Evaluation of Dimensional Stability of 3D-printed Dental Casts.

OBJECTIVE: The objective was to investigate the dimensional stability of different types of 3D printed dental models, and to measure the dimensional changes over time. METHODS: Four dental casts with different constructions were printed. The four types of models were as follows: hollow casts with 2.5 mm wall thickness (2,5mm.H), hollow casts with 2 mm wall thickness (2mm.H), hollow casts with 2 mm wall thickness with stabilization bars (2mm.B) and hollow casts with 2 mm wall thickness with gypsum base (2mm.G). The casts were digitized with a laboratory scanner (3Shape E3 Red E Scanner) to obtain the reference Standard Tessellation Language (STL) files. All models were stored at room temperature and scanned again after 1 day and after 1, 2 and 10 weeks. This data was compared to the reference STL file and was analysed by comparing the deformation using surface fitting software (Geomagic Control X, 3D Systems). The results were statistically evaluated using paired Student's t-tests, with the significance level set at p<0.05. RESULTS: There were significant differences in dimensional stability after 10 weeks between the four different dental casts. According to our results, the 2mm.B casts showed the least deformation which was followed by the 2mm.H casts. However, both the 2,5mm.H and the 2mm.G casts showed significant deformation compared to the 2mm.B casts. CONCLUSIONS: Within the limitations of this study - using only one printer and one type of resin - we found that the deformation of all investigated casts remained within the clinically acceptable range. However, there were significant differences between the various construction types printed with the Bego Varseo Printer and Bego Varseo Wax Model Gray material. CLINICAL SIGNIFICANCE: It is crucial to determine how long 3D printed models can maintain their accuracy to prevent potential adverse effects, especially given the extended storage periods required for the time-consuming procedures in prosthodontic and orthodontic treatments.

Color Comparison Between Intraoral Scanner and Spectrophotometer Shade Matching: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review and meta-analysis compared the accuracy of intraoral scanners and spectrophotometers in determining tooth shade. MATERIALS AND METHODS: An electronic search of five databases (PubMed, Scopus, Embase, Web of Science, CENTRAL) was conducted on October 19, 2023. A total of 163 studies were identified from the databases, of which 23 articles were eligible for inclusion. In vivo and in vitro quasi-experimental studies were included. After data extraction, a quantitative analysis was performed to determine the accuracy of the intraoral scanner in subgroups using four outcomes: trueness and precision with different measurement locations. A random-effects model was used to pool effect sizes. The pooled proportion with a 95% confidence interval (CI) was used for the effect size measure. RESULTS: Eleven articles were included in the meta-analysis. Trueness with the intraoral scanner was between 0.28 (CI: 0.09-0.60) and 0.38 (CI: 0.24-0.53). Repeatability was between 0.81 (CI: 0.64-0.91) and 0.85 (CI: 0.74-0.92). Trueness showed low, and precision had moderate certainty of evidence. CONCLUSION: The trueness of shade matching with intraoral scanners is low compared to spectrophotometers, although the precision is considered high and is similar to spectrophotometers. CLINICAL SIGNIFICANCE: Shade determination with intraoral scanners is not recommended.

Quantitative examination of factors influencing the colour reproduction ability of lithium disilicate glass-ceramics.

BACKGROUND: Effects of ceramic translucency, layer thickness, and substrate colour on the shade of lithium disilicate glass-ceramic restorations proved to be significant in several studies, however, quantitative, numerical results on the relationship between the colour difference and these parameters are still lacking. The purpose of this in vitro study was to quantitatively determine how the colour reproduction ability of a lithium disilicate glass-ceramic is affected by its translucency, layer thickness, and substrate colour. METHODS: Ceramic samples were prepared from A2 shade IPS e.max CAD blocks with high and low translucencies (HT and LT) in a thickness range of 0.5-2.5 mm (+/- 0.05 mm). Layered samples were acquired utilizing composite substrates in 9 shades; transparent try-in paste was used. The spectral reflectance of the specimens was assessed under D65 standard illumination with a Konica Minolta CM-3720d spectrophotometer. The CIEDE2000 colour difference (ΔE00) between two samples was analysed using perceptibility and acceptability thresholds set at 50:50%. Statistical analysis involved linear regression analysis and the Kruskal-Wallis test. RESULTS: An increase in the thickness of 0.5 mm reduced the ΔE00 of the HT samples to 72.8%, and that of the T samples to 71.1% (p < 0.0001). 7 substrates with HT and LT specimens had significantly different results from the mean (p < 0.05). A thickness of 0.5 mm is not sufficient to achieve an acceptable result at any level of translucency, while the low translucency ceramic at a thickness of 1.5 mm gave acceptable results, except for severely discoloured substrates (ND8 and ND9). CONCLUSIONS: The colour reproduction ability of lithium disilicate glass-ceramics is significantly affected by their translucency, layer thickness, and 7 substrates out of 9 substrates examined.

