning data was evaluated for positive and negative deviations separately. All data were subjected to univariate analysis of variance using SPSS version 24 (IBM). RESULTS: Mean (± SD) positive deviations ranged from 4.6 ± 0.7 µm (TR, veneer) to 25.9 ± 2.4µm (OC, full crown). Mean negative deviations ranged from -7.2 ± 0.6 µm (TR, veneer) to -26.4 ± 3.8 µm (OC, full crown). There were significant differences (P < .05) in terms of trueness and precision among the different IOSs and preparation geometries. CONCLUSION: The transfer accuracy of simple geometries was significantly more accurate than those of the more complex prosthetic geometries. Overall, however, the IOSs used in this study yielded results that were clinically useful for the investigated preparation types, and the mean positive and negative deviations were in clinically acceptable ranges.

A new 3D-method to assess the inter implant dimensions in patients - A pilot study.

BACKGROUND: Complex implant treatments have steadily increased within implant prosthodontics. Based on the lower implant mobility, implant impressions need high accuracy in the model transfer to receive a high passive fit within the final prosthodontic restoration. To analyze the accurate 3-dimensional (3D) inter-implant-positions, a reference point is indispensable. However, there is no reference in the patients mouth, so the aim of the present study was to develop a new method based on a custom-made-measuring-aid (CMA) to assess the inter implant dimensions (InID) in patients. MATERIAL AND METHODS: Initially an implant master model (IMM/patient equivalent) was digitized by computed tomography. A CMA was fixed on the impression posts and the inter implant dimensions (InID) were recorded with a coordinate measurement machine (CMM). For comparison to conventional and digital impression techniques, 10 impressions per technique were taken. InIDs for the IMM, the CMA and the two impression techniques were compared. To give a proof of principle, the new 3D-method was applied to three patients as pilot cases. Results for trueness and precision were analyzed by pairwise comparisons (p< .05). All data were subjected to univariate ANOVA. RESULTS: Mean deviation for InID ranged from 10.3±18µm(CMA) to 41.7±36µm(conventional). There were partially significant differences for InID between the CMA and the different impression techniques. There were no significant differences for InID within the CMA. The InID in the in-vivo evaluation ranged from 42.3µm to 376.7µm(digital) and from 58.3µm to 274.0µm(conventional). There were partially significant differences between the techniques. CONCLUSIONS: Within the limits of this study, with the developed method using a CMA it is possible to assess the true 3D-InID with a decisive higher accuracy than possible with a conventional or digital implant impression. Overall, the CMA in this study generated results that were deemed clinically useful for the investigated inter implant positions. Key words:Dental Implants, Dimensional Measurement Accuracy, Dental Impression Technique, Intraoral Scanner.

Torsion and linear accuracy in intraoral scans obtained with different scanning principles.

PURPOSE: Few investigations have examined the production of single restorations using intraoral scanners (IOS). Data on full-arch scans are rare, and data regarding torsion within the entire arch are very sparsely reported. Therefore, the aim of this study was to examine the deviations of torsion and linear distances in full-arch scans of three IOS based on different scanning principles. METHODS: A cobalt-chrome-molybdenum alloy master model (CCMM) with four hemispheres was fabricated by laser sintering. The CCMM was digitized using a laboratory scanner (ATOS-Core/GOM) and scanned with three IOS (Omnicam/Sirona(OC); True Definition/3M(TD); TriosII/Cara-Version/Kulzer(TR)). All scan data were exported in a standard STL-file format and were analyzed with GOM Inspect software (V7.5/GOM). Torsion between the right and left side of the arch and linear accuracy (trueness and precision) were evaluated. After normality was confirmed, all data were subjected to parametric statistical analyses. RESULTS: The torsion ranged from 0.07±0.03°(OC) to 0.29±0.14°(TD). Pairwise comparisons showed significant differences between the OC and TD scanners and between the TR and TD scanners. The linear distances ranged from 6±5µm(OC) to 298±317µm(TD). Significant differences were observed among all investigated IOS (p=0.05). CONCLUSIONS: Although the highest torsion was observed for the TD scanner, it is still not clear whether the differences between the IOS are related to the scanning principle or to the scanning algorithm. Due to the high clinical relevance of full-arch restorations, future studies should consider torsion. Regarding linear accuracy, no general difference related to the scanning principles of the IOSs was observed.

Influence of the Accuracy of Intraoral Scanbodies on Implant Position: Differences in Manufacturing Tolerances.

PURPOSE: To assess the manufacturing tolerances of three different intraoral scanbodies (ISBs) and their possible influence on the transfer of the intraoral implant position to the digital cast. MATERIALS AND METHODS: Three different ISBs were measured using x-ray computed tomography. The length, diameter, angle, and target volume deviation were analyzed, and the data were subjected to a univariate analysis of variance. RESULTS: There were significant differences between all three ISBs in length, diameter, and target volume deviations (P < .05). CONCLUSION: Manufacturing tolerances of ISBs have the potential to decisively affect the transfer accuracy of the implant position from the recorded intraoral position to the digital cast, which needs to be considered.