Association between 3D palatal morphology and upper arch dimensions in buccally displaced maxillary canines early in mixed dentition.

Objectives: To evaluate the association between maxillary dental arch transverse dimensions, palatal depths, palatal area and volume with buccally displaced canine (BDC) in mixed dentition subjects when compared to non-BDC subjects using laser scanner 3D technology. Materials and methods: Sixty Caucasian subjects, 8-11 years of age (mean, 9.26 ± 1.48 years), were included. In each group (BDC and non-BDC) 30 children were matched. Digital dental casts were obtained using a 3 Shape D700 laser scanner. Intercanine and intermolar widths (cusp and gingival levels), anterior and posterior palatal depth (cusp level), palatal surface area and volume were measured. An independent sample Student's t-test and an ANOVA were undertaken with significance level set as P < 0.05. Results: Intercanine widths at the cusp (1.76 mm; P = 0.020) and the gingival level (1.6 mm; P = 0.006), palatal area (133 mm2; P = 0.021) and volume (790 mm3; P = 0.046) were significantly lower in the BDC compared to the control group. Limitations: A smaller part of the subjects was in late mixed dentition phase. To overcome this limitation a matched control group was used. Some subjects did not have some teeth because of the transition phase which might have had an influence on the dental measurements. However, these subjects were not excluded to avoid introducing a bias. Conclusions: 3D evaluation of the maxillary arch and palate highlighted significant differences between BDC and non-BDC mixed dentition subjects. Maxillary dental arch dimensions and palate morphology may allow early identification and prevention of maxillary canine impaction.

Stress distribution of bulk-fill resin composite in class II restorations.

PURPOSE: To study the influence of the resin bonding layer thickness and the bulk filling material stiffness in adhesive class II mesio-occlusal-distal (MOD) restorations using numerical finite element analysis (FEA). METHODS: Four 3D-FE models of teeth restored with different filling material stiffness and resin bonding layer thickness were built-up and analyzed. The 3D model of a sound lower molar was also analyzed and compared with restored ones. The tooth tissues (enamel, dentin), dental restoration and bolus on the occlusal surface, was divided into 3D solid CTETRA elements with four grid points. The adhesive bonding around the dental restoration was modeled with shell elements. Polymerization shrinkage was simulated with a thermal expansion approach. Mechanical behavior of restored models in terms of stress and displacement distributions, under the combination effects of polymerization shrinkage and occlusal load (600 N), was analyzed. All the materials were assumed to behave as elastic materials throughout the entire deformation. RESULTS: Numerical results show that the mechanical response of the restored models was very different compared to the sound tooth ones, where the stress was uniformly distributed from enamel to dentin with no critical stress concentration. In the restored models, the highest stress values were detected in the enamel, near the enamel-dentin interface and in the bulk restorative material. Tooth preparations A and B showed lower gradient stresses than corresponding C and D. The value of the vertical displacement components in models A and B were higher than corresponding C and D. The maximum displacement values were mainly located around the groove and were higher by an order of magnitude than the sound models. The results showed better mechanical response with models A and B compared to C and D. It is also evident that resin bonding thickness slightly affected the stress level of the restored teeth. CLINICAL SIGNIFICANCE: Class II MOD direct bulk resin composite restorations showed a high susceptibility to damage at the marginal and internal tissue interfaces depending on their own stiffness. The use of resin-based bulk filling materials is not recommended for large class II MOD adhesive restorations due to mechanical behavior failure risk.

The role of cortical zone level and prosthetic platform angle in dental implant mechanical response: A 3D finite element analysis.

