Accuracy of static computer-aided implant surgery (S-CAIS) using CAD-CAM surgical templates fabricated from different additive manufacturing technologies.

STATEMENT OF PROBLEM: Different 3D printers are available for guided implant surgery, but studies that evaluate their source of errors and their cost-effectiveness are lacking. PURPOSE: The purpose of this in vitro study was to compare the accuracy of different 3-dimensional (3D) printed surgical templates made using different additive manufacturing technologies and to evaluate the effect of implant location on the accuracy of fully guided implant placement. MATERIAL AND METHODS: Fifty partially edentulous maxillary typodonts with edentulous sites in the right second premolar (SP), right lateral incisor (LI), left central incisor (CI), and left first molar (FM) locations were scanned and printed from the standard tessellation language (STL) datasets. The study compared 5 groups for the fabrication of implant surgical templates: Varseo S-Bego (Bego), Polyjet-Stratasys (Poly), Low Force Stereolithography-FormLabs (LFS), P30+-Straumann (P30), and M2-Carbon (M2). After fully guided implant placement, the typodont was scanned, and the 3D implant positions were compared with the master model by superimposing the STL files. Descriptive statistics were calculated for groups and subgroups, and comparisons among the groups and subgroups were conducted via 2-way mixed analysis of variance, Tukey honest significant difference, and post hoc Bonferroni tests (α=.05). RESULTS: The results were site specific and not consistent within each group. For angle deviation, the within-group analysis for P30 demonstrated significantly lower values for implants positioned at site SP (1.4 ±0.8 degrees) than for sites LI (2.3 ±0.7 degrees; P=.001) and CI (2.3 ±0.8 degrees; P=.007). For 3D offset at base for implant CI, LFS was significantly higher than Bego (P=.002), Poly (P=.035), or M2 (P=.001); P30 was also significantly higher than Bego (P=.014) and M2 (P=.006). LFS had a significantly higher 3D offset at the tip than Bego (P=.001) and M2 (P=.022) for implant CI. CONCLUSIONS: The choice of 3D printer seemed to influence fully guided implant surgery in terms of the final implant position compared with initial implant planning. However, although statistically significant differences were present across groups, all additive manufacturing technologies were within clinically acceptable values.

Influence of zirconia crown artifacts on cone beam computed tomography scans and image superimposition of tomographic image and tooth surface scan: An in vitro study.

STATEMENT OF PROBLEM: Zirconia restorations create significant artifacts on 3D cone beam computed tomography (CBCT) imaging. Static computer-assisted implant surgery (s-CAIS) relies on the accuracy of superimposition between an intraoral surface scan and CBCT imaging. However, how the artifacts from zirconia on the tomographic image might affect the predictability of s-CAIS is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of zirconia crown restorations on the superimposition process for s-CAIS. MATERIAL AND METHODS: Four stone casts generated 4 groups: a control group (CG) with no crowns and 3 experimental groups with 4 (TG4), 7 (TG7), and 13 (TG13) zirconia crowns. A total of 40 CBCT scans were made for the 4 groups (n=10). All CBCTs were imported into a computer planning software program, and the casts from all 4 groups were scanned by using a high-resolution laboratory scanner. The standard tessellation language (STL) files were imported, segmented, and the 3 files superimposed for all groups. The accuracy of the superimposition was assessed, in millimeters, in 3 planes corresponding to anterior-posterior, horizontal, and vertical, as well as the overall measurement, and the results were analyzed statistically (α=.05). RESULTS: The overall analysis demonstrated statistically significant differences between all groups (P<.001), except between CG and TG4. The anterior-posterior dimension demonstrated significant differences between CG and TG7 (P<.001), CG and TG13 (P<.001), TG4 and TG7 (P=.004), and TG4 and TG13 (P=.001). For the vertical dimension analysis, significant differences were found between CG and TG7 (P=.001), CG and TG13 (P<.001), and TG4 and TG13 (P<.001). For the horizontal variable, statistically significant differences were found between CG and TG7 (P=.049), CG and TG13 (P<.001), TG4 and TG13 (P<.001), and TG7 and TG13 (P=.003). CONCLUSIONS: The accuracy of the superimposition of the images was influenced by the number of zirconia crowns, with an increased number reducing the superimposition accuracy.

Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up.

PURPOSE: To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year. MATERIALS AND METHODS: The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test. RESULTS: Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n = 13/16), yielding a statistically significant difference between the 2 groups (p = 0.01). CONCLUSIONS: After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI: 47.2-71.3%) and 8.9% (95% CI: 2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI: 73.0-92.5%) and 30.1% (95% CI: 12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.

