Development of impression trays for treating infants with trisomy 21 before their deciduous teeth erupt.

The treatment of infants with trisomy 21 (TS21) with a myostimulation plate can improve their development and quality of life. The manufacture of these plates requires an accurate cast of the maxilla, and their efficacy relies on their stability and retention. As such, the quality of the impression is a determining factor. The lack of commercially available stock trays for infants with TS21 creates difficulties, including inadequate impression quality and the risk of inhaling impression material. The present technique simplifies impression making for infants with TS21 from 3 months of age to when their maxillary deciduous teeth erupt by using computer-aided design and computer-aided manufacturing (CAD-CAM) impression trays. Sixty-five stored gypsum maxillary casts from infants with TS21 that had been used to manufacture myostimulation plates were analyzed to select four differently sized representative casts for designing the impression trays. A CAD software program was used to digitally shape four sizes of the impression tray from the selected gypsum casts. Practitioners interested in this approach can download and export the standard tessellation language (STL) files using a quick response (QR) code. The impression trays should be manufactured with the stereolithography additive technique using biocompatible resin. This technique allows practitioners to make accurate maxilla impressions for infants with TS21 by manufacturing their own impression trays using the free-access STL files rather than the cumbersome conventional method.

Effectiveness of a 3D simulation tool to teach the designing of metal removable partial dentures: A mixed-method study.

INTRODUCTION: Acquiring insights into the framework design of metal-based removable partial dentures (mRPD) is a current challenge in dental education. The aim of the present study was to explore the effectiveness of a novel 3D simulation tool to teach designing mRPD by investigating the learning gain and the acceptance and motivation towards the tool of dental students. MATERIALS AND METHODS: A 3D tool based on 74 clinical scenarios was developed for teaching the design of mRPD. Fifty-three third year dental students were randomly divided into two groups, with the experimental group (n = 26) having access to the tool during 1 week while the control group (n = 27) had no access. Quantitative analysis was based on a pre- and post-test in order to evaluate the learning gain, technology acceptance and motivation towards using the tool. Moreover, qualitative data was collected by means of an interview and focus group to get additional insights into the quantitative results. RESULTS: Although the results showed a higher learning gain for students in the experimental condition, the study did not find a significant difference between both conditions based on quantitative results. However, during the focus groups, all students of the experimental group revealed that the 3D tool improved their understanding of mRPD biomechanics. Moreover, survey results revealed that students positively evaluated the perceived usefulness and ease of use of the tool and indicated to have the intention to use the tool in the future. Suggestions were made for a redesign (e.g. creating scenarios themselves) and further implementation of the tool (e.g. analysing the scenarios in pairs or small groups). CONCLUSION: First results of the evaluation of the new 3D tool for teaching the design framework of mRPD are promising. Further research based on the design-based research methodology is needed to investigate the effects of the redesign on motivation and learning gain.

Effect of dimensional variations on the manufacturing process and the 3D shrinkage ratio of stereolithographic dental alumina ceramics.

The purpose of the present study was to evaluate the influence of height and length variations of alumina ceramics manufactured by stereolithography on deformations caused by the manufacturing process and on the 3D shrinkage ratio to control the final dimensions and improve the adaptation of stereolithographic ceramic dental prostheses. Two different U-shaped models were designed with variable heights or lengths. The specimens were manufactured by stereolithography and were scanned using a microtomographic device before and after the heat treatment. Dimensional variations were measured using inspection software. The number and surface of layers of alumina ceramic influenced the reliability of the stereolithography manufacturing but did not influence the 3D shrinkage ratio. The larger the layer surface, the larger the deformation of the ceramic. Dental ceramics manufactured by stereolithography with smallest layer surface are the most reliable. This helps in the selection of the build orientation.

Impact of type of bonding agent on adhesion of CAD-CAM denture bases and teeth manufactured using different techniques: A preliminary study.

