The use of digital technologies in peri-implant soft tissue augmentation - A narrative review on planning, measurements, monitoring and aesthetics.

OBJECTIVE: To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri-implant soft tissue conditions and aesthetics. METHODS: A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri-implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search. RESULTS: Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri-implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra-crestal tissue height and keratinized mucosa width, (ii) evaluation of peri-implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri-implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians. CONCLUSION: As digital technologies progress, their full potential in peri-implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered.

Digital planning and bone regenerative technologies: A narrative review.

OBJECTIVES: The aim of this narrative review was to explore the application of digital technologies (DT) for the simplification and improvement of bone augmentation procedures in advanced implant dentistry. MATERIAL AND METHODS: A search on electronic databases was performed to identify systematic reviews, meta-analyses, randomized and non-randomized controlled trials, prospective/retrospective case series, and case reports related to the application of DT in advanced implant dentistry. RESULTS: Seventy-nine articles were included. Potential fields of application of DT are the following: 1) the use of intra-oral scanners for the definition of soft tissue profile and the residual dentition; 2) the use of dental lab CAD (computer-aided design) software to create a digital wax-up replicating the ideal ridge and tooth morphology; 3) the matching of STL (Standard Triangulation Language) files with DICOM (DIgital COmmunication in Medicine) files from CBCTs with a dedicated software; 4) the production of stereolithographic 3D models reproducing the jaws and the bone defects; 5) the creation of surgical templates to guide implant placement and augmentation procedures; 6) the production of customized meshes for bone regeneration; and 7) the use of static or dynamic computer-aided implant placement. CONCLUSIONS: Results from this narrative review seem to demonstrate that the use of a partially or fully digital workflow can be successfully used also in advanced implant dentistry. However, the number of studies (in particular RCTs) focused on the use of a fully digital workflow in advanced implant dentistry is still limited and more studies are needed to properly evaluate the potentials of DT.

Evaluating free segmentation tools for CBCT-derived models: Cost-effective solutions.

OBJECTIVES: This study evaluated the segmentation accuracy and reliability of free software packages and compared them with commercial alternatives. MATERIAL AND METHODS: A total of 36 stone models were scanned using a desktop scanner and then imaged by cone beam computed tomography (CBCT). The CBCT volumes were segmented using 2 free software packages (3D Slicer and Blue Sky Plan) and 2 commercial software packages (Mimics and OnDemand3D). Stereolithography (STL) files generated by the desktop scanner were used as the control group (reference models). The accuracy of segmentation was evaluated by (1) comparing 6 linear measurements taken from each STL model generated by the 4 software packages with that obtained by the scanner, and (2) deviation analysis of each STL model generated by the 4 software packages with that obtained by the scanner. Absolute error and percentage error, repeated measures anova and Friedman test followed by post hoc analysis, intraclass correlation coefficient (ICC), and Pearson's r were used to evaluate the accuracy of the tested software packages. RESULTS: There was no statistically significant difference in all intra-arch measurements obtained using the four software packages. Measurements obtained using the free software packages and the scanner showed excellent positive correlation, ranging from 0.825 to 0.988, confirming equivalence with commercial software packages. CONCLUSION: Within the settings of the current study, accurate and time-saving segmentations with high positive correlation could be performed using the tested free segmentation software packages (3D Slicer and Blue Sky Plan). Nevertheless, further evaluation is necessary to gage their accuracy using different CBCT modalities.

Translucent monolithic zirconia titanium-supported FP1 full-arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges.

OBJECTIVE: Despite the wide clinical use of translucent zirconia for full-arch implant prostheses, reduced flexural strength and fracture toughness compared with high-strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full-arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented. CLINICAL CONSIDERATIONS: Computer-guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three-dimensional (3D)-printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft-tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart. CONCLUSIONS: Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full-arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full-arch prosthesis. CLINICAL SIGNIFICANCE: Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full-arch prosthesis.

Digital resources for surgical and restorative treatment of excessive gingival display in one session.

