Dimensional changes of the gingival tissues induced by clear aligners and fixed orthodontic appliances: A retrospective study.

OBJECTIVE: The aim of this study was to evaluate gingival tissue adaption induced by orthodontic tooth movement, in terms of clinical crown height (i.e., attachment loss), and thickness of the keratinized gingiva at the margin level. METHODS: Pre- and post-treatment intraoral models/scans of 100 orthodontically treated patients (50 treated with clear aligners and 50 treated with fixed appliance) were acquired. Models were digitally scanned. Each couple of pre- and post-treatment scans were superimposed using the Compare© software (Medit spa, Seoul, Republic of Korea) taking the same reference landmarks in all cases, that were the palatal rugae for the upper arch, and the labial median frenulum for the lower arch. Only teeth that had undergone vestibulo-palatal (or vice versa) movement, greater than 1 mm were included in the analyses. The change from pre-treatment to post-treatment, in the clinical crown height and thickness of the keratinized gingiva at the margin level were digitally measured and compared between the two groups. Statistical analysis included paired t-tests, and unpaired t-tests with significance set at p<0.05. RESULTS: There was a statistically significant change in clinical crown height and gingival thickness in both groups. However, a clinically relevant attachment loss was found only within the fixed appliance group. Whereas, regarding the change in gingival thickness, there was no clinically relevant changes between the two groups. CONCLUSIONS: Orthodontic tooth movement with fixed appliance is associated to a clinically relevant attachment loss. Clear aligners seem to be associated with a more discrete attachment loss than the one observed with fixed appliances. CLINICAL RELEVANCE: Orthodontists should pay attention and monitoring the clinical crown height (i.e., attachment loss) during orthodontic movement, mostly when using fixed appliances.

3D printed versus milled stabilization splints for the management of bruxism and temporomandibular disorders: study protocol for a randomized prospective single-blinded crossover trial.

BACKGROUND: Nowadays, stabilization splints for the management of bruxism and temporomandibular disorders (TMD) can be produced utilizing a digital workflow comprising a digital impression of the teeth, digital splint design, and computer-aided manufacturing of the splints. The latter is usually a milling process, however, more recently 3D printing gained popularity due to its better cost and time efficiency. It remains unknown whether 3D printed stabilization splints are inferior to milled splints regarding clinical outcomes. METHODS: This clinical trial assesses the non-inferiority of 3D printed occlusal splints compared to milled occlusal splints in a monocentric prospective randomized single-blinded crossover trial with two cohorts. One cohort includes 20 participants with bruxism, the other 20 participants with pain-related TMD, i.e., myalgia, myofascial pain, or arthralgia of the jaw muscles/the temporomandibular joint(s) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Michigan-type stabilization splints are fabricated in a digital workflow by milling or 3D printing using CE-marked materials within their intended purpose. The participants wear a milled and a 3D printed splint in a randomized order for 3 months each, with follow-up visits after 2 weeks and 3 months. Investigated outcome parameters are oral health-related quality of life (OHRQoL) evaluated by the Oral Health Impact Profile (OHIP-G14), participant satisfaction as rated on a visual analog scale, therapeutic efficacy, and technical result of the splints. In this context, therapeutic efficacy means antagonist wear and-in the TMD group-reduction of pain/disability assessed by the Graded Chronic Pain Scale (GCPS v2.0) and clinical assessment following the DC/TMD standard, while technical outcome measures splint fit, wear and fracture rate. DISCUSSION: The trial will provide important information on the clinical outcome of 3D printed stabilization splints in comparison to milled splints and will, therefore, enable an evidence-based decision in favor of or against a manufacturing process. This, in turn, will guarantee for a maximum of the patient's OHRQoL during splint therapy, therapeutic efficacy, and longevity of the splints. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00033904. Registered on March 15, 2024.

Application of digital workflow and technologies in clinical paediatric dentistry: a scoping review.

