Comparison accuracy of digital and analog method using milled occlusal splints.

OBJECTIVE: This clinical trial aims to compare the accuracy of interocclusal registration in centric relation taken with polyvinyl siloxane and intraoral scanner (IOS) with the fabrication of occlusal devices. METHODS: Thirty-one participants were included in the trial registered at ClinicalTrials.gov (NCT05317182) receiving two different occlusal devices from two different workflows. One workflow was performed using polyvinyl siloxane impression material and the other with IOS. Every splint was scanned before and after the occlusal adjustments to compare the volumetric changes using the Root Mean Square deviation (RMS). Furthermore, three evaluators assessed the 3D comparison using color maps in a Visual Analog Scale (VAS). RESULTS: The average values of RMS were higher for the analog approach (0.01 ± 0.067) than the digital approach (0.065 ± 0.035). However, the differences were not statistically significant (p < 0.063) between the two impression techniques. For the semiquantitative analysis performed by blinded evaluators, differences in VAS values between the impression for the digital (2.08 ± 2.4) and analog (3.80 ± 3.3) technique were statistically significant. The three evaluators agreed in more than 90% of the qualitative dichotomous evaluation. CONCLUSION: Digital impressions did not show inferior accuracy compared to conventional impressions when assessed using quantitative measurements. CLINICAL SIGNIFICANCE: This clinical trial provided evidence on registering interocclusal relationship at increased vertical dimension with fully digital workflow for complete arch prosthesis.

CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study.

OBJECTIVE: To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow. MATERIALS AND METHODS: Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05). RESULTS: The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations. CONCLUSIONS: Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow. CLINICAL SIGNIFICANCE: Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.

A fully digital protocol to provide a fixed interim complete denture for immediate loading for a completely edentulous patient: A dental technique.

Complete arch immediate-loading implant-supported prostheses can represent a major challenge for the patient and the dental team. Obtaining stable references and an accurate occlusal record after implant placement to provide an interim prosthesis is a difficult task and can deviate from the initial treatment plan. The described technique presents a fully digital protocol to provide an immediate complete arch implant-supported fixed interim prosthesis for edentulous patients by making postoperative cone beam computed tomography and intraoral digital scans that correlate with the previous plan.

Fabrication of a facially generated tooth reduction guide for minimally invasive preparations: A dental technique.

This article describes a 3D virtual diagnostic analysis for treatment planning an esthetically driven functional rehabilitation by using computer-aided design and computer-aided manufacturing (CAD-CAM) technology. In this protocol, a digitally planned diagnostic waxing (exocad DentalCAD) was used to visualize the proposed tooth position and the presence of areas without sufficient material thickness for the prospective additive restorations. This approach uses an additively manufactured clear resin guide to selectively reduce surfaces of a tooth erupted beyond the proposed occlusal plane. By using a 3D-printed occlusal reduction guide, the digital diagnostic waxing is accurately represented, tooth reduction controlled, and adequate occlusal clearance for the required restorative material thickness provided with a minimally invasive approach.

The digital alveolar cast: A revised approach to an old concept.

An alveolar cast is recommended for the fabrication of specific fixed dental prostheses. The analog workflow for such casts is labor-intensive, time-consuming, and highly skill dependent. Advancements in digital technologies are bringing new, efficient, and streamlined protocols for dental practice. This article presents a digital workflow for the fabrication of an alveolar cast by using computer-aided design and computer-aided manufacturing (CAD-CAM)technologies.

Magnetic extrusion technique for restoring severely compromised teeth: A case report.

An orthodontic magnetic extrusion technique is described for the management of an extensively damaged maxillary premolar. A cylindrical neodymium-iron-boron (Nd2Fe14B) magnet was attached to the remaining tooth structure, and a second magnet was placed on a resin-bonded partial denture. A 4.5-mm extrusion was obtained after 3 adjustments, and the tooth was prepared with a 3-mm buccal and 2-mm lingual ferrule by following a biologically oriented preparation technique and restored with a monolithic zirconia crown. Eighteen months after completing the treatment, no evidence of soft tissue dehiscence, abnormal tooth mobility, endodontic failure, or root resorption was found.