OBJECTIVE: This article aims to showcase the implementation of a digital workflow in addressing a case of multifactorial excessive gingival display in a patient with high esthetic demands, incorporating both surgical and restorative interventions in a single session. CLINICAL CONSIDERATIONS: A 28-year-old female patient presented with excessive gingival display, attributed to a combination of short teeth due to altered passive eruption, lip hyperactivity, and a sub-nasal depression that lodged the upper lip during spontaneous smiling. The multidisciplinary treatment strategy encompassed surgical crown lengthening, the placement of a biovolume in the maxillary concavity, and the rehabilitation of the six anterior teeth with direct composite resin, all done in a single session. Smilecloud Biometrics was used to digitally plan the smile, and the final wax-up/mock-up was approved by the patient prior to any irreversible procedure. A digital planning center (GuiderLab) enabled the materialization of the virtual planning and the printing of the periodontal surgical guide, the biovolume, and the resin layering guides for the restorative technique. CONCLUSIONS: Adopting a digital workflow in multidisciplinary cases with excessive gingival display leads to predictable and more expedited outcomes, ensuring a favorable result between soft and hard tissues. CLINICAL SIGNIFICANCE: Excessive gingival display is a condition with multifactorial etiologies, including dentoalveolar, periodontal, skeletal, or muscular origins, or a combination of these factors. The diagnoses of altered passive eruption and a hypermobile upper lip are common in daily clinical practice and can be successfully managed through surgical crown lengthening and filling of the maxillary concavity, respectively. To achieve the desired outcome, restorative procedures often complement these surgical interventions.

Immediate loading on two adjacent single dental implants with definitive nonsplinted restorations: A proof of concept in the posterior zone.

OBJECTIVES: To evaluate clinical, clinician- and patient-reported outcomes (PROs) of two adjacent single posterior implants immediately loaded with definitive single crowns up to 1 year. Ten patients in need of two adjacent posterior single implants were included. All implants were placed applying a fully digital workflow. Definitive screw-retained single zirconia crowns were delivered within 72 h after implant placement. Clinical parameters, patient- and clinician-reported outcomes were assessed up to 1 year of follow-up. CLINICAL CONSIDERATIONS: Clinical outcomes remained stable, with no implant failures or technical and biological complications throughout the observation period. Patient satisfaction was very high at baseline (crown delivery) and remained consistently high at 6 and 12 months of follow-up. Crown insertion 3 days after implant placement was rated as an easy procedure by clinicians. CONCLUSIONS: Two adjacent single implants with immediate definitive restorations (<72 h) in the posterior region appear to be a viable and easy treatment option to shorten the overall treatment time and potentially enhancing patient satisfaction. However, randomized controlled trials are needed to confirm the advantages of this treatment protocol over a delayed loading approach. CLINICAL SIGNIFICANCE: In selected cases, immediate implant loading with definitive restorations in the posterior region appears a valuable and straightforward option to shorten the overall treatment time.

3D virtual patient-Magnetically retained printed stackable system for implant guided placement: Case report.

OBJECTIVE: The aim of this report is to present the complete workflow of 3D virtual patient for planning and performing implant surgery with magnetically retained 3D-printed stackable guides. CLINICAL CONSIDERATIONS: A 3D-printed stackable system was proposed based on bone, dental, and facial references. Initially, a 66-year-old male patient was digitalized through photographs, cone beam computed tomography, and intraoral scans (Virtuo Vivo, Straumann). All files were merged to create a 3D virtual patient in the planning software (coDiagnostiX, Straumann). Sequential stackable guides were designed, printed, and cured. Magnets were inserted into connectors, and the interim protheses received color characterization. Four mounted guides were produced for the specific purposes of pin fixation, bone reduction, implant placement, and immediate provisionalization. After surgery and healing period, patient digital data were updated. Final implant positions were compared to planned values and inconsistencies were clinically acceptable. The mean angular deviation was 5.4° (3.2-7.3) and mean 3D discrepancies were of 0.90 mm (0.46-1.12) at the entry point and 1.68 mm (1.00-2.20) at implant apex. Case follow-up revealed stability, patient's comfort, and no intercurrences. CONCLUSION: Magnetically retained stackable guides provide treatment accuracy and reduce surgical and prosthetic complications. The projected virtual patient enhances decision-making and communication between the multidisciplinary team and the patient, while decreases time and costs. CLINICAL SIGNIFICANCE: Bidimensional diagnosis and freehand implant placement have limitations and outcomes often rely on professionals' expertise. Performing facially driven virtual planning improves treatment predictability. This approach promotes function, esthetic harmony, and patient satisfaction. Implant guided surgery and 3D printed prostheses constitute a reproducible digital workflow that can be implemented into clinical practice to optimize dental care.

The fracture strength and the failure mode of lithium disilicate or resin nano ceramics as a crown, overlay, or endocrown restoration on endodontically treated teeth.

