Fully Digital versus Conventional Workflows for Fabricating Posterior Three-Unit Implant-Supported Reconstructions: A Prospective Crossover Clinical Trial.

This study assessed the clinical variables influencing the success of three-unit implant-supported fixed dental prostheses (ISFDPs) fabricated using either fully digital or conventional workflows. The clinical trial evaluated 10 patients requiring three-unit ISFDPs in the posterior mandible. Maxillomandibular relation records, and digital and conventional impressions were obtained from each patient using an intraoral scanner (IoS) and polyvinylsiloxane (PVS), and the frameworks were fabricated using zirconia and cobalt-chromium, respectively. A 2 µm accuracy scanner scanned the conventional master casts and standard reference models. The stereolithography (STL) files of the digital and conventional impressions were superimposed on the standard model file, and the accuracy was calculated with the best-fit algorithm. The framework adaptation and passivity were assessed using the one-screw and screw resistance tests. The time required for occlusal adjustment of both types of reconstructions, including the duration of the whole treatment, was recorded. The aesthetic appearance of ISFDPs was rated by each patient and clinician using a self-administered visual analogue scale questionnaire and the FDI World Dental Federation aesthetic parameters, respectively. The sample size was based on the power calculation, and alpha was set at 0.05 for the statistical analyses. The impression accuracy, framework adaptation and passivity, and reconstructions aesthetics did not significantly differ between the digital and conventional approaches. The total fabrication time was significantly shorter using the digital workflow. Within the limitations of this clinical study, the fully digital workflow can be used for the fabrication of ISFDPs with a clinical outcome comparable to that of the conventional workflow.

Understanding the Lived Experience of North American Dental Patients With a Single-Tooth Implant in the Upper Front Region of the Mouth: Protocol for a Qualitative Study.

BACKGROUND: Assessment of the subjective experiences of individuals with maxillary anterior (ie, the upper front region of the mouth) single-tooth implants is limited mainly to quantitative measurements of satisfaction with appearance. Interestingly, there is unexplained variability in the relationship between satisfaction and appearance. OBJECTIVE: This qualitative study protocol aims to explore and better understand the satisfaction with appearance and function in a Canadian population with maxillary anterior single-tooth implants treated at a postgraduate university clinic. Thus, we aim to obtain diversity among participants relating to the identification of esthetically pleasing and displeasing cases from a clinician perspective. METHODS: A qualitative research design using interpretative phenomenology analysis (IPA) will provide an adaptable inductive research approach. The participants will be recruited, and consent documents, photographs, digital intraoral scans, and self-administered questionnaire responses will be obtained from them. The transcribed verbatim data from audio-recorded, in-depth, semistructured, one-to-one interviews of the participants will be managed, coded, and analyzed thematically with computer-assisted qualitative data analysis software. The IPA will consider the COnsolidated criteria for REporting Qualitative (COREQ) guidelines when applicable. RESULTS: For the qualitative interview, we plan to include at least eight patients to conduct up to 1.5 hours of open-ended interviews with each participant aided by an interview guide. Ethical approval was granted by the University of British Columbia Behavioral Research Ethics Board (H19-00107) in May 2019. Two American dental foundations funded this study. CONCLUSIONS: The analysis in this study will elucidate the aspects (including their value) that influence participant satisfaction at different dental implant treatment stages. This will be the first qualitative study on this group of the population to explore and obtain a better understanding of their satisfaction with appearance and function, as well as any other patient-reported outcome measures that could be identified. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25767.

Reliability of Interproximal Bone Height Measurements in Bone- and Tissue-Level Implants: A Methodological Study for Improved Calibration Purposes.