Evaluating the influence of palate scanning on the accuracy of complete-arch digital impressions-An in vitro study.

OBJECTIVES: To assess the impact of including the palate and the number of images recorded during intraoral digital scanning procedure on the accuracy of complete arch scans. METHODS: An experienced operator conducted 40 digital scans of a 3D printed maxillary model and divided them into two groups: 20 with inclusion of the palate (PAL) and 20 without (NPAL). Each set of scans was performed using an intraoral scanner (IOS) (Trios 5; 3Shape A/S; Copenhagen, Denmark). The resulting STL files were imported into the Geomagic Control X software (3D Systems, Rock Hill, SC, USA) for accuracy comparison. A reference STL file was created using a 3Shape E3 laboratory scanner (3Shape Scanlt Dental 2.2.1.0; Copenhagen, Denmark). The number of images captured was recorded during the scanning procedure. RESULTS: In the case of the right side no statistically significant difference in trueness was detected (84 µm ± 45.6 for PAL and 80.4 ± 40.4 µm for NPAL). In the case of the left side no significant difference in trueness was observed (215.1 ± 70.2 µm for PAL and 233.9 ± 70.7 µm for NPAL). In the case of the arch distortion a statistically significant difference in trueness was seen between the two types of scans (135.3 ± 71.9 µm for PAL and 380.4 ± 255.1 µm for NPAL). The average number of images was 831.25, and 593.8 for PAL and NPAL, respectively. CONCLUSIONS: Scanning of the palatal area can significantly improve the accuracy of dental scans in cases of complete arches. In terms of the number of images, based on the current results, obvious conclusions could not be drawn, and further investigation is required. CLINICAL SIGNIFICANCE: Scanning the palate may be beneficial for improving the accuracy of intraoral scans in dentate patients. Consequently, this should be linked to an appropriate scanning strategy that predicts palatal scanning.

Trueness of five different 3D printing systems including budget- and professional-grade printers: An In vitro study.

Problem: Several types of 3D printers with different techniques and prices are available on the market. However, results in the literature are inconsistent, and there is no comprehensive agreement on the accuracy of 3D printers of different price categories for dental applications. Aim: This study aimed to investigate the accuracy of five different 3D printing systems, including a comparison of budget- and higher-end 3D printing systems, according to a standardized production and evaluation protocol. Material and methods: A maxillary reference model with prepared teeth was created using 16 half-ball markers with a diameter of 1 mm to facilitate measurements. A reference file was fabricated using five different 3D printers. The printed models were scanned and superimposed onto the original standard tesselation language (.stl) file, and digital measurements were performed to assess the 3-dimensional and linear deviations between the reference and test models. Results: After examining the entire surface of the models, we found that 3D printers using Fused filament fabrication (FFF) technology -120.2 (20.3) µm create models with high trueness but high distortion. Distortions along the z-axis were found to be the highest with the stereolithography (SLA)-type 3D printer at -153.7 (38.7) µm. For the 4-unit FPD, we found 201.9 (41.8) µm deviation with the digital light processing (DLP) printer. The largest deviation (-265.1 (55.4) µm) between the second molars was observed for the DLP printer. Between the incisor and the second molar, the best results were produced by the FFF printer with -30.5 (76.7) µm. Conclusion: Budget-friendly 3D printers are comparable to professional-grade printers in terms of precision. In general, the cost of a printing system is not a reliable indicator of its level of accuracy.