INTRODUCTION: Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode. The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core. MATERIALS AND METHODS: Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture. RESULTS: Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength. CONCLUSION: No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

Evaluation of the accuracy of conventional and digital implant impression techniques in bilateral distal extension cases: a randomized clinical trial.

BACKGROUND: This clinical study aims to evaluate the accuracy of the conventional implant impression techniques compared to the digital impression ones in bilateral distal extension cases. METHODS: A total of 32 implants were placed in eight patients missing all mandibular posterior teeth except the first premolars. Each patient received a total of four implants, with two implants placed on each side, in order to provide support for three units of screw-retained zirconia restorations. Following osteointegration, the same patient underwent two implant-level impression techniques: Conventional open-tray impressions CII (splinted pick-up) and digital implant impressions DII with TRIOS 3 Shape intraoral scanner. The accuracy of impressions was evaluated utilizing a three-dimensional superimposition analysis of standard tessellation language (STL) files. Subsequently, the scan bodies were segmented using Gom inspect software to measure three-dimensional deviations in a color-coding map. Data were statistically analyzed using the Kruskal Wallis test and then a post-hoc test to determine the significance level (P < 0.05). RESULTS: The study revealed that higher angular and positional deviations were shown toward distal scan bodies compared to mesial ones for both impression techniques. However, this difference was not statistically significant (P > 0.05). CONCLUSION: Splinted open-tray conventional impression and intraoral scanning implant impression techniques have demonstrated comparable accuracy. TRIAL REGISTRATION: Clinical Trials.gov Registration ID NCT05912725. Registered 22/06/ 2023- Retrospectively registered, https://register. CLINICALTRIALS: gov .

An esthetic minimally invasive rehabilitation performed with a fully digital workflow and hybrid restorative approach.

AIM: The aim of the present study was to demonstrate that fully digital workflows can provide predictable esthetic and functional outcomes. MATERIALS AND METHODS: The present clinical case report provides a step-by-step documentation of a full-mouth rehabilitation planned and performed with a fully digital approach utilizing an adhesive and no-prep method. After assessing the patient's needs, a treatment plan was established that considered the patient's functional and esthetic requests. The overlap of 2D images and 3D models and facial scans of the patient allowed the digital previsualization of the esthetic result by implementing the "copy-paste" approach to restore the maxillary anterior sextant. CONCLUSION: The final outcome was satisfactory in terms of esthetics, function, and soft tissue health.

Crown adjustment and chairside efficiency of single-unit restorations fabricated from immediate and staged impressions using a digital workflow for posterior implants.

PURPOSE: This is a clinical study to compare immediate and staged impression methods in a complete digital workflow for single-unit implants in the posterior area. MATERIALS AND METHODS: Sixty patients requiring single-unit implant crowns were enrolled. Forty patients were assigned to the test group, immediate digital impression after implant surgery with crown delivery 4 months later. The remaining 20 patients were assigned to the control group, staged digital impressions 4 months after implant surgery, and crown delivery 1 month later. Both workflows involved free-model CAD-CAM crown fabrications. The crowns were scanned before and after clinical adjustment using an intraoral scanner (TRIOS Color; 3Shape). Two 3D digital models were trimmed and superimposed to evaluate the dimensional changes using Geomagic Control software. Chairside times for the entire workflow were recorded. Kruskal-Wallis was performed to compare crown adjustments between two groups, while One-way ANOVA was used to compare chairside time durations between the test and control groups. RESULTS: All crowns were delivered without refabrication. The average maximum occlusion adjustment of crowns was -353.2 ± 207.1 µm in the test group and -212.7 ± 150.5 µm in the control group (p = 0.02). The average area of occlusal adjustment, measured as an area of deviation larger than 100 µm, was 14.8 ± 15.3 and 8.4 ± 8.1 mm2 in the test and control groups, respectively (p = 0.056). There were no significant differences in the mesial and distal contact adjustment amounts, or the maximum deviations of the proximal area, between the two groups. The mean chair-side time was 50.25 ± 13.48 and 51.20 ± 5.34 min in the test and control groups, respectively (p = 0.763). CONCLUSIONS: The immediate impression method in the digital workflow for single-unit implants required more occlusal adjustments of crowns but showed similar chairside times compared to the staged impression method.

Digital workflow for duplication of gold onlay anatomy to monolithic zirconia onlay for a complete denture: A technique paper.