PURPOSE: To evaluate two agents for bonding denture bases and teeth manufactured either by stereolithography (SLA) or by the subtractive mixed technique. METHODS: Two types of cylinders [small for the tooth resin and large for the base resin) were designed using CAD software according to the ANSI/ADA 15-2008 (R2013)] specification. For SLA manufacturing, 30 small cylinders were shaped with Denture Teeth resin and 30 large cylinders with Denture Base resin. For the mixed technique, 30 large cylinders were manufactured by SLA with V-print dentbase resin, and 30 small cylinders were milled with a CediTEC DT disk. Half the specimens were bonded with liquid Denture Base resin and half with CediTEC Primer and Adhesive, according to the manufacturers' protocols. Shear bond strength was measured using a universal testing machine. The failure mode was noted for all the specimens. RESULTS: The shear bond strength values were not significantly different between the groups (P> 0.05). Specimens bonded with liquid Denture Base resin displayed cohesive failure (P> 0.05, ײ= 0). Of the specimens bonded with CediTEC Primer and Adhesive, cohesive failures were observed with five specimens manufactured with the SLA technique and one specimen manufactured with the mixed technique (P> 0.05, ײ= 3.33). The Chi-square test results were significant between groups with different bonding agents regardless of the technique used (P< 0.001). Within the limitations of the present study, even if the shear bond strength values were similar, the failure mode analysis suggests that the uncured liquid Denture Base resin may be more effective than the CediTEC Primer and Adhesive for bonding denture bases and teeth manufactured either by SLA or the mixed technique. CLINICAL SIGNIFICANCE: The present study suggests that the uncured liquid resin (Denture Base) used as a bonding agent and the denture base and tooth materials (V-Print and CediTEC DT) manufactured by SLA and the subtractive technique are clinically compatible.

Sodium carbonate improves adherence of two-layer alginate for preliminary impressions of complete dentures.

PURPOSE: This in vitro study evaluated the effect of sodium carbonate (Na2CO3) concentration on adhesion between two layers of irreversible hydrocolloid wash impression material. METHODS: The first layer of irreversible hydrocolloid was brushed with three concentrations (0.1, 0.7, or 7.0 wt.%) of Na2CO3. Irreversible hydrocolloid not brushed with Na2CO3 was used as a negative control. Adhesion between the two layers (bond strength and adhesion energy) was then evaluated using a traction test, and the fracture modes were identified. The results of traction test were analyzed with a one-way ANOVA followed by a Tukey post hoc test. Chi-square test was used for analyzed failure mode after testing (α= 0.05). RESULTS: The bond strength (0.034 ±0.005 MPa) and adhesion energy (60.240 ±12.817 J.m⁻ ²) of the 0.7% Na2CO3 group were significantly higher than those of the other groups (P< 0.05). The 0.7% Na2CO3 group displayed only cohesive failure (ײ= 16; P< 0.0001). CLINICAL SIGNIFICANCE: Conditioning the surface of the first layer of irreversible hydrocolloid with 0.7% sodium carbonate improved adhesion between the two layers and may help clinicians improve the quality of the preliminary impressions of removable complete dentures.

Effect of build orientation on the manufacturing process and the properties of stereolithographic dental ceramics for crown frameworks.

STATEMENT OF PROBLEM: Stereolithography (SLA) ceramic crown frameworks are suitable for clinical use, but the impact of SLA build orientation has not been identified. PURPOSE: The purpose of this in vitro study was to investigate the effect of 3 build orientations on the physical and mechanical properties and the microstructure of SLA alumina dental ceramics. MATERIAL AND METHODS: The physical and mechanical properties and microstructures of 3 different oriented SLA alumina ceramics (ZX, ZY, and XY) were evaluated by visual observation, hydrostatic weighing (n=10/group), Weibull analyses (n=30/group), scanning electron microscopy, 3-point flexural strength (n=30/group), fracture toughness (indentation, single-edge-V-notched-beam) (n=4/group), and Vickers hardness (n=15/group) testing. The hydrostatic weighing, 3-point flexural strength, fracture toughness, and Vickers hardness testing data were statistically analyzed (α=.05). RESULTS: The minimum resting period of slurries between the polymerization of 2 layers was shorter for the ZY- and ZX-oriented specimens and increased with the layer surface. The density and Vickers hardness of the SLA-manufactured specimens were similar for all groups (P>.05). The 95% confidence intervals of the Weibull moduli of the ZX- and ZY-oriented specimens were higher than that of the XY-oriented specimens, with no overlap fraction. The ZY-oriented specimens displayed significantly higher 3-point flexural strength (P<.05) and fracture toughness as evaluated by the single-edge-V-notched-beam method than the ZX-oriented specimens (P<.05). They also displayed significantly higher 3-point flexural strength than the XY-oriented specimens (P<.05). The microstructural analysis showed that the texturing was heterogeneous and that the major axis of the large grains of alumina ran parallel to the orientation of the layers. CONCLUSIONS: The ZY orientation produced a reliable dental ceramic by SLA, with the shortest general manufacturing time and the highest mechanical strength when the layers were perpendicular to the test load surface.

Evaluation of the use of a guided bur during preclinical teaching of tooth preparation: A pilot study.