Number of Implants May Not Significantly Affect Long-term Clinical Outcomes of Complete-Arch Implant-Supported Prosthesis.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Optimal number of implants for complete-arch implant-supported prostheses with a follow-up of at least 5 years: A systematic review and meta-analysis. de Luna Gomes JM, et al. J Prosthet Dent 2019;121(5):766-774.e3. SOURCE OF FUNDING: Information not available. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

Double Full-Arch Fixed Implant-Supported Prostheses: Outcomes and Complications after a Mean Follow-Up of 5 Years.

PURPOSE: To retrospectively assess complications and clinical and radiographic outcomes of edentulous patients treated with double full-arch implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.1 years. MATERIALS AND METHODS: The single-visit clinical and radiographic examination included medical and dental history review and clinical assessment of biologic and technical complications encountered with all implants and IFCDPs. Life table analysis and Kaplan-Meier survival curves were calculated. Analysis was conducted to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. RESULTS: Nineteen edentulous patients restored with 38 IFCDPs were included. A total of 249 implants were placed and 2 implants failed after a mean observation period of 5.1 years (range: 1-12 years), yielding an overall implant survival rate of 99.2% and prosthesis survival rate of 92.1%. Three out of 38 IFCDPs were lost, 1 after implant losses and 2 due to technical complications. The most frequent minor biologic complication was soft tissue recession with an estimated 5-year rate of 45.5% (95% CI: 39.4-57.5), while the most frequent major complication was peri-implantitis with an estimated 5-year implant-based rate of 9.5% (95% CI: 6.7-11.3). The most frequent minor technical complication was wear of the prosthetic material with an estimated 5-year rate of 49.0% (95% CI: 37.4-76.4), while the most frequent major technical complication was fracture of the prosthetic material with an estimated 5-year dental unit-based rate of 8.0% (95% CI: 6.6-10.1). CONCLUSIONS: After a mean use time of 5.1 years, high implant and prosthesis survival rates were observed. The most frequent major biologic complication was peri-implantitis, and the most frequent major technical complication was fracture of the prosthetic material. The 5-year estimated cumulative rates for "prosthesis free of biologic complications" was 50.7% (95% CI: 33.7-65.4) and for "prosthesis free of technical complications" was 57.1% (95% CI: 39.3-71.5).

Implant survival rates and biologic complications with implant-supported fixed complete dental prostheses: A retrospective study with up to 12-year follow-up.

OBJECTIVES: To assess the rate of biologic complications and implant survival in edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of 5.2 years (range: 1-12 years). MATERIALS AND METHODS: A single-visit clinical and radiographic examination was performed to assess types and rates of biologic complications with ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). RESULTS: Of 457 rough surface dental implants supporting 71 IFCDPs (52 patients), six had failed, yielding an implant survival rate of 98.7% after a mean observation period of 5.2 years after definitive prosthesis insertion. The most frequent minor biologic complication was soft tissue recession (7.7% annual rate), inflammation under the IFCDP (7.4% annual rate), and peri-implant mucositis (6.3% annual rate). The most frequent major biologic complication was peri-implantitis (2.0% annual rate), in 46/457 implants (10.1%) supporting 19 IFCDPs and late implant failure (0.3% annual rate). The frequency of biologic complications was not statistically different between Group 1 and Group 2. The presence of high plaque index had significant effect on bone loss. CONCLUSIONS: After a mean exposure time of 5.2 years postdefinitive prosthesis insertion (range: 1-12 years), implant survival rate of 98.7% was achieved. The six implant failures in three patients occurred after 5 years and affected the prosthesis survival. Soft tissue recession was the most frequent minor biologic complication, whereas peri-implantitis was the most frequent major biologic complication. A 10-year implant-based mucosal recession rate of 77% (95% CI: 68.2-87.9) and a 10-year implant-based peri-implantitis rate of 20% (95% CI: 16.9-24.9) were found.

Digital Evaluation of Three Splinting Materials Used to Fabricate Verification Jigs for Full-Arch Implant Prostheses: A Comparative Study.