OBJECTIVE: The aim of this study was to evaluate the influence of three different dental implant neck geometries, under a combined compressive/shear load using finite element analysis (FEA). The implant neck was positioned in D2 quality bone at the crestal level or 2 mm below. METHODS: One dental implant (4.2 × 9 mm) was digitized by reverse engineering techniques using micro CT and imported into Computer Aided Design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model similar to the digitized implant. Three different models were generated with different implant neck configurations, namely 0°, 10° and 20°. D2 quality bone, composed of cortical and trabecular structure, was modeled using data from CT scans. The implants were included in the bone model using a Boolean operation. Two different fixture insertion depths were simulated for each implant: 2 mm below the crestal bone and exactly at the level of the crestal bone. The obtained models were imported to FEA software in STEP format. Von Mises equivalent strains were analyzed for the peri-implant D2 bone type, considering the magnitude and volume of the affected surrounding cortical and trabecular bone. The highest strain values in both cortical and trabecular tissue at the peri-implant bone interface were extracted and compared. RESULTS: All implant models were able to distribute the load at the bone-implant contact (BIC) with a similar strain pattern between the models. At the cervical region, however, differences were observed: the models with 10° and 20° implant neck configurations (Model B and C), showed a lower strain magnitude when compared to the straight neck (Model A). These values were significantly lower when the implants were situated at crestal bone levels. In the apical area, no differences in strain values were observed. SIGNIFICANCE: The implant neck configuration influenced the strain distribution and magnitude in the cortical bone and cancellous bone tissues. To reduce the strain values and improve the load dissipation in the bone tissue, implants with 10° and 20 neck configuration should be preferred instead of straight implant platforms.

Stress Distributions for Hybrid Composite Endodontic Post Designs with and without a Ferrule: FEA Study.

The aim of the current work was to analyze the influence of the ferrule effect for hybrid composite endodontic post designs consisting of carbon (C) and glass (G) fiber-reinforced polyetherimide (PEI), in upper canine teeth. Starting from theoretical designs of C-G/PEI hybrid composite posts with different Young's moduli (Post A-57.7 GPa, Post B-31.6 GPa, Post C-graduated from 57.7 to 9.0 GPa in the coronal-apical direction) in endodontically treated anterior teeth, the influence of the ferrule effect was determined through finite element analysis (FEA). On the surface of the crown, a load of 50 N was applied at 45° to the longitudinal axis of the tooth. Maximum principal stresses were evaluated along the C-G/PEI post as well as at the interface between the surrounding tooth structure and the post. Maximum stress values were lower than those obtained for the corresponding models without a ferrule. The presence of a ferrule led to a marked decrease of stress and gradients especially for posts A and B. A less marked effect was globally found for Post C, except in a cervical margin section along a specific direction, where a significant decrease of the stress was probably due to local geometric features, compared to the model without a ferrule. The presence of a ferrule did not generally provide a marked benefit in the case of the graduated Post C, in comparison to other C-G/PEI posts. The outcomes suggest how such a hybrid composite post alone should be sufficient to optimize the stress distribution, dissipating stress from the coronal to the apical end.

A Further Analysis on Ti6Al4V Lattice Structures Manufactured by Selective Laser Melting.

Mechanical and architectural features play an important role in designing biomedical devices. The use of materials (i.e., Ti6Al4V) with Young's modulus higher than those of natural tissues generally cause stress shielding effects, bone atrophy, and implant loosening. However, porous devices may be designed to reduce the implant stiffness and, consequently, to improve its stability by promoting tissue ingrowth. If porosity increases, mass transport properties, which are crucial for cell behavior and tissue ingrowth, increase, whereas mechanical properties decrease. As reported in the literature, it is always possible to tailor mass transport and mechanical properties of additively manufactured structures by varying the architectural features, as well as pore shape and size. Even though many studies have already been made on different porous structures with controlled morphology, the aim of current study was to provide only a further analysis on Ti6Al4V lattice structures manufactured by selective laser melting. Experimental and theoretical analyses also demonstrated the possibility to vary the architectural features, pore size, and geometry, without dramatically altering the mechanical performance of the structure.

The influence of poly(ester amide) on the structural and functional features of 3D additive manufactured poly(ε-caprolactone) scaffolds.

The current research reports for the first time the use of blends of poly(ε-caprolactone) (PCL) and poly(ester amide) (PEA) for the fabrication of 3D additive manufactured scaffolds. Tailor made PEA was synthesized to afford fully miscible blends of PCL and PEA using different percentages (5, 10, 15 and 20% w/w). Stability, characteristic temperatures and material's compatibility were studied through thermal analyses (i.e., TGA, DSC). Even though DMTA and static compression tests demonstrated the possibility to improve the storage modulus, Young's modulus and maximum stress by increasing the amount of PEA, a decrease of hardness was found beyond a threshold concentration of PEA as the lowest values were achieved for PCL/PEA (20% w/w) scaffolds (from 0.39 ±â€¯0.03 GPa to 0.21 ±â€¯0.02 GPa in the analysed load range). The scaffolds presented a controlled morphology and a fully interconnected network of internal channels. The water contact angle measurements showed a clear increase of hydrophilicity resulting from the addition of PEA. This result was further corroborated with the improved adhesion and proliferation of human mesenchymal stem cells (hMSCs). The presence of PEA also influenced the cell morphology. Better cell spreading and a much higher and homogenous number of cells were observed for PCL/PEA scaffolds when compared to PCL ones.