Digital workflow for designing an interim implant-supported restoration with an optimal emergence profile in an open-source software program.

The esthetics and emergence profile design of implant-supported restorations in the anterior zone can be challenging. This dental technique describes a digital approach to designing an optimal emergence profile from the implant head to the definitive prosthetic volume with facial cutback for an esthetic implant-supported interim crown. A printed interim implant-supported restoration with an adequate emergence profile and a facial cutback for composite resin layering is obtained.

Fit of complete-arch implant-supported prostheses produced from an intraoral scan by using an auxiliary device and from an elastomeric impression: A pilot clinical trial.

STATEMENT OF PROBLEM: The accuracy of impressions for implant-supported prostheses is essential to ensure a passive fit of the definitive prosthesis. Intraoral scanners (IOSs) have been developed as an alternative to complete-arch implant-supported restorations; however, whether they are sufficiently accurate when more than 3 nonaligned implants are involved is unclear. PURPOSE: The purpose of this pilot clinical study was to determine whether the fit of complete-arch zirconia implant-supported frameworks processed on a cast obtained with an IOS and adjusted with an auxiliary device is equivalent to a prosthesis obtained from an elastomeric impression. MATERIAL AND METHODS: Twelve consecutive participants who were ready for complete-arch restorations on already osseointegrated implants were enrolled. Two records were made, one open-tray with polyether and splinted impression copings and the second with an IOS. A verification gypsum device was used for the elastomeric impression, and a prefabricated auxiliary device was used to adjust the intraoral scans. Two zirconia frameworks with the same design were processed and evaluated intraorally by 2 independent calibrated observers. RESULTS: In 11 of the 12 participants, the digitally processed prosthesis was preferred over the conventionally processed prosthesis. The clinical fit of the prostheses obtained with the completely digital workflow was better than that of those obtained with the conventional workflow. CONCLUSIONS: The use of a prefabricated auxiliary device after intraoral scanning allowed delivery of complete-arch implant-supported monolithic zirconia prostheses with a fit better than those fabricated from conventional impressions.

Stone verification device for verifying the definitive cast of an implant-supported restoration: A dental technique.

To reduce the risk of implant and prosthetic complications, implant-supported prostheses should be passive. A verification device is used to verify the abutment analog position on the definitive cast, and hence its accuracy. This article describes the fabrication of a Type IV stone implant verification device for verifying the accuracy of the definitive cast.

Fabrication of a CAD-CAM combination matrix for trial restorations: A dental technique.

The trial restoration increases outcome predictability in restorative treatments, enhances communication among specialists and patients, and guides tooth preparations. It should reproduce the planned design precisely because many decisions will be made based on the transferred design. Traditionally, a diagnostic waxing design is transferred to the mouth with a flexible silicone matrix. However, a rigid matrix would ensure an accurate transfer of the planned design by avoiding the deformation of the silicone index. A step-by-step technique for fabricating a computer-aided design and computer-aided manufactured (CAD-CAM) rigid matrix relined with polyvinyl siloxane material to fabricate a trial restoration is presented. The technique ensures accurate detail reproduction and dimensional stability, avoiding deformation and ensuring a predictable transfer of the planned design.

European Society of Endodontology position statement: The restoration of root filled teeth.

This position statement on the restoration of root filled teeth represents the consensus of an expert committee, convened by the European Society of Endodontology (ESE). Current clinical and scientific evidence, as well as the expertise of the committee, have been used to develop this statement. The aim is to provide clinicians with evidence-based principles for decision-making on the choice of restoration following the completion of root canal treatment. By discussing the evidence in relation to key topics regarding post-endodontic restoration, a series of clinical recommendations are made. The scientific basis of the recommendations made in this paper can be found in a recently published review article (Bhuva et al. 2021, International Endodontic Journal, https://doi.org/10.1111/iej.13438). It is the intention of the committee to update this statement as further evidence emerges.

Digital scanning under rubber dam: An innovative method for making definitive impressions in fixed prosthodontics.