PURPOSE: The primary aim of this study was to assess the accuracy of different splinting materials to make implant cast verification jigs. The secondary aim was to assess the effect of 20° implant angulation on the accuracy of casts. MATERIALS AND METHODS: An edentulous mandibular arch with five internal connection tissue level implants served as control. The three implants in the anterior region were parallel to each other and the two implants in the posterior region were distally tilted 20° bilaterally. Verification jigs were fabricated with three different materials by splinting prefabricated bars to temporary abutments, resulting in three different groups (n = 15 specimens). Test casts were fabricated with low expansion type IV stone, and subsequently digitized with reference scanner. The STL files from the test casts and the control were superimposed, in order to determine the three-dimensional (3D) deviations. RESULTS: Group 1 (GC Pattern Resin) had a mean (SD) value of 36.59 (12.47) µm; Group 2 (Fixpeed Resin) had a mean (SD) value of 35.9 (10.13) µm; and Group 3 (Triad Gel) had a mean (SD) of 34.12 (7.10) µm. One-way ANOVA showed no statistically significant difference between groups (p = 0.790). For the comparative analysis of the effect of implant angulation, data were normally distributed for Groups 1 and 3 (GC Resin and Triad Gel), but not for group 2 (Fixpeed Resin). The difference between parallel and tilted implants was significant for all three groups: GC Resin (p = 0.024; paired t-test), Fixpeed Resin (p = 0.002; Wilcoxon signed-rank test), and Triad Gel (p = 0.002; paired t-test). CONCLUSIONS: There were no statistically significant differences between the 3D deviations of the test casts fabricated from verification jigs made by three materials (GC Pattern Resin, Fixpeed Resin, and Triad Gel). Parallel implants had nominally significantly less 3D deviations compared with 20° distally tilted implants, but not clinically significant. CLINICAL SIGNIFICANCE: The results of the present study indicate that more than 20° of angulation, has an effect on the 3D accuracy. However, even though the tilted implants had nominally significantly more 3D deviation, it was not clinically significant. The clinical implications of this in vitro study are relevant to the popular full-arch implant rehabilitation concept of tilted and axial implants such as the All-on-four concept. Tilting the posterior implants to increase the antero-posterior spread increases the implant angulation which is then corrected with 30° angulated abutments. This in vitro study shows that even after correction with angulated abutments if the remaining angulation is up to 20°, framework fit may still be achieved. Verification jig is essential tool to achieve the framework fit. (J Esthet Restor Dent 29:102-109, 2017).

Mini Implant-Retained Complete Overdenture Can be an Alternative Treatment Option for Selected Patients.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Complete overdentures retained by mini implants: A systematic review. Lemos CAA, Verri FR, de Souza Batista VE, Santiago JF Jr, Mello CC, Pellizzer EP. J Dent 2017;57:4-13. SOURCE OF FUNDING: The authors did not report any external sources of fund. TYPE OF STUDY/DESIGN: Systematic review.

Influence of coping design on the cervical color of ceramic crowns.

STATEMENT OF PROBLEM: The replication of natural teeth, especially with single-tooth restorations, represents a challenge. Similar to metal ceramic crowns, different designs of zirconia substructures have been suggested to improve the esthetic results of zirconia ceramic crowns. PURPOSE OF STUDY: The purpose of the study was to analyze the color of the cervical portion of single zirconia ceramic crowns fabricated with different zirconia coping designs. MATERIAL AND METHODS: The color, measured on the CIELAB color scale, of 3 different groups of restorations (n=10) fabricated with zirconia coping (Lava) and feldspathic porcelain (Noritake Super Porcelain) was analyzed with a spectrophotometer. Conventional zirconia crowns with zirconia facial margins were compared with ceramic crowns with porcelain facial margins and either a horizontal reduction of the zirconia coping (1.0 mm reduction) or an additional vertical reduction (1.0 mm additional reduction). The 3 groups, each with a different coping extension, were examined with a 1-way ANOVA and the Fisher exact test, and the differences of the groups were evaluated by applying ΔE thresholds (α=.05). RESULTS: The mean color difference among all the groups was not clinically significant (ΔE<3.7). Reduced color differences were present between the 2 porcelain butt margin groups of crowns (ΔE=1.06, between group H and V). Increased differences were present between the zirconia margin group and the porcelain butt margin group (ΔE=2.54 between group C and H; ΔE=2.41 between group C and V). Lab* values were examined in all the groups of crowns to determine the clinical implications. CONCLUSIONS: Within the limitation of the study, no significant differences were present among the tested groups of crowns. Nevertheless, although some differences were present between the zirconia margin group and the porcelain butt margin group, reduced differences were present between the 2 different cutback designs.

Predicting Parkinson's disease using gradient boosting decision tree models with electroencephalography signals.