PURPOSE: The purpose of the present scoping review is to map the literature reporting on the application of digital workflows and digital technologies in the diagnosis, treatment, or management of dental conditions in paediatric patients. Furthermore, the review focuses on identifying possible knowledge gaps in the area and developing specific recommendations for future investigations. METHODS: An electronic search was performed on 3 databases up to July 2023. After the authors independently screened the retrieved articles, they extracted the data and assessed the risk of bias using the JBI (The Joanna Briggs Institute) critical appraisal tools and the Cochrane Risk of Bias 1 tool, depending on the study design assessed. RESULTS: After full-text assessment, 58 studies were identified that met the inclusion and exclusion criteria. The results were divided into two groups according to the study design: 36 were research articles, and 22 were case reports; only the research articles were included in the qualitative synthesis. The most common topic was Scanners/3 d digital model analysis (11 articles), followed by Digital Imaging (8 articles). Digital applications were also a popular topic, and tele-dentistry and artificial intelligence were also present in the included studies. CONCLUSION: Studies investigating the use of digital workflows and digital technologies in the diagnosis, treatment or management of dental conditions in paediatric dentistry are lacking. In general, future investigations should be based on higher quality studies; furthermore, the lack of studies on the clinical validation of digitally fabricated orthodontic devices and restorations in paediatric patients provides insights for future research.

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.

Two- and three-dimensional symmetry of maxillary incisors: A clinical study.

OBJECTIVE: To assess the 2D and 3D natural symmetry of the maxillary incisors. MATERIALS AND METHODS: Maxillary alginate impressions were taken of 59 young adult volunteers. Gender, orthodontic treatment history, and dominant hand were collected. For 2D analysis, a digital caliper was used for measurements on maxillary casts. For 3D analysis, the casts were scanned using a lab scanner, and the labial surface symmetry of contralateral incisors was evaluated. Mann-Whitney tests and Student's t-test were performed, α = 0.05. RESULTS: Results indicated a lack of identical lengths among contralateral central or lateral incisors, with minimal occurrences of identical width measurements. 68% of central incisors and 73% of lateral incisors showed differences in length exceeding 0.2 mm. Central incisors showed more similarities than lateral incisors in width, with 61% central incisors and 47% lateral incisors having differences under 0.2 mm. The differences between highly asymmetrical contralateral teeth are situated at the transitional lines. The influence of sexual dimorphism, orthodontic factors, and the dominant hand on incisors' symmetry was not statistically significant. CONCLUSIONS: 2D and 3D symmetry of the natural maxillary incisors are rare. 3D symmetry remains consistent across orthodontic treatment status, gender, and dominant hand, suggesting its independence from such parameters. CLINICAL SIGNIFICANCE: To achieve a natural and aesthetic smile rehabilitation, the symmetry of the maxillary incisors must be well understood. In our study, 2D and 3D symmetry of the maxillary incisors occurred rarely, but central incisors showed more similarities than lateral incisors in width, with differences under 0.2 mm. On the other hand, differences between highly asymmetrical contralateral teeth are situated at the transitional lines. These conclusions should be included in further computer-assisted three-dimensional smile designs.

Insights into Occlusal Analysis: Articulating Paper versus Digital Devices.

Background: As the demand for digital dentistry constantly increases, digital devices are gradually replacing conventional methods of recording occlusal contacts. The study aimed to assess the inter-rater reliability of occlusal contact point detection using 40 µm articulating paper, Medit i700, and OccluSense and to compare the distribution of occlusal contacts using the articulating paper and intraoral scanner. Material and Methods: The study included 25 participants aged 20 to 30 (13 women and 12 men). Photographs of contact points were taken and marked in maximum intercuspal position (MIP), in protrusive and laterotrusive movements, on working and non-working sides using 40 µm articulating paper and digital devices. The Cohen's Kappa coefficient assessed the inter-rater reliability. The Wilcoxon signed-rank test was used to compare dependent groups, articulating paper, and Medit i700. Results: The Cohen's Kappa index showed that almost perfect agreement was achieved with 40 µm articulating paper. Compared to Medit i700, the 40 µm articulating paper showed an increased mean number of contacts per tooth, except for the third molars. Conclusions: The 40 µm articulating paper has detected more overall contacts than the digital devices, particularly in the posterior areas. An ideal method for registering occlusal contacts has not been established yet.