Combined Casein Phosphopeptide-Amorphous Calcium Phosphate and Fluoride Is Not Superior to Fluoride Alone in Early Carious Lesions: A Meta-Analysis.

There is a growing need for effective methods in the management of early stage carious lesions. Therefore, the aim of this study was to evaluate the effect of combined casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride on white spot lesions (WSLs) compared to fluoride-only interventions. This meta-analysis was performed according to PRISMA guidelines and registered in PROSPERO (CRD42021286245). The Medline, Embase, and Cochrane Central databases were searched until October 17, 2022. Eligible studies were randomized controlled trials. Outcome variables included laser fluorescence (LF), quantitative light-induced fluorescence (QLF), and lesion area scores. The random-effects model was used for analysis, and results were given as standardized mean difference (SMD) and mean difference (MD) with a 95% confidence interval. Risk of bias was assessed using the RoB 2 tool, and the level of evidence with GRADE. Our systematic search yielded 973 records after duplicate removal, 21 studies were included for qualitative synthesis, and 15 studies were eligible for quantitative analysis. No significant difference was found between CPP-ACP and fluoride versus fluoride alone in LF at 1, 3, and 6 months of use: SMD -0.30 (-0.64; 0.04); SMD -0.47 (-1.02; 0.07); SMD -0.49 (-1.13; 0.15), respectively. For QLF, the analysis did not demonstrate significant differences between these two kinds of treatment at 1 and 6 months of use: MD 0.21 (-0.30;0.71); MD 0.60 (-1.70;2.90), but at 3 months, higher QLF values were found in the fluoride-only group compared to the CPP-ACP and fluoride combination was shown regarding the WSLs: MD 0.58 (0.25;0.91). On the contrary, data showed a small but statistically significant decrease in the lesion area in favor of the CPP-ACP plus fluoride versus fluoride alone at 6 months MD -0.38 (-0.72; -0.04). None of these observed changes indicated substantial clinical relevance. The combination of CPP-ACP and fluoride did not overcome the effect of fluoride given alone. Our data suggest that fluoride itself is effective in improving WSLs. However, the certainty of evidence was very low. These results indicate that further studies and future development of more effective products than CPP-ACP are needed in addition to fluoride to achieve robust amelioration of WSLs.

Additional splint therapy has no superiority in myogenic temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials.

Purpose Temporomandibular disorders (TMDs) are frequent stomatological disorders. However, their treatment is controversial. Therefore, we compared the efficacy of combination therapy (splint therapy along with physiotherapy, manual therapy, and counseling) with physiotherapy, manual therapy, and counseling alone. The extent of mouth opening and pain perception were the outcomes.Study selection Systematic searches for English publications were performed using four major literature databases (Cochrane Library, EMBASE, PubMed, and Web of Science). We included randomized controlled trials. We calculated mean differences with 95% confidence interval (CI) for pain perception and maximum mouth opening (MMO) for the two groups. The Hartung-Knapp adjustment was used for cases comprising at least five studies.Results Six articles were included in the pain perception category, and four were reviewed for MMO at baseline. Four articles assessed pain perception, and two assessed MMO at 1 month. Five articles were analyzed upon comparing pain perception at baseline and 1-month follow-up. The mean difference was -2.54 [95% CI: -3.38; to -1.70] in the intervention group and -2.33 [95% CI: -4.06; to -0.61] in the control group. Two articles were analyzed upon comparing MMO at baseline and 1-month follow-up. The mean difference in the intervention group was 3.69 [95% CI: -0.34; 7.72], whereas that in the control group was 3.62 [95% CI: -3.43; 10.67].Conclusions Both therapies can be used in the management of myogenic TMD. Due to the marginal differences between the baseline and 1-month values, our results could not confirm the efficacy of combination therapy.

Current status of optical scanning in facial prosthetics: A systematic review and meta-analysis.