Digital replication of an existing cast gold onlay anatomy to a more esthetic material for a new complete denture is challenging. A technique is presented that uses digital technology to fabricate a new maxillary complete denture with monolithic zirconia onlays that duplicate the anatomy of an existing complete denture with cast gold onlays.

Digital workflow for proximal adjustment of teeth adjacent to implant-supported fixed restorations using a predesigned computer-aided grinding guide.

Clinically, the proximal surfaces of teeth adjacent to an implant restoration usually need to be adjusted to build a preferable adjacency relationship. However, it is difficult for freehand preparation to get a favorable proximal contour in some cases. In the workflow presented here, virtual grinding can be made to adjacent teeth, under the consideration of functional reconstruction and biological requirements, and then the grinding can be implemented using digital templates and a specialized bur. This allows for more precise and accurate adjustments to be made during the clinical procedure, reducing the risk of over- or under-preparation of the proximal surfaces. In addition, the use of specialized diamond burs and grinding guides can make the procedure more efficient and streamlined, reducing the time required for proximal adjustment and minimizing patient discomfort. The resulting implant-supported prosthesis is more likely to function properly and last longer, as the precise proximal contacts can help distribute occlusal forces more evenly across the dentition. Overall, the use of digital technology for precise adjustment of proximal contacts during implant restorations represents an important advancement in modern dentistry, enabling dentists to provide their patients with more accurate, efficient, and effective dental care.

A digital workflow for designing and manufacturing metal frameworks and removable partial dentures: A novel dental technique.

The purpose of this technical report is to demonstrate a fully digital workflow for designing and fabricating metal frameworks and removable partial dentures. After obtaining a digital cast of the dental arch with bilateral distal extension defect, computer-aided design software and 3D printing technology are used for the design and fabrication of the removable partial denture frameworks, denture teeth, and denture bases, instead of the traditional workflow. The assembly of the three components is facilitated through a meticulously structured framework. The technology, which prints metal frameworks, denture bases, and denture teeth through different processes with different materials, achieves full 3D printing technology for making removable partial dentures.

Depth distortion and angular deviation of a fully guided tooth-supported static surgical guide in a partially edentulous patient: A systematic review and meta-analysis.

PURPOSE: This systematic review and meta-analysis aimed to evaluate the depth distortion and angular deviation of fully-guided tooth-supported static surgical guides (FTSG) in partially edentulous arches compared to partially guided surgical guides or freehand. MATERIAL AND METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the Open Science Framework (OSF). The formulated population, intervention, comparison, and outcome (PICO) question was: "In partially edentulous arches, what are the depth distortion and angular deviation of FTSG compared to partially guided surgical guides or freehand?" The search strategy involved four main electronic databases, and an additional manual search was completed in November 2023 by following an established search strategy. Initial inclusion was based on titles and abstracts, followed by a detailed review of selected studies, and clinical studies that evaluated the angular deviations or depth distortion in FTSG in partial arches, compared to partially guided surgical guides or freehand, were included. In FTSG, two surgical approaches were compared: open flap and flapless techniques, and two digital methods were assessed for surgical guide design with fiducial markers or dental surfaces. A qualitative analysis for clinical studies was used to assess the risk of bias. The certainty of the evidence was assessed according to the grading of recommendations, assessment, development, and evaluations (GRADE) system. In addition, a single-arm meta-analysis of proportion was performed to evaluate the angular deviation of freehand and FTSG. RESULTS: Ten studies, published between 2018 and 2023, met the eligibility criteria. Among them, 10 studies reported angular deviations ranging from -0.32° to 4.96° for FTSG. Regarding FTSG surgical approaches, seven studies examined the open flap technique for FTSG, reporting mean angular deviations ranging from 2.03° to 4.23°, and four studies evaluated flapless FTSG, reporting angular deviations ranging from -0.32° to 3.38°. Six studies assessed the freehand surgical approach, reporting angular deviations ranging from 1.40° to 7.36°. The mean depth distortion ranged between 0.19 mm to 2.05 mm for open flap FTSG, and between 0.15 mm to 0.45 mm for flapless FTSG. For partially guided surgical guides, two studies reported angular deviations ranging from 0.59° to 3.44°. Seven studies were eligible for meta-analysis, focusing on the FTSG in open flap technique, with high heterogeneity (I2 (95%CI) = 92.3% (88.7%-96.4%)). In contrast, heterogeneity was low in studies comparing freehand versus FTSG in open flap techniques (I2 (95%CI) = 21.3% (0.0%-67.8%)), favoring the FTSG surgical approach. CONCLUSION: In partially edentulous arches, FTSG systems exhibited less angular deviation than freehand and partially guided surgical guides. Flapless surgical approaches were associated with reduced angular deviation and depth distortion, suggesting a potential preference for the FTSG method in these procedures.