PURPOSE: To evaluate the interobserver and intraobserver agreement between prosthodontists when measuring interproximal peri-implant bone levels from digital periapical radiographs and to introduce a radiographic quality index for periapical imaging assessment. MATERIALS AND METHODS: Periapical radiographs of 122 single implants in the anterior and posterior regions with two categories of imaging quality (ie, optimal and suboptimal) were assessed. Six prosthodontists were asked to linearly measure the distance from the first bone-to-implant contact to the implant platform/shoulder (DIB) using an image processing program (ImageJ 1.48u4, NIH). The procedure was repeated after 3 to 4 weeks. Interobserver and intraobserver agreements were evaluated by intraclass correlation coefficient and kappa. A radiographic quality index developed for periapical imaging assessment has been introduced in this study. Each implant was classified into two categories according to the implant type and the quality of the radiographic image. RESULTS: There were significant interobserver differences (P < .001). Most of the discrepancies between repeated measures were below 0.5 mm (range: 0.37 [SD ± 0.76] to 0.55 [SD ± 0.68]). The interobserver and intraobserver agreements on the bone-level values were "fair to moderate" regardless of the implant type and radiographic quality. With optimal image quality in tissue-level images, "substantial agreement" could be achieved. There was no significant effect of the implant level type (P = .973). CONCLUSION: Image quality, as well as the interpreter, influenced the measurements' reproducibility by prosthodontists. Bone height assessments at bone-level implants seem to be slightly more variable compared with tissue-level assessments; however, there were no significant differences. Specific guidelines on how to estimate DIB for calibration purposes in the case of suboptimal radiographic image quality and how to obtain optimal images need to be developed. The radiographic quality index for periapical imaging assessment is expected to be adopted in future studies.

Clinical performance of zirconia implants: A meta-review.

STATEMENT OF PROBLEM: The clinical effectiveness of zirconia implants as an alternative to titanium implants is still controversial. PURPOSE: The purpose of this analysis was to identify and evaluate systematic reviews reporting on the clinical outcomes of zirconia implants for oral rehabilitation. MATERIAL AND METHODS: An electronic search was undertaken on MEDLINE, Embase, and the Cochrane Oral Health Reviews databases up to December 24, 2018, without language restriction. Eligible reviews were screened and assessed. The eligibility criteria were systematic reviews or meta-analyses, implant survival rate, implant success, marginal bone loss, peri-implant soft tissue status, and biologic and functional complications of zirconia implants. Two review authors independently evaluated the quality assessment of the secondary studies by applying the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. RESULTS: Nine reviews fulfilled the inclusion criteria and were evaluated. Seven reviews were classified as moderate and 2 as high quality. The overall AMSTAR's quality of these reports was moderate. In the primary studies contained in these reviews, zirconia implant clinical outcomes were found to be similar or inferior to those for titanium implants. The few primary clinical studies contained in these reviews were not homogeneous among each other, presented poor methodology, and only offered promising short-term outcomes due to the lack of long-term follow-ups. CONCLUSIONS: Based on this meta-review, in spite of short-term promising results of zirconia implants, evidence with long term is lacking.

In Vivo and In Vitro Effectiveness of Rotary Nickel-Titanium vs Manual Stainless Steel Instruments for Root Canal Therapy: Systematic Review and Meta-analysis.

INTRODUCTION: This systematic review evaluated the effectiveness of nickel-titanium (NiTi) rotary files compared to stainless-steel (SST) hand files. METHODS: An electronic search was performed on Medline, EMBASE, CENTRAL and Scopus databases up to February 2016. An additional hand searching was performed in 13 journals. The studies were classified according to study type and the outcome variables. Two reviewers independently applied eligibility criteria, extracted data, and three reviewers independently assessed the quality of the evidence of each included study according to The Cochrane Collaboration's procedures. A meta-analysis was performed whenever it was possible. RESULTS: The electronic and hand search strategies yielded 1155 references of studies after removal of duplicates. Four clinical studies (two prospective and two retrospective studies) and 18 in vitro studies (on extracted teeth) were included for the qualitative synthesis after full-text evaluation of the eligible studies. The overall level of methodological quality of the studies included can be considered inadequate. Only one clinical study was judged at low risk of bias, whereas most non-clinical studies had a low risk of bias. Three meta-analyses, based on a very limited number of studies, could be performed. Each meta-analysis contained two studies. Of these, one meta-analysis was based on clinical studies. CONCLUSIONS: The results of this systematic review suggested that NiTi rotary instruments were associated with lower canal transportation and apical extrusion when compared to SST hand files, whereas both groups had similar outcomes in terms of success of therapy, amount of residual bacteria, and cleansing ability after treatment. However, due to the limited evidence available, these results should be interpreted with caution. Consequently, more randomized control trials using standardized protocols are needed in order to provide more solid recommendations.