Purpose To assess the accuracy of scanning technologies for constructing facial prostheses on human faces.Study selection Our systematic search was performed on five databases. Studies reporting on human volunteers (P) whose faces were scanned with a scanning technology were eligible. The anthropometrical interlandmark distances (ILDs) were used as indicators of accuracy; the ILDs are measured on the virtual models (I) and directly on the faces (C). The virtual models deviated from their true values (O). Studies reporting the measurements on patients with or without facial deformities were included, but cadavers or inanimate objects were reasons for exclusion. We performed a mean difference (MD) / standardized MD analysis with a random effect model. The difficulties regarding the scanning procedure mentioned in the articles were also assessed.Results We found 3723 records after duplicate removal. Twenty five articles were eligible for the qualitative review, and ten articles were included in the quantitative synthesis. Eight different ILDs were compared in MD analyses. The differences were between -0.54-0.43 mm. We also performed a regional three-dimensional analysis to compare scanning technologies in each major region. No significant differences were found in any of the regions and axes. The most mentioned difficulties were artifacts due to motion or blinking.Conclusions The results suggest no systematic skew in linear dimensions neither between direct caliper measurements nor between measurements on the scanned models, scanning technologies, or facial regions.

Comparative analysis of surgical and prosthetic rehabilitation in maxillectomy: A systematic review and meta-analysis on quality-of-life scores and objective speech and masticatory measurements.

STATEMENT OF PROBLEM: Patients with oro-antral communication, whether from trauma, disease, or congenital anomalies, have options for surgical reconstruction or prosthetic obturation, but guiding interdisciplinary protocols are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to compare surgical reconstruction and prosthetic obturation, identifying correlations with baseline characteristics to determine the most effective approach for specific patients. MATERIAL AND METHODS: A systematic search was conducted in 4 databases. Searching, screening, data extraction, and risk of bias assessment were performed by 2 reviewers. Eligible studies focused on patients with palatomaxillary defects from cancer-related maxilla surgeries. Traumatic or congenital defects were excluded. The study compared prosthetic restoration (either with surgical or definitive obturators) to surgical reconstruction using flaps or grafts. Patients with surgical restoration after tooth extraction were excluded. Both subjective and objective outcomes were used for comparison. RESULTS: Thirteen articles were included in the qualitative synthesis and 9 in the meta-analysis. Patient scores on quality-of-life questionnaires, objective speech, and masticatory ability evaluations were compared. The number of patients who underwent surgical reconstruction was 206, whereas 260 patients received prosthetic obturators. Results showed no significant differences. In the "activity" domain of the University of Washington QoL questionnaire, however, the 1.92 (0.45, 3.40) score difference was not clinically relevant. However, the heterogeneity of trials, the transient nature of subjective evaluations, the low number of participants, and major confounding biases did not allow a solid conclusion to be drawn. CONCLUSIONS: The growing number of maxillectomy patients demands firm evidence on which rehabilitation to choose and when it should be done. The result suggests that obturator devices and surgical reconstruction have similar effects on quality of life and health outcomes. A multicentric registry in which patient strata could be analyzed separately by age, adjuvant therapies, defect sizes, and remaining dentition is advocated.

The effect of generation change on the accuracy of full arch digital impressions.

PURPOSE: This study is aimed to evaluate the effect of generation change on accuracy of IOSs on full-arch scans and the inter-operator reliability. METHODS: In this study, 6 different IOS were tested: 3Shape Trios 3 (20.1.2.), 3Shape Trios 4 (20.1.1.), Medit i500 (2.3.6.), Medit i700 (2.4.6.), Planmeca Emerald (6.0.1.) and Planmeca Emerald S (6.0.1.). Eighteen dental students, inexperienced in scanning, took part in this study as operators. Each operator made 10 digital impressions; altogether, 30 impressions were made by each scanner. The 30 STL files were imported to the Geomagic Control X program, where they were compared to a reference STL file; the surface point's deviation of the full arch and the distance between the second molars' distobuccal cusps were measured, the inter-operator reliability was also investigated. RESULTS: A significant increase in accuracy was found between Trios 3 and 4 in the case of both parameters and between Medit i500 and i700 in the case of full arch. There was no significant difference between Planmeca generations. In case of the inter-operator reliability no significant difference was detected. CONCLUSION: Within this current study's limitation, it can be concluded that surface digitalization's accuracy can be modified with generation changes and that digital technology is less technique sensitive than traditional impression taking.

Less marginal bone loss around bone-level implants restored with long abutments: A systematic review and meta-analysis.