FE analysis of conceptual hybrid composite endodontic post designs in anterior teeth.

OBJECTIVES: To assess conceptual designs of dental posts consisting of polyetherimide (PEI) reinforced with carbon (C) and glass (G) glass fibers in endodontically treated anterior teeth. METHODS: 3D tessellated CAD and geometric models of endodontically treated anterior teeth were generated from Micro-CT scan images. Model C-G/PEI composite posts with different Young's moduli were analyzed by Finite Element (FE) methods post A (57.7GPa), post B (31.6GPa), post C (from 57.7 to 9.0GPa in the coronal-apical direction). A load of 50N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum principal stress distribution was determined along the post and at the interface between the post and the surrounding structure. RESULTS: Post C, with Young's modulus decreasing from 57.7 to 9.0GPa in the coronal-apical direction, reduced the maximum principal stress distribution in the restored tooth. Post C gave reduced stress and the most uniform stress distribution with no stress concentration, compared to the other C-G/PEI composite posts. SIGNIFICANCE: The FE analysis confirmed the ability of the functionally graded post to dissipate stress from the coronal to the apical end. Hence actual (physical) C-G/PEI posts could permit optimization of stress distributions in endodontically treated anterior teeth.

Theoretical Design of Multilayer Dental Posts Using CAD-Based Approach and Sol-Gel Chemistry.

A computer-aided design (CAD)-based approach and sol-gel chemistry were used to design a multilayer dental post with a compositional gradient and a Young’s modulus varying from 12.4 to 2.3 GPa in the coronal-apical direction. Specifically, we propose a theoretical multilayer post design, consisting of titanium dioxide (TiO2) and TiO2/poly(ε-caprolactone) (PCL) hybrid materials containing PCL up to 24% by weight obtained using the sol-gel method. The current study aimed to analyze the effect of the designed multilayer dental post in endodontically treated anterior teeth. Stress distribution was investigated along and between the post and the surrounding structures. In comparison to a metal post, the most uniform distributions with lower stress values and no significant stress concentration were found when using the multilayer post.

Mechanical and Thermal Properties of Dental Composites Cured with CAD/CAM Assisted Solid-State Laser.

Over the last three decades, it has been frequently reported that the properties of dental restorative composites cured with argon laser are similar or superior to those achieved with conventional halogen and light emitting diode (LED) curing units. Whereas laser curing is not dependent on the distance between the curing unit and the material, such distance represents a drawback for conventional curing units. However, a widespread clinical application of this kind of laser remains difficult due to cost, heavy weight, and bulky size. Recently, with regard to the radiation in the blue region of the spectrum, powerful solid-state lasers have been commercialized. In the current research, CAD (computer-aided design)/CAM (computer-aided manufacturing) assisted solid-state lasers were employed for curing of different dental restorative composites consisting of micro- and nanoparticle-reinforced materials based on acrylic resins. Commercial LED curing units were used as a control. Temperature rise during the photopolymerisation process and bending properties were measured. By providing similar light energy dose, no significant difference in temperature rise was observed when the two light sources provided similar intensity. In addition, after 7 days since curing, bending properties of composites cured with laser and LED were similar. The results suggested that this kind of laser would be suitable for curing dental composites, and the curing process does not suffer from the tip-to-tooth distance.

Influence of thread shape and inclination on the biomechanical behaviour of plateau implant systems.