OBJECTIVE: To provide a comprehensive protocol for final impressions making under rubber dam isolation by using an intraoral scanner. CLINICAL CONSIDERATION: Impression making after tooth preparation with rubber dam isolation are impossible with conventional physical impressions, which are not with intraoral scanners. Digital technologies have disrupted dentistry in the last decades, bringing new, straightforward, and more time-efficient protocols for dental practice. CONCLUSIONS: Taking in consideration the beneficial properties of scanning under rubber dam this protocol can be highly recommended for everyday use for making definitive intraoral scans for tooth-supported restorations. CLINICAL SIGNIFICANCE: The described protocol offers the possibility to make a final impression in a stress-free environment, without blood or saliva, to obtain a better visualization and scanning of the finish line, and the potential of save time on definitive impression making.

Guided tooth autotransplantation in edentulous areas post-orthodontic treatment.

OBJECTIVE: Tooth autotransplantation with a complete root formation to replace one or more lost teeth is indicated as a cost-effective alternative to implants. The aim of this case report was to describe a successfully guided autotransplantation of a maxillary third molar with fully formed roots into a surgically created socket after orthodontic space opening. CLINICAL CONSIDERATIONS: A guided autotransplantation of the maxillary left third molar into the missing maxillary left first molar site was chosen. After virtually orientating donor tooth to confirm its optimum fit, it was deemed necessary to open 4 mm the mesiodistal space. Following the orthodontic movement, a 3-dimensional (3D)-guiding template and a milled surgical guide were manufactured to allow the donor tooth to be transplanted exactly in the planned position. The 2-year follow-up periapical radiograph showed a continuous periodontal space with no signs of apical periodontitis or root resorption. CONCLUSIONS: Virtual planning and 3D-printed tooth replica combined with guided surgery can simplify the autotransplantation technique for both the clinician and the patient, particularly when the socket has been completely created during surgery. CLINICAL SIGNIFICANCE: Virtual digital planning, which can accurately calculate the exact space to open orthodontically before an autotransplantation, could prove essential to enhancing the precision of 3D placement of the donor tooth in the recipient site.

Guided tooth preparation device fabricated with a complete digital workflow: A dental technique.

Guided tooth preparations allow clinicians to provide fixed dental prostheses for dentate patients in an efficient manner. One approach uses a digital preparation device technique where the preparation of a tooth needing a crown is guided by a device. Compared with conventional techniques, this method allows for accurate abutment preparation more efficiently and with improved quality. By controlling tooth preparation, this method preserves natural tooth structure and provides adequate clearance for the restorative material. To illustrate this technique, an adhesive minimally invasive fixed complete-mouth rehabilitation was provided by using a 3D-printed digital preparation device.

A method for determining the position of the abutment screw of any cement-retained implant-supported prosthesis.

Removing cement-retained implant-supported prostheses may be challenging for clinicians. A method combining a cone beam computed tomography (CBCT) and a digital scan with a virtual surgical planning software program is described to identify the perforation site of a cement-retained implant-supported prosthesis to locate the abutment screw.

Protocol for the clinical assessment of passive fit for multiple implant-supported prostheses: A dental technique.

With monolithic materials and the new technologies for framework production, assessment of passive fit before fabrication of the definitive prosthesis or its framework is essential to avoid prosthesis remakes. This article describes an updated clinical protocol to assess passive fit during the prosthesis fabrication process through the systematic use of tactile feel while tightening the retaining screws, the visual or radiographic evaluation when performing the 1-screw or Sheffield fit test, and the torque/time graph obtained during the placement of the implant- or abutment-retaining screws with a torque-controlled surgical motor.

Immediately loaded interim complete-arch implant-supported fixed dental prostheses fabricated with a completely digital workflow: A clinical technique.

A digital method for delivering an immediately loaded interim complete-arch implant-supported prosthesis is described. Reference pins were used to accurately superimpose a postoperative scan with the scan bodies in place on a preoperative scan with the framework design, including the interocclusal relationship and the occlusal scheme. A prefabricated auxiliary device was used after surgery to record the position of the implants and after scanning to obtain an accurate transfer of the implant positions by means of a free software program, allowing an excellent fit of the fabricated prosthesis. This technique can help in the fabrication of an interim prosthesis with better fit and comfort and reduced chair time than conventional techniques.