The aim of this study was to investigate the biological outcomes of bone-level implants restored with long vs. short abutments, with regard to the 'one abutment at one time' protocol. The systematic search was performed in five databases: MEDLINE (PubMed), EMBASE, Web of Science, Scopus, and CENTRAL for randomized controlled trials up to January 14, 2023. Data were collected for marginal bone loss, bleeding on probing, and probing pocket depth by two reviewers. As effect size measure, mean difference (MD), and risk ratio (RR) were used for continuous and categorical outcomes, R-statistics software was used for conducting statistical analyses. For quality and certainty assessment, Risk of Bias Tool 2, ROBINS-I, and GRADE approach were used. The search resulted in 4055 records without any duplicates. After title, abstract, and full-text analysis, eight articles were found eligible for inclusion. Bone-level and platform-switched implants presented less marginal bone loss after 6 months and 1 year as well, when long abutments were used (MD 0.63, 95% CI: [-0.16; 1.42]) and (MD 0.26, 95% CI: [-0.02; 0.53]). However, subgroup analysis revealed no difference in marginal bone loss when applying 'one abutment at one time' protocol (p = 0.973). Bleeding on probing and probing pocket depth presented similarly good results in both groups without almost any differences (RR 0.97, 95% CI: [0.76; 1.23]) and (MD -0.05, 95% CI: [-1.11; 1.01]). Longer abutments on bone-level implants seem to be a favorable choice for decreasing early marginal bone loss, irrespective of connection timing.

Evaluation of the accuracy of intraoral scanners for complete-arch scanning: A systematic review and network meta-analysis.

OBJECTIVES: This network meta-analysis (NMA) aimed to compare the complete-arch scanning accuracy of different intraoral scanners (IOSs) to that of reference standard tessellation language (STL) files. DATA: Studies comparing the trueness and precision of IOS STL files with those of reference STL scans for different arch types (dentate, edentulous, completely edentulous with implants, and partially edentulous with implants) were included in this study. SOURCES: An electronic search of five databases restricted to the English Language was conducted in October 2021. STUDY SELECTION: A total of 3,815 studies were identified, of which 114 were eligible for inclusion. After study selection and data extraction, pair-wise comparison and NMA were performed to define the accuracy of scanning for four arch subgroups using four outcomes (trueness and precision expressed as mean absolute deviation and root mean square values). Cochrane guidelines and the QUADAS-2 tool were used to assess the risk of bias. GRADE was used for certainty assessment. RESULTS: Fifty-three articles were included in this NMA. Altogether, 26 IOSs were compared directly and indirectly in 10 network systems. The accuracy of IOSs scans were not significantly different from the reference scans for dentate arches (three IOSs), edentulous arches (three IOSs), and completely edentulous arches with implants (one IOS). The accuracy of the IOSs was significantly different from the reference scans for partially edentulous arches with implants. Significant accuracy differences were found between the IOSs, regardless of clinical scenarios. CONCLUSIONS: The accuracy of complete-arch scanning by IOSs differs based on clinical scenarios. CLINICAL SIGNIFICANCE: Different IOSs should be used according to the complete arch type.

Effect of thickness, translucency, and substrates on the masking ability of a polymer-infiltrated ceramic-network material.

OBJECTIVE: The aim of this in vitro study is to evaluate the masking ability of polymer-infiltrated ceramic-network materials (PICN) with different translucencies and thicknesses on multiple types of substrates. MATERIALS AND METHODS: Ceramic samples were prepared of VITA ENAMIC blocks in two different translucencies (2M2-T, 2M2-HT) in a thickness range of 0.5-2.5 mm (±0.05 mm). Layered specimens were obtained using composite substrates in nine shades and transparent try-in paste. Spectral reflectance of specimens was measured using a Konica Minolta CM-3720d spectrophotometer and D65 standard illumination. CIEDE2000 color difference (ΔE00 ) between two samples was evaluated using 50%:50% perceptibility and acceptability thresholds. Specular component of the reflection was examined with Specular Component Excluded (SCE) and Included (SCI) settings. Statistical evaluation was performed by linear regression analysis, Kruskal-Wallis test, and multiplicative effect analysis. RESULTS: An increase in thickness of 0.5 mm reduces ΔE00 of HT samples to 73.5%, of T samples to 60.5% (p < 0.0001). Five substrates with HT specimens, and three substrates with T specimens had significantly different results from average (p < 0.05). There is a significant difference between SCE and SCI data depending on the wavelength (p < 0.0001). CONCLUSIONS: Masking ability of PICN materials is influenced by the thickness and translucency of the ceramic, and by the substrate. Reflection of the examined PICN material is characterized by both diffuse and specular reflection. CLINICAL SIGNIFICANCE: Although PICN materials have been available on the market for 10 years now, there is a lack of information regarding their masking ability. Acquiring in-depth data and thereby practical experience of the factors affecting the esthetics of PICN materials is essential for creating perfectly lifelike restorations.