www crownorfill com, un sitio que proporciona acceso instantáneo a la información basada en evidencia sobre restauraciones dentales posteriores: [Carta al Editor] / www.crownorfill. com Is the online tool that provides instant accessto evidence-based literature on dental restorations:[Letter to the Editor]

Crown-or-Fill© es una aplicación en un sitio web que resume la literaturabasada en la evidencia sobre los resultados del tratamiento para restauraciones en dientes posteriores en función de condiciones preexistentes. Los datos presentados se recogieron en dos revisionessistemáticas publicadas.

Crown-or-Fill© It is an application on a website that summarizes evidence based literature on treatment outcomes for restorations on posterior teeth as a function of pre-existing conditions. The data presented was collected in two published systematic reviews.

Corrección de la sonrisa con toxina botulínica en un paciente con parálisis facial / Smile enhancement with botulinum toxin in a patient with facial palsy

Resumen: La parálisis facial altera la función muscular desencadenando diversas alteraciones funcionales, psicológicas, emocionales, estéticas y sociales. Existen múltiples causas y tratamientos quirúrgicos y no quirúrgicos para tratar el lado paralizado. Sin embargo, en pacientes con parálisis facial de larga evolución, en quienes el tratamiento quirúrgico ha generado mínimos beneficios o pacientes no candidatos a tratamientos quirúrgicos, el uso de toxina botulínica es una alternativa viable para tratar lado afectado cuando existen secuelas como sincinesias, hipertonía o espasmo hemifacial. En el lado no afectado también se utiliza para ocasionar simetría estética y funcional estática y dinámica. Se presenta un caso clínico de un paciente varón con parálisis facial idiopática derecha tratado con quimiodenervación contralateral selectiva con toxina botulínica y su evolución favorable hacia la funcionalidad y normalización de la simetría facial dinámica.

Abstract: By altering muscle function, facial palsy causes functional, psychological, emotional, aesthetic and social changes. There are several etiologies and multiple treatments to treat paralyzed side. However, patients with longstanding facial palsy, patients in whom surgical treatment has generated minimal benefits or patients who are not candidates for surgical treatments, the use of botulinum toxin is an adequate alternative to treat affected side when there are sequelae as sinkynesis, hypertony or hemifacial spasm. In the unaffected side is also used to cause static and dynamic aesthetic and functional symmetry. We present a male patient with right idiopathic facial palsy treated with selective contralateral chemodenervation with botulinum toxin. This treatment resulted in the patient's favorable evolution towards functionality and normalization of dynamic facial symmetry.

Impact of a "TED-Style" presentation on potential patients' willingness to accept dental implant therapy: a one-group, pre-test post-test study.

PURPOSE: A survey was conducted to assess the impact of a TED-like educational session on participants' willingness to accept dental implant therapy. MATERIALS AND METHODS: Volunteers interested in having information about dental implant therapies were recruited and asked to complete a two-part survey before and after an educational session. The initial survey elicited demographic information, self-perceived knowledge on dental implants and willingness to this kind of treatment. A "TED-style" presentation that provided information about dental implant treatments was conducted before asking the participants to complete a second set of questions assessing the impact of the session. RESULTS: The survey was completed by 104 individuals, 78.8% were women and the mean age was 66.5±10.8. Before the educational session, 76.0% of the participants refused dental implants mainly due to lack of knowledge. After the educational session, the rejection of dental implants decreased by almost four folds to 20.2%. CONCLUSION: This study proved that an educational intervention can significantly increase willingness to accept treatment with dental implants in a segment of the population who is interested in having information about dental implant therapy. Furthermore, educational interventions, such as TED-like talks, might be useful to increase popular awareness on dental implant therapy.