OBJECTIVE: To assess the influence of implant thread shape and inclination on the mechanical behaviour of bone-implant systems. The study assesses which factors influence the initial and full osseointegration stages. METHODS: Point clouds of the original implant were created using a non-contact reverse engineering technique. A 3D tessellated surface was created using Geomagic Studio® software. From cross-section curves, generated by intersecting the tessellated model and cutting-planes, a 3D parametric CAD model was created using SolidWorks® 2017. By the permutation of three thread shapes (rectangular, 30° trapezoidal, 45° trapezoidal) and three thread inclinations (0°, 3° or 6°), nine geometric configurations were obtained. Two different osseointegration stages were analysed: the initial osseointegration and a full osseointegration. In total, 18 different FE models were analysed and two load conditions were applied to each model. The mechanical behaviour of the models was analysed by Finite Element (FE) Analysis using ANSYS® v. 17.0. Static linear analyses were also carried out. RESULTS: ANOVA was used to assess the influence of each factor. Models with a rectangular thread and 6° inclination provided the best results and reduced displacement in the initial osseointegration stages up to 4.58%. This configuration also reduced equivalent VM stress peaks up to 54%. The same effect was confirmed for the full osseointegration stage, where 6° inclination reduced stress peaks by up to 62%. SIGNIFICANCE: The FE analysis confirmed the beneficial effect of thread inclination, reducing the displacement in immediate post-operative conditions and equivalent VM stress peaks. Thread shape does not significantly influence the mechanical behaviour of bone-implant systems but contributes to reducing stress peaks in the trabecular bone in both the initial and full osseointegration stages.

Modal analysis for implant stability assessment: Sensitivity of this methodology for different implant designs.

OBJECTIVE: To investigate the influence of implant design on the change in the natural frequency of bone-implant system during osseointegration by means of a modal 3D finite element analysis. METHODS: Six implants were considered. Solid models were obtained by means of reverse engineering techniques. The mandibular bone geometry was built-up from a CT scan dataset through image segmentation. Each implant was virtually implanted in the mandibular bone. Two different models have been considered, differing in the free length of the mandibular branch ('long branch' and 'short branch') in order to simulate the variability of boundary conditions when performing vibrometric analyses. Modal analyses were carried out for each model, and the first three resonance frequencies were assessed with the respective vibration modes. RESULTS: With reference to the 'long branch' model, the first three modes of vibration are whole bone vibration with minimum displacement of the implant relative to bone, with the exception of the initial condition (1% bone maturation) where the implant is not osseointegrated. By contrast, implant displacements become relevant in the 'short branch' model, unless osseointegration level is beyond 20%. The difference between resonance frequency at whole bone maturation and resonance frequency at 1% bone maturation remained lower than 6.5% for all modes, with the exception of the third mode of vibration in the 'D' implant where this difference reached 9.7%. With reference to the 'short branch', considering the first mode of vibration, 61-68% of the frequency increase was achieved at 10% osseointegration; 72-79% was achieved at 20%; 89-93% was achieved at 50% osseointegration. The pattern of the natural frequency versus the osseointegration level is similar among different modes of vibration. SIGNIFICANCE: Resonance frequencies and their trends towards osseointegration level may differ between implant designs, and in different boundary conditions that are related to implant position inside the mandible; tapered implants are the most sensitive to bone maturation levels, small implants have very little sensitivity. Resonance frequencies are less sensitive to bone maturation level beyond 50%.

Mechanical behavior of bulk direct composite versus block composite and lithium disilicate indirect Class II restorations by CAD-FEM modeling.