Zirconia full-arch implant prostheses: Survival, complications, and prosthetic space dimensions with 115 edentulous jaws.

PURPOSE: To assess the survival and complication rates of 115 monolithic zirconia implant-supported fixed complete dental prostheses (IFCDPs) with an up to 6-year follow-up. MATERIALS AND METHODS: One hundred fifteen edentulous jaws (71 patients) underwent complete-arch implant treatment with a digital workflow and were rehabilitated with monolithic zirconia IFCDPs. The primary outcome was to assess survival and complication rates while the secondary outcome was to measure the cross-sectional dimensions (prosthetic space) of those 115 monolithic zirconia IFCDPs and to correlate potential technical complications with the prosthetic space dimensions. RESULTS: Out of the 115 zirconia IFCDPs, 2 fractured, yielding a 98.6% survival rate up to a 6-year follow-up. The most commom minor technical complications were loss of screw access channel filling and porcelain chipping for the modified monolithic IFCDPs. There was no significant association between the count and type of complications and jaw location (maxilla vs. mandible) or prosthesis type (FP1 vs. FP3), according to Fisher's exact test. For maxillary zirconia IFCDPs, the mean square surface for the at the posterior abutment cross-sectional area was 25.18 mm2 at the lingual side of the abutment and 34.19 mm2 at the buccal side, respectively. The anterior abutment cross-sectional area was 33.92 mm2 at the lingual side of the abutment and 29.49 mm2 at the buccal side, respectively. For mandibular zirconia IFCDPs, the mean square surface at the posterior abutment cross-sectional area was 29.89 mm2 at the lingual side of the abutment and 39.05 mm2 at the buccal side, respectively. The anterior abutment cross-sectional area was 27.07 mm2 at the lingual side of the abutment and 56.50 mm2 at the buccal side, respectively. At the connector cross-sectional area, the mean square surface for the maxillary zirconia IFCDPs was 64.33 and 90.56 mm2 for the mandibular zirconia IFCDPs. The two fractures occurred in the midline (anterior area) for both maxillary FP1 prosthesis and mandibular FP3 prosthesis. The mean surface area at the connector for the maxillary FP1 prosthesis was 28.50 and 82.11 mm2 for the mandibular FP3 prosthesis, and was within the range of IFCDP connector square surface area. There was no significant association between the thickness of the zirconia prosthesis and the encountered prosthesis fractures. CONCLUSIONS: Monolithic zirconia IFCDPs yielded a 98.6% survival rate, after a mean observation period of 62 months with an SE of 3.1. The connector mean surface area in the two fractured IFCDPs was within the square surface range (minimum-maximum) as for the remaining 113 complication-free IFCDPs.

Reverse scan body: Complete digital workflow for double full-arch zirconia prostheses.

During intraoral complete-arch digital implant scanning, one of the most technique-sensitive steps is the implant data acquisition and merging of different surface geometry data sets for prototype prosthesis fabrication due to the absence of fixed landmarks. Recently developed extraoral techniques have allowed for an alternative approach for the digital acquisition of implant position in completely edentulous patients. Specifically, extraoral digital scanning of the conversion prosthesis after connecting reverse scan bodies has been proposed as an efficient approach. The reverse scan body protocol digitally simulates the traditional back-pouring technique long utilized in analog workflows. The present article describes a technique for simplifying the digital workflow for the fabrication of passive-fitting definitive prostheses using the reverse scan body concept.

Survey in radiation oncology departments in Germany, Austria, and Switzerland: state of digitalization by 2023.

PURPOSE: The aim of this work was to assess the current state of digitalization in radiation oncology departments in Germany, Austria, and Switzerland. METHODS: A comprehensive survey was conducted in a digital format, consisting of 53 questions that covered various aspects of digitalization including patient workflow, departmental organization, radiotherapy planning, and employee-related aspects. RESULTS: Overall, 120 forms were eligible for evaluation. Participants were mainly physicians or medical physicists responsible for digitalization aspects in their departments. Nearly 70% of the institutions used electronic patient records, with 50% being completely paperless. However, the use of smartphone apps for electronic patient reported outcomes (ePROMs) and digital health applications (DIGA) was limited (9% and 4.9%, respectively). In total, 70.8% of the radio-oncology departments had interfaces with diagnostic departments, and 36% had digital interchanges with other clinics. Communication with external partners was realized mainly through fax (72%), e­mails (55%), postal letters (63%), or other digital exchange formats (28%). Almost half of the institutions (49%) had dedicated IT staff for their operations. CONCLUSION: To the best of our knowledge, this survey is the first of its kind conducted in German-speaking radiation oncology departments within the medical field. The findings suggest that there is a varied level of digitalization implementation within these departments, with certain areas exhibiting lower rates of digitalization that could benefit from targeted improvement initiatives.