INTRODUCTION: Parkinson's disease (PD) is a neurodegenerative disorder with only symptomatic treatments currently available. Although correct, early diagnoses of PD are important, the existing diagnostic method based on pathologic examinations only has an accuracy of approximately 80.6%. Although electroencephalography (EEG)-based assistive technology has been introduced, it has been difficult to implement in practice due to the high computational complexity and low accuracy of the analysis methods. This study proposed a fast, accurate PD prediction method using the Hjorth parameter and the gradient boosting decision tree (GBDT) algorithm. METHOD: We used an open EEG dataset with 41 PD patients and 41 healthy controls (HCs); EEG signals were recorded from participants at the University of New Mexico (PD: 27 vs. HC: 27) and University of Iowa (PD: 14 vs. HC: 14). We explored the analytic time segment and frequency range in which the Hjorth parameter best represents the EEG characteristics of PD patients. RESULTS: Our best model (CatBoost-based) distinguished PD patients from controls with an accuracy of 89.3%, an area under the receiver operating characteristics curve (AUC) of 0.912, an F-score of 0.903, and an odds ratio of 115.5. These results showed that our models outperformed those of all other previous works and were even superior to previously known pathologic examination-based diagnoses with long-term follow-up (accuracy = 83.9%). CONCLUSION: The proposed methods are expected to be utilized as an effective method for improving the diagnosis of PD.

Influence of framework design on the cervical color of metal ceramic crowns.

STATEMENT OF PROBLEM: The replication of natural teeth, especially for single tooth restorations in patients with high esthetic needs, represents a challenge. PURPOSE: The purpose of the study was to analyze the color of the cervical portion of single metal ceramic crowns fabricated with different metal framework designs. MATERIAL AND METHODS: The color, as measured on the CIELAB color scale, of 3 different groups of restorations (n=10) fabricated with a high noble metal alloy (V-Deltaloy) and feldspathic porcelain (Noritake Super Porcelain) was analyzed with a colorimeter. Conventional metal ceramic crowns with metal facial margins were compared to metal ceramic crowns with porcelain facial margins and a horizontal reduction of the metal framework (1.0 mm reduction) or an additional vertical reduction (1.0 mm reduction). In all specimens, the finish line was positioned at a subgingival or equigingival level. The 6 groups obtained by the combination of the levels of the 2 factors (framework extension and finish line location) were examined with an ANOVA Fisher's F-test and a post hoc Tukey's HSD test (α=.05). RESULTS: The mean color difference for all the groups was clinically acceptable (ΔE<3.7). Conventional metal ceramic crowns showed higher differences in relation to finish line location (ΔE=2.34), while a vertical reduction of the framework was related to lower values (ΔE=0.96). Mean Lab* values were reported for all the groups of crowns. Statistically significant differences were present for L*, a*, and b* values when related to framework extension. Considering each value in relation to the interaction between framework extension and finish line location factors, significant differences were present only for L* and a* values. CONCLUSIONS: No significant differences in base shade were present among the investigated crowns. Nevertheless metal ceramic crowns with vertical cut-back and porcelain facial margins presented more consistent results that tended to be closer to those of natural teeth.

EEG dataset and OpenBMI toolbox for three BCI paradigms: an investigation into BCI illiteracy.

BACKGROUND: Electroencephalography (EEG)-based brain-computer interface (BCI) systems are mainly divided into three major paradigms: motor imagery (MI), event-related potential (ERP), and steady-state visually evoked potential (SSVEP). Here, we present a BCI dataset that includes the three major BCI paradigms with a large number of subjects over multiple sessions. In addition, information about the psychological and physiological conditions of BCI users was obtained using a questionnaire, and task-unrelated parameters such as resting state, artifacts, and electromyography of both arms were also recorded. We evaluated the decoding accuracies for the individual paradigms and determined performance variations across both subjects and sessions. Furthermore, we looked for more general, severe cases of BCI illiteracy than have been previously reported in the literature. RESULTS: Average decoding accuracies across all subjects and sessions were 71.1% (± 0.15), 96.7% (± 0.05), and 95.1% (± 0.09), and rates of BCI illiteracy were 53.7%, 11.1%, and 10.2% for MI, ERP, and SSVEP, respectively. Compared to the ERP and SSVEP paradigms, the MI paradigm exhibited large performance variations between both subjects and sessions. Furthermore, we found that 27.8% (15 out of 54) of users were universally BCI literate, i.e., they were able to proficiently perform all three paradigms. Interestingly, we found no universally illiterate BCI user, i.e., all participants were able to control at least one type of BCI system. CONCLUSIONS: Our EEG dataset can be utilized for a wide range of BCI-related research questions. All methods for the data analysis in this study are supported with fully open-source scripts that can aid in every step of BCI technology. Furthermore, our results support previous but disjointed findings on the phenomenon of BCI illiteracy.