Three-Dimensional Printed Lingual Arch Space Maintainer: A Game Changer in Pediatric Dentistry.

Early loss of deciduous teeth is a challenging situation to handle. In recent years, the loss of deciduous teeth has become very frequent because of the increased risk of caries. Space maintainers play a vital role in preventing space loss. Lingual arch space maintainers are effectively used to maintain space in the lower arch. In order to retain the length of the lower arch and to prevent mesial migration of the mandibular first permanent molar, lingual arch space maintainers are often indicated. Conventional lingual arch fabrication is technique-sensitive and cumbersome. Additionally, it has many documented drawbacks like solder breakage, cement loss, soft tissue lesions, etc. With the advent of newer technology like three-dimensional (3D) printing, the fabrication of appliances and prostheses has become more predictable, accurate, and relatively easier. The present case report highlights the technique and advantages of 3D printing to fabricate lingual arch space maintainers, which has the potential to revolutionize preventive orthodontics in pediatric dentistry.

A real-time interactive restoration system for intraoral digital videos using segment anything model.

Objective: Poor conditions in the intraoral environment often lead to low-quality photos and videos, hindering further clinical diagnosis. To restore these digital records, this study proposes a real-time interactive restoration system using segment anything model. Methods: Intraoral digital videos, obtained from the vident-lab dataset through an intraoral camera, serve as the input for interactive restoration system. The initial phase employs an interactive segmentation module leveraging segment anything model. Subsequently, a real-time intraframe restoration module and a video enhancement module were designed. A series of ablation studies were systematically conducted to illustrate the superior design of interactive restoration system. Our quantitative evaluation criteria contain restoration quality, segmentation accuracy, and processing speed. Furthermore, the clinical applicability of the processed videos was evaluated by experts. Results: Extensive experiments demonstrated its performance on segmentation with a mean intersection-over-union of 0.977. On video restoration, it leads to reliable performances with peak signal-to-noise ratio of 37.09 and structural similarity index measure of 0.961, respectively. More visualization results are shown on the https://yogurtsam.github.io/iveproject page. Conclusion: Interactive restoration system demonstrates its potential to serve patients and dentists with reliable and controllable intraoral video restoration.

Revolutionizing Smiles: Advancing Orthodontics Through Digital Innovation.

Orthodontics is undergoing a digital revolution, transforming traditional techniques with modern technology. This evolution is driven by the need for precise diagnosis and treatment planning. Digital platforms, including digital radiography and cone beam computed tomography (CBCT), are replacing conventional methods, enhancing documentation, analysis, and appliance production. Three-dimensional imaging enables customized treatment plans and appliance design using computer-aided design and computer-aided manufacture (CAD/CAM). Integration of digital models and software facilitates treatment simulation and patient communication. Digital videography enhances diagnostic capabilities. Embracing digital processes is essential for improved patient care and practice efficiency in orthodontics. This review article on digital orthodontics aims to provide a comprehensive overview and critical analysis of the current advancements, technologies, applications, benefits, and challenges in the field of orthodontics utilizing digital tools and technologies.

The Bio-Restorative Concept for Implant-Supported Restorations.

OBJECTIVE: This study aims to present the bio-restorative approach in implant dentistry, which combines biological and restorative concepts through digital planning. This concept combines periodontal, surgical, and prosthetic variables, aiming to reduce patient morbidity while achieving satisfactory esthetic and functional outcomes in implant-supported restorations in the long term. OVERVIEW: Implant dentistry evolved from a primarily surgical to a recent prosthetically driven approach. This evolution was partly due to advancements in bone reconstructive techniques and an increased demand for esthetic outcomes. Recently, digital planning has introduced a new paradigm that allows for the full integration of both approaches. The bio-restorative concept considers functional, esthetic, and biological variables in a virtual planning environment. This is achieved through the simultaneous digital assessment of (A) anatomical site characteristics and (B) implant restorative variables. These variables include digital tooth arrangement, soft-hard tissue conditions, implant variables, supra-platform components, and a surgical plan that respects or modifies peri-implant phenotype. CONCLUSIONS: The bio-restorative concept is intended to improve contemporary implant dentistry by integrating updated biological and prosthetic notions through digital planning. Adopting this paradigm has the potential to redefine the standards in implant dentistry, fostering a holistic and patient-centered approach. CLINICAL CONSIDERATIONS: It enhances patient and clinician satisfaction through more efficient and less invasive procedures. Significantly, it improves predictability, leading to successful implant-supported restorations in the long term.