OBJECTIVES: To study the influence of resin based and lithium disilicate materials on the stress and strain distributions in adhesive class II mesio-occlusal-distal (MOD) restorations using numerical finite element analysis (FEA). To investigate the materials combinations in the restored teeth during mastication and their ability to relieve stresses. METHODS: One 3D model of a sound lower molar and three 3D class II MOD cavity models with 95° cavity-margin-angle shapes were modelled. Different material combinations were simulated: model A, with a 10µm thick resin bonding layer and a resin composite bulk filling material; model B, with a 70µm resin cement with an indirect CAD-CAM resin composite inlay; model C, with a 70µm thick resin cement with an indirect lithium disilicate machinable inlay. To simulate polymerization shrinkage effects in the adhesive layers and bulk fill composite, the thermal expansion approach was used. Shell elements were employed for representing the adhesive layers. 3D solid CTETRA elements with four grid points were employed for modelling the food bolus and tooth. Slide-type contact elements were used between the tooth surface and food. A vertical occlusal load of 600 N was applied, and nodal displacements on the bottom cutting surfaces were constrained in all directions. All the materials were assumed to be isotropic and elastic and a static linear analysis was performed. RESULTS: Displacements were different in models A, B and C. Polymerization shrinkage hardly affected model A and mastication only partially affected mechanical behavior. Shrinkage stress peaks were mainly located marginally along the enamel-restoration interface at occlusal and mesio-distal sites. However, at the internal dentinal walls, stress distributions were critical with the highest maximum stresses concentrated in the proximal boxes. In models B and C, shrinkage stress was only produced by the 70µm thick resin layer, but the magnitudes depended on the Young's modulus (E) of the inlay materials. Model B mastication behavior (with E=20GPa) was similar to the sound tooth stress relief pattern. Model B internally showed differences from the sound tooth model but reduced maximum stresses than model A and partially than model C. Model C (with E=70GPa) behaved similarly to model B with well redistributed stresses at the occlusal margins and the lateral sides with higher stress concentrations in the proximal boxes. Models B and C showed a more favorable performance than model A with elastic biomechanics similar to the sound tooth model. SIGNIFICANCE: Bulk filling resin composite with 1% linear polymerization shrinkage negatively affected the mechanical behavior of class II MOD restored teeth. Class II MOD direct resin composite showed greater potential for damage because of higher internal and marginal stress evolution during resin polymerization shrinkage. With a large class II MOD cavity an indirect composite or a lithium disilicate inlay restoration may provide a mechanical response close to that of a sound tooth.

Mechanical behavior of endodontically restored canine teeth: Effects of ferrule, post material and shape.

OBJECTIVE: To assess the effect of a ferrule design with specific post material-shape combinations on the mechanical behavior of post-restored canine teeth. METHODS: Micro-CT scan images of an intact canine were used to create a 3-D tessellated CAD model, from which the shapes of dentin, pulp and enamel were obtained and geometric models of post-endodontically restored teeth were created. Two types of 15mm post were evaluated: a quartz fiber post with conical-tapered shape, and a carbon (C) fiber post with conical-cylindrical shape. The abutment was created around the coronal portion of the posts and 0.1mm cement was added between prepared crown and abutment. Cement was also added between the post and root canal and a 0.25mm periodontal ligament was modeled around the root. Four models were analysed by Finite Element (FE) Analysis: with/without a ferrule for both types of post material and shape. A load of 50N was applied at 45° to the longitudinal axis of the tooth, acting on the palatal surface of the crown. The maximum normal stress criterion was adopted as a measure of potential damage. RESULTS: Models without a ferrule showed greater stresses (16.3MPa) than those for models with a ferrule (9.2MPa). With a ferrule, stress was uniformly distributed along the abutment and the root, with no critical stress concentration. In all models, the highest stresses were in the palatal wall of the root. Models with the C-fiber post had higher stress than models with the quartz fiber posts. The most uniform stress distribution was with the combination of ferrule and quartz fiber post. SIGNIFICANCE: The FE analysis confirmed a beneficial ferrule effect with the combination of ferrule and quartz fiber post, with tapered shape, affording no critical stress concentrations within the restored system.

CAD-FE modeling and analysis of class II restorations incorporating resin-composite, glass ionomer and glass ceramic materials.

OBJECTIVES: To investigate the influence of specific resin-composite, glass ceramic and glass ionomer cement (GIC) material combinations in a "multi-layer" technique to replace enamel and dentin in class II mesio-occlusal-distal (MOD) dental restorations using 3D-Finite Element Analysis (FEA). METHODS: Four 3D-FE models (A-D) of teeth, adhesively restored with different filling materials, were created and analyzed in comparison with a 3D model (E) of a sound lower molar. Models A, B & C had "multilayer" constructions, consisting of three layers: adhesive, dentin replacement and enamel replacement. Model A: had a low modulus (8GPa) composite replacing dentin and a higher modulus (12GPa) composite replacing enamel. Model B: had a GI cement replacing dentin and a higher modulus (12GPa) composite replacing enamel. Model C: had a low modulus (8GPa) composite replacing dentin and a very high modulus (70GPa) inlay replacing enamel. Model D: had a lithium disilicate inlay replacing both dentin and enamel with a luting cement base-layer. Polymerization shrinkage effects were simulated and a load of 600N was applied. All the materials were assumed to behave elastically throughout the entire deformation. RESULTS: Model A showed the highest stress distribution along all the adhesive interfaces of the shrinking resin-based materials with a critical condition and failure risk marginally and internally. Model D, by contrast, showed a more favorable performance than either of the multilayer groups (A-C). Stress and displacement plots showed an elastic response similar to that obtained for the sound tooth model. Model B and Model C performed according to their bilayer material properties. The use of a non-shrink dentin component simulating a GIC clearly affected the shrinkage stress at the basis of the Model B; while the bulk resin composite having a 12GPa Young's modulus and linear polymerization shrinkage of 1% strongly influenced the biomechanical response in the bucco-lingual direction. SIGNIFICANCE: Direct resin-based composite materials applied in multilayer techniques to large class II cavities, with or without shrinking dentin layers, produced adverse FEA stress distributions and displacements. An indirect lithium disilicate inlay used to replace lost dentin and enamel in posterior restored teeth generated lower stress levels, within the limits of the elastic FEA model.