Functional recovery in patients with schizophrenia: recommendations from a panel of experts.

BACKGROUND: The management of schizophrenia is evolving towards a more comprehensive model based on functional recovery. The concept of functional recovery goes beyond clinical remission and encompasses multiple aspects of the patient's life, making it difficult to settle on a definition and to develop reliable assessment criteria. In this consensus process based on a panel of experts in schizophrenia, we aimed to provide useful insights on functional recovery and its involvement in clinical practice and clinical research. METHODS: After a literature review of functional recovery in schizophrenia, a scientific committee of 8 members prepared a 75-item questionnaire, including 6 sections: (I) the concept of functional recovery (9 items), (II) assessment of functional recovery (23 items), (III) factors influencing functional recovery (16 items), (IV) psychosocial interventions and functional recovery (8 items), (V) pharmacological treatment and functional recovery (14 items), and (VI) the perspective of patients and their relatives on functional recovery (5 items). The questionnaire was sent to a panel of 53 experts, who rated each item on a 9-point Likert scale. Consensus was achieved in a 2-round Delphi dynamics, using the median (interquartile range) scores to consider consensus in either agreement (scores 7-9) or disagreement (scores 1-3). Items not achieving consensus in the first round were sent back to the experts for a second consideration. RESULTS: After the two recursive rounds, consensus was achieved in 64 items (85.3%): 61 items (81.3%) in agreement and 3 (4.0%) in disagreement, all of them from section II (assessment of functional recovery). Items not reaching consensus were related to the concepts of functional recovery (1 item, 1.3%), functional assessment (5 items, 6.7%), factors influencing functional recovery (3 items, 4.0%), and psychosocial interventions (2 items, 5.6%). CONCLUSIONS: Despite the lack of a well-defined concept of functional recovery, we identified a trend towards a common archetype of the definition and factors associated with functional recovery, as well as its applicability in clinical practice and clinical research.

Safety concerns of Piezoelectric Units in Implantable Cardioverter Defibrillator.

PURPOSE: Evidence-based research appears to conflict on the potential risk of electromagnetic interference (EMI) between piezoelectric units (Pzs) and implantable cardioverters and defibrillators (ICDs). The purpose of this study was to observe whether the EMI produced by Pzs is hazardous for ICDs. MATERIALS AND METHODS: A cross-sectional study of 6 Pzs was conducted in vitro for EMI using an ICD system. To simulate the human body's electrical resistance, electrographic recordings were made of the ICD and lead that were immersed in a bath of saline solution. The variables investigated were the presence of EMI, the distance between the ICD and the Pz, and signal intensity, damage, and type of damage to the ICD and lead. Each series of tests was repeated 3 times, beginning with a 15-second baseline recording (control), until all recording conditions had been covered. Each Pz was recorded under the following conditions: less than 2 cm from the tip of the ICD lead; less than 2 cm from the ICD; less than 2 cm from the lead body and coils; and 15 cm from the lead or the ICD (R4). RESULTS: In the positive control (direct contact between the lead or the ICD with the Pz switched on), the ICD detected electrical activity as false heart activity. However, after covering all test conditions, no EMI was produced by the Pzs. CONCLUSION: No EMI or permanent changes in the functioning of the ICD were detected in vitro.

Encouraging Editorial Flexibility in Cases of Textual Reuse.

Because many technical descriptions of scientific processes and phenomena are difficult to paraphrase and because an increasing proportion of contributors to the scientific literature are not sufficiently proficient at writing in English, it is proposed that journal editors re-examine their approaches toward instances of textual reuse (similarity). The plagiarism definition by the US Office of Research Integrity (ORI) is more suitable than other definitions for dealing with cases of ostensible plagiarism. Editors are strongly encouraged to examine cases of textual reuse in the context of both, the ORI guidance and the offending authors' proficiency in English. Editors should also reconsider making plagiarism determinations based exclusively on text similarity scores reported by plagiarism detection software.