Efficacy of Virtual Preparation Simulators Compared to Traditional Preparations on Phantom Heads.

BACKGROUND: Virtual simulators are increasingly being introduced in dental education. This study investigates whether virtual simulators offer comparable or superior educational efficacy when compared to traditional phantom simulators. MATERIALS AND METHODS: Participants were randomly allocated into groups: Virtual Preparation (SIM; n = 30) and Traditional Preparation (FRA; n = 30). Students were tasked with preparing tooth 36 for a full-cast crown during free practice for four days. Faculty staff provided feedback to both groups. Examinations were administered and graded by three examiners (preclinical and clinical consultants and a dental surgery consultant). Additionally, a survey was conducted to assess each training concept. RESULTS: The FRA group achieved significantly better grades in the preparation exam evaluations by all three examiners, compared to the SIM group. Interrater reliability showed only moderate agreement, with the clinical examiner giving better grades than the other two. The questionnaire results indicate that while participants managed with the virtual system, they preferred the analog system for exams and patient preparation. CONCLUSION: Virtual simulators do not seem to be as good when it comes to practicing for a preparation exam or clinical preparation, especially for unexperienced students. However, they still appear to be useful as an additional tool for introducing students to the topic of preparation.

Effect of build orientation on the wear resistance and hardness of denture teeth fabricated using digital light processing: An in vitro study.

PURPOSE: This in vitro study investigated the effect of build orientation on the wear resistance and hardness of denture teeth fabricated using digital light processing (DLP) compared to other denture tooth materials. METHODS: Disc-shaped specimens were prepared using denture tooth monomers and DLP devices in three build orientations: 0°, 45°, and 90°. Specimens of the same shape were fabricated using denture tooth materials for subtractive manufacturing, commercially available polymethylmethacrylate (PMMA) resin, and composite resin. The wear resistance was evaluated as the wear volume loss after 50,000 wear cycles using a ball-on-disc wear device in water for two-body wear and poppy seed slurry for three-body wear. The Vickers hardness values of the materials were measured. Two-way and one-way analyses of variance were performed for wear resistance and hardness, respectively, followed by Tukey's honest significance test. RESULTS: The interaction between the denture tooth resins and maximum wear volume was significant (P < 0.01). The 0° build orientation exhibited the lowest wear volume in the three-body wear test and the highest hardness among the three build orientations. The 0° DLP-fabricated specimens demonstrated significantly less wear volume than that of the PMMA specimens and a wear volume comparable to that of the milled specimens. However, the 0° DLP-fabricated specimens showed significantly lower hardness than that of the milled and PMMA specimens. The composite resin specimens exhibited the highest wear resistance and hardness. CONCLUSIONS: A 0° build orientation is recommended for DLP-fabricated denture teeth compared to 45° and 90° orientations to achieve greater wear resistance and hardness.

A digital workflow for full-mouth rehabilitation using CAD-CAM tooth reduction template.

A digital workflow is presented for multiple transfers of targeted jaw relation and restorative spaces from interim to definitive restorations in patients with severe tooth wear. Following analysis of the targeted restorative space, segmented arch stereolithographic templates were digitally created and fabricated for precise control of reduction depth. Then, the jaw relation was transferred from the initially determined stabilization splint to the temporary fixed restoration and definitive restoration by using a digital articulator. This digital approach yielded a stabilized jaw relationship and restorative spaces transferring effect throughout successive stages of occlusal reconstruction resulting in satisfactory prosthetic outcomes.