Objectives: An innovative calibrated bur, aiming to improve precision during reduction of the incisal edge, was recently proposed to guide practitioners during tooth preparation. However, limited information is available concerning its usefulness in dental preclinical education. The aim of this study was to evaluate whether using this innovative guided bur improves learning experience quality and the performance of students during tooth preparation. Material and methods: After having provided written consent, 60 second-year students were divided into two groups. One group used a 1-mm rounded bur to perform depth grooves, whereas the second group used the innovative guided bur, consisting in a 2-mm-depth marker with a stopping surface. Once the grooves were obtained, they were then connected using the same wheel bur in both groups. The aim was to obtain a final 2-mm reduction of the incisal edge. Quality of the learning experience (stress level, motivation to restart, self-evaluation of the preparation, and difficulty) was quantified using a visual analog scale. Duration of the procedure was also measured in both groups. 3D measurements for each tooth were performed using an STL comparison software. Results: There were no significant differences between groups in terms of stress and self-evaluation of the preparation. Students in the guided bur group reported significantly lower perception of exercise difficulty (p < .001) and significantly higher motivation to restart the procedure (p < .001). The guided bur group performed the procedure in 16.4% less time than the rounded bur group. The use of the guided bur led to a 23% over-reduction, whereas the use of the rounded bur led to a 10% under-reduction. Conclusions: Overall, the present study shows that the guided bur provides significant improvement in the student's learning experience with increased motivation and decreased perception of difficulty. It shortens the duration of procedure performance, but it also induces a reduction in preparation accuracy.

Stereolithography: A new method for processing dental ceramics by additive computer-aided manufacturing.

OBJECTIVES: The aim of this study was to compare the physical and mechanical properties of stereolithography (SLA)- manufactured alumina ceramics of different composition to those of subtractive- manufactured ceramics and to produce suitable dental crown frameworks. METHODS: The physical and mechanical properties of a control and six experimental SLA ceramics prepared from slurries with small (S) and large (L) particles (0.46±0.03 and 1.56±0.04µm, respectively) and three dry matter contents (70%, 75%, 80%) were evaluated by dynamic rheometry, hydrostatic weighing, three3-point flexural strength measurements, and Weibull analyses, and by the micrometrics measurement of shrinkage ratio before and after the heat treatments. RESULTS: S75 was the only small particle slurry with a significantly higher viscosity than L70. The viscosity of the S80 slurry made it impossible to take rheological measurements. The viscosities of the S75 and S80 slurries caused deformations in the printed layers during SLA manufacturing and were excluded from further consideration. SLA samples with low dry matter content had significantly lower and densityflexural strengths. Only SLA samples with a large particle size and high dry matter content (L75 and L80) were similar in density and flexural strength to the subtractive- manufactured samples. The 95% confidence intervals of the Weibull modulus of the L80 ceramic were higher (no overlap fraction) than those of the L75 ceramic and were similar to the control (overlap fraction). The Weibull characteristics of L80 ceramic were higher than those of L75 ceramic and the control. SLA can be used to process suitable crown frameworks but shows results in anisotropic shrinkage. SIGNIFICANCE: The hH High particle size and dry matter content of the L80 slurry allowed made it possible to produce a reliable ceramic by SLA manufacturing with an anisotropic shrinkage, and a density, and flexural strength similar to those of a subtractive-manufactured ceramic. SLA allowed made it possible to build up a dense 3D alumina crown framework with controlled shape. Further studies on the marginal adaptation and shrinkage model of alumina crown frameworks will be required to optimize the process.

Optimization and Preclinical Perception of an Artificial Simulator for Endodontic Training: A Preliminary Study.

The aim of this study was to evaluate the performance of ceramic, hybrid ceramic, and commercial plastic bloc root canal simulator (RCS) as preclinical training aids in the learning phase of endodontic treatments. A previously developed hydroxyapatite ceramic RCS was improved by adding epoxy resin to the ceramic matrix to more closely mimic the organic phase of dentin and to simulate the clinical situation as realistically as possible. The sintered hydroxyapatite ceramic RCS was vacuum infiltrated with epoxy resin, and the degree of infiltration was evaluated by methylene blue staining. The suitability of the resin-infiltrated ceramic simulator (CR) for preclinical endodontic training was compared to that of a non-infiltrated ceramic simulator (C) and a commercial epoxy bloc (P) using a cohort of 30 dental students at one dental school in France. The study was conducted in 2016. The students' perceptions following the required exercises using the CR, C, and P were scored using a questionnaire. The learning outcomes were also assessed by examining the canal preparations that the students performed on extracted teeth using a master cone try-in test. The vacuum process resulted in a good degree of resin infiltration into the ceramic. The questionnaire showed that the C and CR groups generally reported greater satisfaction, especially for radiographic visualizations, than the P group. The CR group had a higher score than the P group for tactile sensation. There was no significant difference among the three groups with respect to the canal preparations using extracted teeth. Resin infiltration improved the performance of the ceramic RCS, especially with respect to perception during root canal instrumentation. A larger scale student training investigation and an assessment by experienced endodontists are required to validate the model.

