Do 3D-printed and milled tooth-supported complete monolithic zirconia crowns differ in accuracy and fit? A systematic review and meta-analysis of in vitro studies.

STATEMENT OF PROBLEM: Additive (3-dimensional printing) and subtractive (milling) methods are digital approaches to fabricating zirconia restorations. Comparisons of their resultant fabrication accuracy and restoration fit are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate the accuracy and fit of monolithic zirconia crowns fabricated by 3-dimensional printing and milling. MATERIAL AND METHODS: The PubMed (Medline), Scopus, Embase, Web of Science, Cochrane Library, and Google Scholar databases were searched up to August 2023. Eligible records were included, and the standardized mean difference (SMD) analyzed 4 outcomes: marginal fit, intaglio fit, trueness, and precision. Publication bias was analyzed with Trim-and-fill, the Egger regression test, and Begg funnel plot. Methodological quality was rated using the QUIN tool. RESULTS: A total of 15 publications were found eligible out of the initial 6539 records. The 3-dimensional printing group demonstrated a lower marginal fit (SMD=1.46, 95% CI=[0.67, 2.26], P<.001; I2=83%, P<.001) and trueness (SMD=0.69, 95% CI=[0.20, 1.18], P=.006; I2=88%, P<.001) and a significantly higher precision (SMD=-2.19, 95% CI=[-2.90, -1.48], P<.001; I2=56%, P=.045). The intaglio fit did not differ significantly across the study groups (SMD=0.77, 95% CI=[-0.22, 1.77], P=.127; I2=87%, P<.001). CONCLUSIONS: Given the high degree of heterogeneity, it can be cautiously concluded that while 3-dimensional printing led to greater precision, the outcomes of the 2 accuracy and adaptation parameters most crucial to the longevity of the restorations-trueness and marginal fit-showed the superiority of the milling technique.

The internal and marginal adaptation of lithium disilicate endocrowns fabricated using intra and extraoral scanners: An in-vitro study.

OBJECTIVES: The impression technique highly influences the adaptation of ceramic restorations. Not enough information is available to compare the marginal (MF) and internal fit (IF) of endocrowns fabricated with various digitization techniques. Therefore, this in-vitro study aimed to compare the MF and IF of lithium disilicate (LDS) endocrowns fabricated through direct and indirect digital scanning methods. MATERIALS AND METHODS: One extracted maxillary molar was used to fabricate endocrowns. The digitization of the model was performed with (G1) direct scanning (n = 10) utilizing an intraoral scanner (IOS), (G2) indirectly scanning the conventional impression taken from the model using the same IOS (n = 10), (G3) indirectly digitalizing the obtained impression using an extraoral scanner (EOS) (n = 10), and (G4) scanning the poured cast using the same EOS (n = 10). The MF and IF of the endocrowns were measured using the replica method and a digital stereomicroscope. The Kruskal-Wallis test was used to analyze data. RESULTS: The studied groups differed significantly (p<0.001). G2 (130.31±7.87 µm) and G3 (48.43±19.14 µm) showed the largest and smallest mean vertical marginal gap, respectively. G2 and G3 led to the highest and lowest internal gaps in all regions, respectively. With significant differences among the internal regions (p<0.001), the pulpal area demonstrated the most considerable misfit in all groups. CONCLUSIONS: Scanning the impression using an extraoral scanner showed smaller marginal and internal gaps.

Correlation between the upper airway volume and the hyoid bone position, palatal depth, nasal septum deviation, and concha bullosa in different types of malocclusion: A retrospective cone-beam computed tomography study.

BACKGROUND: The upper airway volume is among the factors that affect orthodontic treatment plans. Cone-beam computed tomography (CBCT), as an accurate diagnostic modality, can help assess anatomical structures associated with the upper airway volume. OBJECTIVES: This study aimed to use CBCT to determine if there are differences in the upper airway volume between different sagittal and vertical skeletal patterns, considering the hyoid bone position, palatal depth, nasal septum deviation (NSD), and concha bullosa. MATERIAL AND METHODS: From among 105 initial CBCT samples retrieved from the archive of a private radiology clinic in Tehran, Iran, 90 CBCT scans of 27 males and 63 females aged 17-65 years were considered in the study according to the inclusion criteria. The upper airway volume was assessed with regard to Angle's classification (using the A point-nasion-B point angle (ANB)), the vertical skeletal dimension (using the sella-nasion plane to mandibular plane angle (SN-MP)), the hyoid bone position, palatal depth, NSD, and concha bullosa, using CBCT and the NNT ® software. The one-way analysis of variance (ANOVA), Levene's test and the t test were used to analyze the data with the SPSS Statistics for Windows software, v. 17.0. RESULTS: The upper airway volume was significantly smaller in long-face cases (p = 0.037). There was no significant correlation between the upper airway volume and Angle's classification, the hyoid bone position, palatal depth, NSD, and concha bullosa. CONCLUSIONS: The vertical skeletal dimension was the only parameter that was related to the upper airway volume. The results of this study can be considered while preparing orthodontic treatment plans.