Introducing a novel approach to dental color reproduction using AI technology.

OBJECTIVE: This article aims to describe a systematic method for tooth color reproduction with ceramics restorations employing artificial intelligence (AI) software named Matisse. It provides a comprehensive analysis of the entire process, beginning with shade-taking and extending to ceramic application in a complex clinical case in the anterior region-specifically, a single central restoration supported by an implant. CLINICAL CONSIDERATIONS: The clinical case presented highlights the potential of Matisse software for generating ceramic (inSync-Jensen Dental, USA) and staining (Miyo-Jensen Dental, USA) recipes over a zirconia abutment (Katana-Noritake Dental, Japan). This approach achieves an optimal single central restoration utilizing CAD-CAM and layering techniques. CONCLUSIONS: The systematic method employing the Matisse software achieved accurate color reproduction for a single central restoration supported by an implant. This result was achieved by the dental ceramist within the first attempt and without seeing the patient in the entire process. CLINICAL SIGNIFICANCE: The Matisse AI-assisted protocol offers a systematic and scientifically grounded method for color reproduction in dentistry for indirect restorations.

Are physical and mechanical properties of 3D resins dependent on the manufacturing method?

This research analyzed the effect of the manufacturing method on the flexural strength and color stability of 3D-printed resins used for producing indirect restorations. For this, two dental restorative biocompatible resin materials, OnX (OnX, SprintRay) and CB (Crown and Bridge, Dentca), were divided into 2 groups according with manufacturing method (printed with a Pro95 3D printer - SprintRay; and not printed, with samples obtained with the fluid resin being poured on PVS molds for further light activation in the post-curing process), and subdivided into 2 groups according to the post-curing method: VG (Valo Grand, Ultradent Products) for 120 s and PC (Procure 2, SprintRay). Bar-shaped samples were used to evaluate the flexural strength 24 h after storage in distilled water at 37 °C using a universal testing machine. Disk-shaped samples were used to evaluate the color stability with a spectrophotometer at baseline, after 1-7 days in dark dry storage at 37 °C, and after 1 day of artificial aging in water at 60 °C. Data were evaluated using 3-way ANOVA (flexural strength) and 4-way repeated measures ANOVA (color stability), followed by the Tukey's HSD test (α = .05). Flexural strength showed significant results for resin (p < .001), while manufacturing and post-curing methods were not significant (p > .05). The interaction effects between resin and manufacturing method (p = .978), and between resin, manufacturing method and post-curing method (p = .659) were not significant. In general, OnX showed higher flexural strength values than CB, regardless of manufacturing method or post-curing protocol. Color stability results showed significant results for resin (p < .001), time (p < .001), resin and time (p = .029), and resin and curing method (p < .001), but no differences considering resin and manufacturing mode (p = .87), or resin, manufacturing method and curing method (p = .35). In general, OnX showed a higher color change than CB, longer storage times resulted in increased color change for both materials, and CB cured with VG showed lower color alteration than CB cured with PC2. The manufacturing method (3D printed or not 3D printed) does not seem to influence the flexural strength and color stability of 3D printed resins. This may indicate that, at least from a physical-mechanical perspective, the final properties of the material are mainly dependent on the post-curing process.

Revolutionizing CAD/CAM-based restorative dental processes and materials with artificial intelligence: a concise narrative review.

Artificial intelligence (AI) is increasingly prevalent in biomedical and industrial development, capturing the interest of dental professionals and patients. Its potential to improve the accuracy and speed of dental procedures is set to revolutionize dental care. The use of AI in computer-aided design/computer-aided manufacturing (CAD/CAM) within the restorative dental and material science fields offers numerous benefits, providing a new dimension to these practices. This study aims to provide a concise overview of the implementation of AI-powered technologies in CAD/CAM restorative dental procedures and materials. A comprehensive literature search was conducted using keywords from 2000 to 2023 to obtain pertinent information. This method was implemented to guarantee a thorough investigation of the subject matter. Keywords included; "Artificial Intelligence", "Machine Learning", "Neural Networks", "Virtual Reality", "Digital Dentistry", "CAD/CAM", and "Restorative Dentistry". Artificial intelligence in digital restorative dentistry has proven to be highly beneficial in various dental CAD/CAM applications. It helps in automating and incorporating esthetic factors, occlusal schemes, and previous practitioners' CAD choices in fabricating dental restorations. AI can also predict the debonding risk of CAD/CAM restorations and the compositional effects on the mechanical properties of its materials. Continuous enhancements are being made to overcome its limitations and open new possibilities for future developments in this field.