User Experience of Intraoral Scanners in Dentistry: Transnational Questionnaire Study.

INTRODUCTION: Intraoral scanners (IOS) are continuing to gain popularity in clinical dentistry, replacing the traditional impression-taking and related technology. Despite their increasing importance, there are few data on the utility and usage of IOS amongst dentists. This study investigates the user experience of IOS technology as well as the perceived quality of a variety of IOS used by dental clinicians worldwide. METHODS: An online survey of 1072 dentists was conducted to elicit data on the number of individual IOS used, their accessibility, the maintenance fees, and the programmes used. The first part of the questionnaire included demographic data and related questions, whilst the second part focussed on the specific IOS used by the respondents and the satisfaction with their scanners. RESULTS: We surveyed 1072 respondents from 109 different countries. More than three-quarters of the survey cohort (78.8%) use IOS in their daily work, whilst 21.17% do not. The average number of scanners owned by the respondents was 1.5 (±0.9), and in total, the cohort used 36 different types of IOS. More than one-third (38.6%) of the respondents used computer-aided design (CAD) software as well. As for the frequency of IOS usage, 51.5% used the system on a daily basis, 28.2% did so 2 to 3 times a week, and 10.0% did so once a week. Overall, the top 3 IOS used by the cohort were Medit i700 followed by wireless Medit i700 and Dentsply Sirona Primescan. CONCLUSIONS: This study describes, for the first time, the IOS user experience in an international cohort. More than 75% of the respondents used IOS on a daily basis in their practice, whilst Medit and Dentsply Sirona brands were the most popular scanners amongst the group. It appears that digital impression-taking technology is universal, and digital workflow in dentistry will continue to grow.

Comparison of the learning curve of intraoral scanning with two different intraoral scanners based on scanning time.

BACKGROUND: The appearance of intraoral scanners (IOSs) in dental offices was an important milestones for the digital innovations in dentistry. Knowing the learning curve for intraoral scanning is crucial, because it can serve as a guideline for clinicians before buying a new IOS. The aim of the present in vivo study was to determine the learning curve required by dental students for intraoral scanning with the 3Shape Trios 4 IOS and the CEREC Primescan IOS, based on scanning time. METHODS: A total of 20 dental students with no previous experience in intraoral scanning participated in the present study. 10 students scanned with Trios 4® IOS (TRI) and 10 students took digital impressions with Primescan® IOS (CER). Every student created 15 digital impressions from patients. Prior to taking the impressions, theoretical and practical education was provided. The total scanning time included the upper and lower arches as well as bite registration, for which average values were calculated. Statistical analysis was performed using the Stata package with a mixed-effects generalized least squares regression models. RESULTS: The average total scanning times were the following: TRI - 205 s for the 1st impression, 133.6 s for the 15th, CER - 289.8 s for the 1st impression, 147 s for the 15th. The model-based estimate of the difference between the two in case of TRI was 57.5 s, and in CER was 144.2 s which is a highly significant improvement in both cases (P < 0.0001). The slope of the scanning time vs. learning phase curve gradually approached flatness, and maintained a plateau: TRI - from the 11th measurement and CER - from the 14th measurement onward. CONCLUSIONS: Given the limitations of the present study, we found difference between the learning curve of scanner types which are operate various principle of imaging. In case of the TRI fewer digital impressions (11 repeating) were sufficient to reach the average scanning time of an experienced user than using CER (14 repeating). TRIAL REGISTRATION: The permission for this study was given by the University Ethics Committee of Semmelweis University (SE RKEB number: 184/2022).