[Müllerian anomalies. Obstructed hemivagina and ipsilateral renal anomaly syndrome (OHVIRA)]. / Malformaciones müllerianas. Síndrome de hemivagina obstruida y anomalía renal ipsilateral (OHVIRA).

Müllerian duct anomalies are a group of uncommon and underdiagnosed entities, which cause specific symptoms in adolescent females and may be associated with infertility as well as adverse pregnancy outcomes. These malformations occur as a result of an arrest or abnormal development of the Müllerian ducts in different stages of the female reproductive tract during gestation. Obstructed hemivagina and ipsilateral renal anomaly syndrome (OHVIRA), formerly known as the Herlyn-Werner-Wunderlich syndrome, is a rare entity characterized by the presence of a uterus didelphys with an obstructed hemivagina cause by a vaginal septum and the association of a renal anomaly (most commonly renal agenesis) ipsilateral to the obstruction. This syndrome may remain undiagnosed during childhood and usually becomes symptomatic after menarche, causing obstructive symptoms. Occasionally it may be identified after the evaluation of a patient with infertility or recurrent pregnancy loss. The clinical diagnosis is very challenging and requires imaging studies in which ultrasound and MRI play an essential role in the diagnosis, classification and treatment plan. Opportune diagnosis and treatment achieve complete improvement of symptoms, adequate reproductive prognosis and avoid major complications such as endometriosis, pelvic adhesions and infertility. The purpose of this review is to demonstrate the pathophysiology, clinical manifestations, diagnostic methods and treatment of the obstructed hemivagina and ipsilateral renal anomaly syndrome.

Las malformaciones de los conductos de Müller son un grupo de entidades raras y poco diagnosticadas que ocasionan síntomas inespecíficos en adolescentes y pueden acompañarse de problemas de infertilidad y RESULTADOS obstétricos adversos. Estas malformaciones ocurren durante la gestación como consecuencia del desarrollo anormal de los conductos de Müller en diferentes etapas del proceso de formación del aparato reproductor femenino. El síndrome de hemivagina obstruida y anomalía renal ipsilateral, antes conocido como el síndrome de Herlyn-Werner-Wünderlich, es un padecimiento poco común, caracterizado por útero didelfo con una hemivagina obstruida por un tabique vaginal, y la asociación de una anomalía renal (agenesia renal principalmente) ipsilateral a la obstrucción. Este síndrome rara vez se identifica durante la niñez y se vuelve sintomático posterior a la menarquia, ocasionado por los síntomas obstructivos. A veces se identifica posterior a la evaluación de una paciente con problemas de infertilidad o pérdidas gestacionales recurrentes. El diagnóstico clínico es difícil, por eso se requieren estudios de imagen en los que el ultrasonido y la resonancia magnética desempeñan un papel decisivo para el diagnóstico, clasificación y plan terapéutico. El diagnóstico y tratamiento oportunos logran la desaparición de los síntomas, con pronóstico reproductivo adecuado, y se evitan las principales complicaciones: endometriosis, adherencias pélvicas e infertilidad. OBJETIVO: mostrar la fisiopatología, las manifestaciones clínicas, los métodos diagnósticos y terapéuticos del síndrome de hemivagina obstruida y anomalía renal ipsilateral.

Improving oral rehabilitation through the preservation of the tissues through alveolar preservation.

When performing a tooth extraction, imminent collapse of the tissue by resorption and remodeling of the socket is a natural occurrence. The procedure for the preservation of the alveolar ridge has been widely described in the dental literatures and aims to maintain hard and soft tissues in the extraction site for optimal rehabilitation either with conventional fixed or removable prosthetics or implant-supported prosthesis.