Robot-assisted dental implant surgery procedure: A literature review.

Robot-assisted dental surgery has gained significant attention in the field of dental implant therapy as an alternative to conventional free-hand surgery. It addresses challenges faced by human operators, such as limited visibility, operator fatigue, and lack of experience, which can lead to errors. Dental implant robots offer improved precision, efficiency, and stability, enhancing implant accuracy and reducing surgical risks. Accurate placement of dental implants is crucial to avoid complications during and after surgery. Robotic guidance in dental implant surgery provides several benefits. Firstly, the robotic arm offers haptic feedback, allowing physical guidance when placing the implant in the desired position. Secondly, a patient tracker integrated into the robotic system monitors patient movement and provides real-time feedback on a screen. This feature ensures that the surgeon is aware of any changes and can adjust accordingly. Lastly, the robotic system operates under human-robot collaboration, with the surgeon maintaining control and oversight throughout the procedure. Therefore, the objective of the current study is to review the dental implant robots, as well as accuracy and efficiency (e.g. operation and preparation time) of robot-assisted dental implant surgery procedures.

3D-printed shell complete dentures as a diagnostic aid for implant planning and fabricating interim restorations for complete arch rehabilitations: A case series.

3D-printed shell complete dentures generated from a scan of the patient's existing prostheses can simplify and expedite the surgical planning and interim restoration design for complete arch rehabilitations. Three patients were rehabilitated with endosteal implants, and interim restorations were generated from the contours of the 3D-printed shell complete dentures used as diagnostic aids. This case series report presents the recommended protocol and its clinical progression, in addition to clinical and radiographic images of the treatment outcomes.

Intraoral scanner-based virtual facebow transferring: A chairside dental technique.

Accurately mounting dental casts on an articulator is an essential step in prosthetic treatments. In digital dentistry, virtual articulator mounting procedures rely on virtual facebow records. However, virtual facebow records usually require devices like face scanners or jaw motion tracking systems that are not commonly available in most dental practices. The present technique report describes a straightforward intraoral scanner-based virtual facebow transfer approach. In this technique, a reference facebow joint support was first scanned and aligned with a virtual articulator. Then, a patient's facebow joint support and bite fork assembly were scanned chairside with an intraoral scanner and aligned with the virtual articulator by matching common features with the reference facebow joint support. After aligning the patient's intraoral scans with the patient's bite fork scan that was already superimposed on the virtual articulator, a virtual mounting process was achieved. Once the corresponding reference facebow joint supports have been generated, this technique can be easily implemented with most facebow systems and be seamlessly integrated into daily clinical practice as only an intraoral scanner and a conventional facebow were required.

Clinical and Histological Efficacy of Digitally Designed CAD CAM Allogenic Bone Blocks. A Prospective Cohort.

The growth in bone reconstructive surgery has been unsurpassed in recent decades. However, most bone regenerative products lack any potential for delivering site-specific morphologically driven augmentation. It was therefore the purpose of this study to evaluate the histological and clinical incorporation of a novel CAD CAM allogenic block bone graft for the reconstruction of complex 3- dimensional alveolar defects. In addition the clinical outcome of dental implants subsequently placed and loaded within these grafts was assessed with up to 5 years in function. Results demonstrated that 4 of the initial 17 blocks failed (23.5%). The remaining 13 blocks plus an additional two replacement blocks were fully or partially incorporated within the recipient bone site (79%). Of the 29 implants placed within the integrated blocks, no failures occurred with up to 5 years in function, with a recorded mean marginal bone loss by implant of -0.5mm.