The impact of software updates on accuracy of intraoral scanners.

BACKGROUND: Digital workflow is showing an increasing tendency in everyday dentistry. Accuracy is essential during digital dental workflows for all indication areas. The present study aimed to evaluate the effect of software updates on the accuracy of intraoral scanner (IOS) devices. METHODS: 3Shape Trios 3 Pod with software versions 18.1.2. (TRI3_1) and 20.1.2. (TRI3_2); 3Shape Trios 4 Move, version 19.2.2. (TRI4_1); and 3Shape Trios 4 Pod, version 20.1.1. (TRI4_2) were used to take direct optical impressions from a polymethyl methacrylate (PMMA) full arch reference model with prepared teeth (FDI 11,14,17 for crowns and FDI 26 for onlay) and an edentulous region (between FDI 14 and 17). The scanners were used eight times; STL files were imported into Geomagic Control X for accuracy assessment by comparing them to a reference data set created by an industrial high-precision scanner (AICON SmartScan-3D C5). The average deviation of the surface points was calculated in three locations: across a full arch (Parameter 1), the region of a four-unit bridge (Parameter 2), and a single prepared abutment (Parameter 3). RESULTS: In parameter 1 and 2, the newest model with the latest software (TRI4_2) reached the highest accuracy (31.06 ± 5.24 µm and 21.69 ± 7.50 µm). In parameter 3, an older generation scanner running legacy software produced the highest accuracy: TRI4_1, 11.75 ± 0.35 µm. CONCLUSION: Appropriate software updates can significantly increase the trueness and precision of intraoral scanner devices. With updated software, the older generation can match the accuracy level of latest equipment.

Clear guidance to select the most accurate technologies for 3D printing dental models - A network meta-analysis✰.

OBJECTIVES: Thus far, the findings of numerous studies conducted on the accuracy of three-dimensional (3D) printed dental models are conflicting. Therefore, the aim of the network meta-analysis (NMA) is to determine the accuracy of 3D printed dental models compared with digital reference models. DATA: Studies comparing the accuracy of 3D printed full-arch dental models manufactured using different printing techniques to initial STL files were included. SOURCES: This study was registered in PROSPERO (CRD42021285863). An electronic search was performed across four databases in November 2021, and search was restricted to the English language. STUDY SELECTION: A systematic search was conducted based on a prespecified search query. 16,303 articles were pooled after the removal of the duplicates. Following study selection and data extraction, 11 eligible studies were included in the NMA in 6 subgroups. The outcomes were specified as trueness and precision and expressed as root mean square (RMS) and absolute mean deviation values. Seven printing technologies were analyzed: stereolithography (SLA), digital light processing (DLP), fused deposition modeling/fused filament fabrication (FDM/FFF), MultiJet, PolyJet, continuous liquid interface production (CLIP), and LCD technology. The QUADAS-2 and GRADE were used to evaluate the risk of bias and certainty of evidence. CONCLUSIONS: SLA, DLP, and PolyJet technologies were the most accurate in producing full-arch dental models. CLINICAL SIGNIFICANCE: The findings of the NMA suggest that SLA, DLP, and PolyJet technologies are sufficiently accurate for full-arch dental model production for prosthodontic purposes. In contrast, FDM/FFF, CLIP, and LCD technologies are less suitable for manufacturing dental models.

Teledentistry: A Future Solution in the Diagnosis of Oral Lesions: Diagnostic Meta-Analysis and Systematic Review.