The effects of cavity-margin-angles and bolus stiffness on the mechanical behavior of indirect resin composite class II restorations.

OBJECTIVE: To study the influence of the different class II mesio-occlusal-distal (MOD) cavity shape on the stress and strain distributions in adhesive indirect restorations, using numerical finite element analysis (FEA). To investigate the relationship between restored teeth failure and stiffness of food, three values of Young's modulus were used for the food. METHODS: A 3D model of a sound lower molar and three class II MOD cavities with different shape were created. Slide-type contact elements were used between tooth surface and food. An adhesive resin-based cement, modeled with fixed-type contact elements, and a single restorative filling materials were considered. To simulate polymerization shrinkage effect, which is basically restricted to the thin composite cement layer, shell elements were employed and the thermal expansion approach was used. A vertical occlusal load of 600N was applied, while assigning fixed zero-displacements on the cutting surfaces below the crevices. All the materials were assumed to be isotropic and elastic. A static linear analysis was carried out. RESULTS: In the lingual cusp, the displacements increased as the values of the stiffness food increased. In the restored teeth, the stress near the restoration-tooth interface was strongly dependent on the MOD cavity shape. The stress peaks were mainly located along the enamel-dentin interface at the lingual side; wedge-shaped MOD cavity with a low angle, in combination with the lowest food stiffness provided the best results. SIGNIFICANCE: A more complex load application on the occlusal surfaces was introduced. Food stiffness slightly affected the stress distribution of the restored and sound teeth. Teeth with adhesive class II MOD indirect resin composite restorations were potentially more susceptible to damage if the class II MOD cavity-margin-angle was higher than 95°. Restored teeth with a higher cavity-margin-angle led to considerable stress concentration in the lingual cusp along the enamel-dentin interface. These models were more susceptible to fracture in the lingual cusps when compared to the buccal ones.

A new method to assess the accuracy of a Cone Beam Computed Tomography scanner by using a non-contact reverse engineering technique.

AIM: Today Cone Beam Computed Tomography (CBCT) has become an important image technique for dento-maxilla facial applications. In the paper a new method to assess the geometric accuracy of these systems was proposed. It uses a free form benchmark model and a non-contact Reverse Engineering (RE) system. METHOD: The test geometry chosen for this study was designed in such a way that it simulated human spongy bone, cortical bone, gingiva and teeth and it composed of removable free form parts. It was acquired with a high-resolution laser scanner (D700 Scanner - 3Shape, Denmark). The reference 3D surface models obtained with the laser scanner was compared with the 3D models that were created from a CBCT system (Scanora 3D - Soderex, Finland) and from a traditional Multi-Slice Computed Tomography (MSCT) scanner (LightSpeed VCT 64 Slice - General Electric, USA) at different reconstruction settings, using an iterative closest point algorithm (ICP) in Geomagic(®) software. RESULTS: The comparison between the different pairs of CAD models clearly shows that there is a good overlap between the models. CONCLUSIONS: Although the results obtained in this study could lead to increase the use of CBCT for an increasing number of dental procedures, the publication of the European Commission guidelines represents a baseline on which the clinicians should rely heavily when considering the use of CBCT in their practice. CLINICAL SIGNIFICANCE: The results of this research show that the accuracy of CBCT 3D models is comparable to MSCT 3D models.

A comparison between customized clear and removable orthodontic appliances manufactured using RP and CNC techniques.