A double-blind randomized within-subject study to evaluate clinical applicability of four digital workflows for the fabrication of posterior single implant crown.

OBJECTIVE: To compare efficiency and clinical efficacy of posterior single implant crowns (PSIC) fabricated using four digital workflows. MATERIALS AND METHODS: Twenty-two patients with one missing first molar were included. Each patient received four screw-retained implant crowns fabricated through four different workflows including a fully digital workflow with immediate digital impression (Group i-IOS), a fully digital workflow with digital impression after implant osseointegration (Group d-IOS), a model-based hybrid workflow using immediate analogue impression (Group i-AI), and a model-based hybrid workflow with conventional analogue impression after implant osseointegration (Group d-AI). The crown delivery sequence was randomized and blinded. The efficiency for each workflow and clinical outcome of each crown were recorded. RESULTS: The average clinical working time in fully digital workflows (i-IOS 46.90 min, d-IOS 45.66 min) was significantly lower than that in the hybrid workflows (i-AI 54.59 min, d-AI 55.96 min; p < .001). Significantly more laboratory time was spent in hybrid workflows (i-AI 839.60 min, d-AI 811.73 min) as compared to fully digital workflows (i-IOS 606.25 min, d-IOS 607.83 min, p < .01). No significant differences in the chairside time at delivery were found. More crowns in Group i-AI (15%) needed additional laboratory interventions than in the other groups (p = .029). CONCLUSION: Digital impression and model-free fully digital workflow improved prosthetic efficiency in the fabrication of PSIC. With the limitation that the results were only applicable to the implant system used and the digital technologies applied, findings suggested that workflows integrating immediate impression with implant surgery procedure was clinically applicable for restoration of PSIC.

Clinical evaluation and quantitative occlusal change analysis of posterior implant-supported all-ceramic crowns: A 3-year randomized controlled clinical trial.

OBJECTIVES: To compare the survival and complication rates of posterior screw-retained monolithic lithium disilicate (LS2 )/veneered zirconia (ZrO2 ) single implant crowns (SICs), as well as analyze the occlusal changes observed during a 3-year follow-up period. MATERIALS AND METHODS: Thirty-three patients were included and randomly divided into two groups. The test group consisted of 17 patients who received monolithic-LS2 -SIC, while the control group consisted of 16 patients who received veneered-ZrO2 -SIC. Implant/prosthesis survival rates, technical complications, peri-implant soft tissue conditions, and quantitative occlusal changes of SIC (obtained by the intra-oral scanner and analyzed in reverse software Geomagic Control 2015) were assessed at 1- and 3-year follow-ups. Bone loss and Functional Implant Prosthodontic Score (FIPS) were evaluated at a 3-year follow-up. RESULTS: After a 3-year follow-up period, one patient dropped out of the follow-up. No implant loss was observed. One crown was fractured, resulting in prosthesis survival rates of 93.75% for the monolithic group and 100% for the veneered group. A technical complication rate of 25% (4/16) was observed in the veneered group (p = .333). No significant differences in the marginal bone loss were observed at the 3-year follow-up (0.00 (-0.22, 0.17) mm versus 0.00 (-0.12, 0.12) mm, p = .956). The total FIPS scores for the test group were 9.0 (9.0, 9.0), while the control group received scores of 9.0 (8.0, 10.0) (p = .953). The changes in mean occlusal clearance were 0.022 ± 0.083 mm for the test and 0.034 ± 0.077 mm for the control group (at 3 years, p = .497). The changes in occlusal contact area were 1.075 ± 2.575 mm2 for the test and 1.676 ± 2.551 mm2 for the control group (at 3 years, p = .873). CONCLUSION: After a 3-year follow-up, screw-retained monolithic LS2 and veneered ZrO2 SIC demonstrated similar survival rates. The occlusal performance of implant prostheses needs to be closely examined during follow-up, and appropriate occlusal adjustments need to be considered.