Influence of Root Canal Curvature on Wall Cleanliness in the Apical Third during Canal Preparation.

OBJECTIVE: The aim of this study was to evaluate the influence of root canal curvature (curved and straight root canals), prepared using reciprocating and rotary files, on wall cleanliness during root canal treatments. METHODS: Thirty curved and 30 straight human root canals were prepared using ProTaper (Dentsply), Pro- Taper Next (Dentsply) and Reciproc files (Dentsply) (n=20/group). The roots were split longitudinally and observed using a scanning electron microscope. Six micrographs were obtained at 1, 3 and 5 mm from the working length (WL). Two blinded observers scored the amount of debris. Mean debris scores were compared using a non-parametric the Mann-Whitney U test or Kruskal-Wallis test, and a Bonferroni correction was used for multiple comparisons. RESULTS: Considering all the shaping systems together, the debris scores were lower in curved root canals (P<0.05). Reciproc and ProTaper Next performed better than ProTaper in straight canals (P<0.05). No difference was found between ProTaper Next and Reciproc regardless of the canal curvature or distance from the WL. Considering all the shaping systems together, cleanliness increased when pulling away from the WL. CONCLUSION: The anatomical configuration of the root canal influences the quality of cleaning by shaping instruments regardless of the instrument kinematics during endodontic procedures. In every circumstance, the last millimetres of the apical third remain the most difficult area to clean.

Influence of heat and ultrasonic treatments on the setting and maturation of a glass-ionomer cement.

PURPOSE: To compare the effect of different treatments (heat capsule, ultrasound, and dual treatments) on the setting kinetics and maturation properties of a conventional GIC (EQUIA, GC) to that of standard setting. METHODS: The optimal durations of the heat and ultrasonic treatments were determined by monitoring changes in the COO-/COOH ratio, surface hardness, and temperature within the samples. The influence of optimal treatments on the maturation properties of the GIC (microhardness, and 3-point flexural strength) were assessed using GIC samples incubated in artificial saliva for 24 hours, 1 month, and 3 months. RESULTS: The optimal durations of the heat and ultrasonic treatments for accelerating setting were 5 minutes and 35 seconds, respectively. The dual treatment using the optimal conditions of the individual treatments further enhanced the setting kinetics. A temperature peak (49°C) within the GIC was detected during setting. Only the dual treatment increased the mechanical properties of the GIC after 24 hours compared to the control, while no significant difference was observed after 1 and 3 months.

Influence of dentist experience with scan spray systems used in direct CAD/CAM impressions.

STATEMENT OF PROBLEM: Direct optical impression systems requiring powder opacification are widely used in prosthodontics, but little information is available about the influence of the dentist on the quality of scan sprays used for computer-aided design and computer-aided manufacturing (CAD/CAM) impressions. PURPOSE: The purpose of this study was to evaluate the influence of operator experience on scan spray homogeneity and thickness on tooth surfaces before direct optical impressions are made. MATERIAL AND METHODS: A total of 36 crown-prepared acrylic resin teeth were coated (Optispray) for direct optical impressions by 3 experienced dentists and 3 inexperienced dentists (n=18 teeth per group). The teeth were visually scored for coating homogeneity (1, heterogeneous; 2, average; 3, homogeneous). To determine the coating thickness (µm), the teeth were resin-embedded, cut, and polished. A stereomicroscope (×100 magnification) was used to examine 148 areas per tooth. The results were statistically analyzed with the nonparametric Spearman and Mann-Whitney tests (α=.05). RESULTS: Coating homogeneity was significantly higher (P<.001) for the experienced group (92.41 ±6.65%) than for the inexperienced group (66.11 ±12.69%). Coatings were significantly thinner for the experienced group (43.1 ±14.09 µm) than for the inexperienced group (70.19 ±31.26 µm) for all crown areas (P=.007). Coatings were 52 µm thinner for occlusal areas (P<.001) for the experienced group than for the inexperienced group. Coatings were significantly thinner for buccal (P=.015) and lingual surfaces (P=.002) for the experienced group than for the inexperienced group. Coatings on cervical surfaces were significantly thinner for the experienced group (43.52 ±15.76 µm) than for the inexperienced group (63.45 ±29.93 µm) (P=.035). CONCLUSIONS: Experienced dentists achieved greater homogeneity and thinner coatings on crown-preparation surfaces than inexperienced dentists.