OBJECTIVES: Aim of the research is to compare the orthodontic appliances fabricated by using rapid prototyping (RP) systems, in particular 3D printers, with those manufactured by using computer numerical control (CNC) milling machines. 3D printing is today a well-accepted technology to fabricate orthodontic aligners by using the thermoforming process, instead the potential of CNC systems in dentistry have not yet been sufficiently explored. MATERIALS AND METHODS: One patient, with mal-positioned maxillary central and lateral incisors, was initially selected. In the computer aided virtual planning was defined that, for the treatment, the patient needed to wear a series of 7 removable orthodontic appliances (ROA) over a duration of 21 weeks, with one appliance for every 3 weeks. A non-contact reverse engineering (RE) structured-light 3D scanner was used to create the 3D STL model of the impression of the patient's mouth. Numerical FEM simulations were performed varying the position of applied forces (discrete and continuous forces) on the same model, simulating, in this way, 3 models with slice thickness of 0.2 mm, 0.1 mm (RP staircase effect) and without slicing (ideal case). To define the areas of application of forces, two configuration "i" and "i-1" of the treatment were overlapped. 6 patients to which for three steps (3rd, 4th and 5th step) were made to wear aligners fabricated starting from physical models by 3D printing (3DP-ROA) and afterwards, for the next steps (6th, 7th and 8th step), aligners fabricated starting from physical models by CNC milling machine (CNC-ROA), were selected. RESULTS: For the 6 patients wearing the CNC-ROA, it was observed a best fitting of the aligner to the teeth and a more rapid teeth movement than the 3DP-ROA (2 weeks compared to 3 weeks for every appliance). FEM simulations showed a more uniform stress distribution for CNC-ROA than 3DP-ROA. CONCLUSIONS: In this research, 6 different case studies and CAD-FEM simulations showed that, to fabricate an efficient clear and removable orthodontic aligner, it is necessary to consider a compromise of several factors. A lower staircase effect (lower layer thickness) and a higher physical prototype accuracy allow a better control of tooth movement.

Reliability of computer designed surgical guides in six implant rehabilitations with two years follow-up.

OBJECTIVE: To evaluate the reliability and accuracy of computer-designed surgical guides in osseointegrated oral implant rehabilitation. MATERIALS AND METHODS: Six implant rehabilitations, with a total of 17 implants, were completed with computer-designed surgical guides, performed with the master model developed by muco-compressive and muco-static impressions. In the first case, the surgical guide had exclusively mucosal support, in the second case exclusively dental support. For all six cases computer-aided surgical planning was performed by virtual analyses with 3D models obtained by dental scan DICOM data. The accuracy and stability of implant osseointegration over two years post surgery was then evaluated with clinical and radiographic examinations. Radiographic examination, performed with digital acquisitions (RVG - Radio Video graph) and parallel techniques, allowed two-dimensional feedback with a margin of linear error of 10%. RESULTS: Implant osseointegration was recorded for all the examined rehabilitations. During the clinical and radiographic post-surgical assessments, over the following two years, the peri-implant bone level was found to be stable and without appearance of any complications. The margin of error recorded between pre-operative positions assigned by virtual analysis and the post-surgical digital radiographic observations was as low as 0.2mm. SIGNIFICANCE: Computer-guided implant surgery can be very effective in oral rehabilitations, providing an opportunity for the surgeon: (a) to avoid the necessity of muco-periosteal detachments and then (b) to perform minimally invasive interventions, whenever appropriate, with a flapless approach.

Effects of thread features in osseo-integrated titanium implants using a statistics-based finite element method.

OBJECTIVE: To investigate the influence of implant design factors in terms of bone integrity and implant stability. MATERIALS AND METHODS: A 3D parametric CAD model was developed. Then, once domain settings and boundary conditions were defined, a 3D FEM model was created. To simulate the physical interaction at the bone-implant interface, identity pairs were introduced. After generating different design scenarios with a DOE approach, the most significant design factors were obtained. RESULTS: This study showed that the geometry of the screw thread highly influenced the implant stability. In particular the degree of bone damage became minimal when adopting 0.40 mm for the thread width and 0.05 mm for the thickness. SIGNIFICANCE: Thread width and thickness play a crucial role to reduce induced stresses and damage in bone. Considering these preliminary results, future improvements should focus on investigating also two-factor and higher interactions to better understand the implant loading mechanism.