Introduction: Teledentistry (TD) can offer a wide range of possibilities in the field of oral medicine. Oral potentially malignant disorders (OPMDs) are hard to detect, and even harder to diagnose correctly. With the help of TD, OPMDs can be detected and diagnosed by a remote specialist. Our aim was to investigate whether TD could provide a reliable diagnostic method compared with clinical oral examination (COE) in the diagnosis of OPMDs. Methods: A systematic search was conducted in three databases (Medline, EMBASE, CENTRAL) until November 2021. We included studies that compared telediagnosis and COE, both made by experts. Pooled specificity and sensitivity were calculated and visualized on a two-dimensional plot. Risk of bias was assessed using the QUADAS-2 tool, and the level of evidence is shown with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Results: Of the 7,608 studies, 13 were included in the qualitative and 9 in the quantitative synthesis. Using TD tools in the detection of oral lesions (OLs) showed high specificity (0.92 confidence interval [95% CI] = 0.59-0.99) and sensitivity (0.93 95% CI = 0.17-1.00). In the differential diagnosis of lesions, we found high sensitivity and specificity (0.942 95% CI = 0.826-0.982 and 0.982 95% CI = 0.913-0.997), respectively. We summarized the available data on time-effectiveness, screening person, referral decision, and technical settings. Conclusion: Detecting OLs with TD tools might lead to earlier diagnosis, treatment, and stricter follow-up of OPMD. TD may offer a great substitution for COE in the diagnosis of OLs, and thus, fewer referrals could be made to special care, resulting in a greater number of treated OPMDs.

Digital intraoral scanner devices: a validation study based on common evaluation criteria.

BACKGROUND: The evolution of intraoral scanners (IOSs) is rapid, and new IOSs appear on the market with different properties depending on the manufacturers. There is no uniform rating system based on a defined set of aspects that has reported in the literature that can be used to compare these devices. This validation study aimed to compare different IOSs based on objective and comprehensive parameters. METHODS: In this study, 12 different IOSs were examined. The IOSs that were tested in this study in order of their delivery included the 3Shape Trios 3 Pod®, Planmeca Emerald®, Straumann DWIO®, GC Aadva®, iTero Element 2®, CEREC Primescan®, Medit i500®, 3Shape Trios 4 Move®, Carestream CS3600®, 3Shape Trios 4 Pod®, Carestream CS3700®, and Planmeca Emerald S®. IOSs were evaluated in four different ways: (a)summary chart, (b)comparative assessment, (c)data based on in vitro measurements and (d)accuracy measurements. A scoring system was created to enable an objective rating of IOSs. RESULTS: The differences among IOSs were demonstrated in point scores (summary chart[max. 10 points] + weight of IOSs[max. 2.5 points] + circumference of IOSs[max. 2.5 points] + in vitro scanning time[max. 2.5 points] + pauses in data capture[max. 2.5 points] + accuracy[max. 10 points] = summary[max. 30 points]). Trios 4 Pod achieved the greatest cumulative score (23.37 points), furthermore it earned the highest points for summary chart and scanning speed. Regarding scanning continuity, the best-performing IOSs, which tied at identical point scores, were the Trios 3 and 4 Pod, Trios 4 Move, iTero Element 2, CS3600 and CS3700. The most accurate IOS was the CEREC Primescan, although it earned the lowest points of the comparative assessment (heaviest IOS). GC Aadva scored 5.73 points of a maximum of 30 points, which was the poorest result in this study. CONCLUSION: The scoring system reflects the differences among IOS devices based on the evaluated objective parameters and can be used to help clinicians select the right IOS device. The new generations of IOSs have more special properties, and their accuracy is higher than the previous versions. Trial registration The permission for this study was granted by University Ethics Committee of Semmelweis University (SE RKEB number:108/2019).

Acalabrutinib and its use in the treatment of chronic lymphocytic leukemia.

Bruton's tyrosine kinase inhibitors have changed the treatment landscape for chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL) and lymphoplasmacytic lymphoma dramatically. In 2019, acalabrutinib was approved by the US FDA for the treatment of treatment-naive and relapsed/refractory CLL and MCL. Acalabrutinib monotherapy was found to be effective and safe in CLL patients. In ASCEND and ELEVATE treatment-naive studies, acalabrutinib monotherapy and the combination with obinutuzumab demonstrated improved efficacy and an acceptable safety profile. The triple combination with venetoclax showed a high rate of molecular remission without an impaired safety profile. Adverse events, with an occurrence rate of >20%, were as follows: grade 1-2 myelosuppression, gastrointestinal toxicity, rash, constitutional symptoms; grade 3 or 4 toxicities were syncope, pneumonia, hypertension, atrial fibrillation, neutropenia and thrombocytopenia.