Vertical marginal fit of zirconia copings fabricated with one direct and three indirect digital scanning techniques.

STATEMENT OF PROBLEM: Direct digitization of the impression by using an intraoral scanner is a newly introduced technique, but studies comparing the method with other digitization techniques are lacking. PURPOSE: The purpose of this in vitro study was to compare the marginal accuracy of zirconia copings fabricated with 4 different scanning methods. MATERIAL AND METHODS: Scans (n=10) of a brass master die were made with a direct method (ISD) in which the die was directly digitized by using an intraoral scanner (IOS) and 3 indirect scanning methods, a conventional impression with polyvinyl siloxane material digitized with either the same IOS (ISI) or with a laboratory extraoral scanner (ESI), or a cast from the impression was scanned by using a laboratory extraoral scanner (ESC). Forty zirconia copings were milled from presintered zirconia blanks and sintered. The vertical marginal gap was measured at 12 points on the master die by using a digital microscope. One-way ANOVA was used to compare the mean differences among the 4 groups, and post hoc analysis was used for pairwise comparison of the groups (α=.05). RESULTS: The mean ±standard deviation of the vertical marginal gap was 73 ±7 µm in the ISD group, 109 ±36 µm in the ISI group, 42 ±4 µm in the ESI group, and 97 ±5 µm in the ESC group. The lowest marginal gap was seen in the ESI group, which was significantly different from the 3 other groups (P≤.001). The copings in the ISD group had a significantly lower marginal gap than those in the ISI (P=.04) and ESC (P<.001) groups. However, the ISI and ESC groups were not significantly different (P=.69). CONCLUSIONS: Marginal adaptation of all zirconia copings fabricated with these 4 scanning techniques was within a clinically acceptable range. However, ESI was the best method of digitization and yielded copings with minimum vertical marginal gap.

Detection of different foreign bodies in the maxillofacial region with spiral computed tomography and cone-beam computed tomography: An in vitro study.

PURPOSE: The detection and exact localization of penetrating foreign bodies are crucial for the appropriate management of patients with dentoalveolar trauma. This study compared the efficacy of cone-beam computed tomography (CBCT) and spiral computed tomography (CT) scans for the detection of different foreign bodies composed of 5 frequently encountered materials in 2 sizes. The effect of the location of the foreign bodies on their visibility was also analyzed. MATERIALS AND METHODS: In this in vitro study, metal, tooth, stone, glass, and plastic particles measuring 1×1×1 mm and 2×2×2 mm were prepared. They were implanted in a sheep's head in the tongue muscle, nasal cavity, and at the interface of the mandibular cortex and soft tissue. CBCT and spiral CT scans were taken and the visibility of foreign bodies was scored by 4 skilled maxillofacial radiologists who were blinded to the location and number of foreign bodies. RESULTS: CT and CBCT were equally accurate in visualizing metal, stone, and tooth particles of both sizes. However, CBCT was better for detecting glass particles in the periosteum. Although both imaging modalities visualized plastic particles poorly, CT was slightly better for detecting plastic particles, especially the smaller ones. CONCLUSION: Considering the lower patient radiation dose and cost, CBCT can be used with almost equal accuracy as CT for detecting foreign bodies of different compositions and sizes in multiple maxillofacial regions. However, CT performed better for detecting plastic particles.

Evaluation of the marginal fit of metal copings fabricated by using 3 different CAD-CAM techniques: Milling, stereolithography, and 3D wax printer.

STATEMENT OF PROBLEM: Digital systems have been developed as substitutes for the traditional fabrication of wax patterns and definitive restorations, but the accuracy of these systems is unclear. PURPOSE: The purpose of this in vitro study was to evaluate and compare the marginal fit of metal copings fabricated from milling, stereolithography (SLA), and 3D wax printer (PolyJet) patterns. MATERIAL AND METHODS: A standard machined brass die model was designed and prepared. To fabricate metal copings of standardized shape and dimensions, the die was scanned and nickel-chromium (Ni-Cr) copings were designed by using a dental designer software program. By using the same CAD data to fabricate 30 patterns through milling, SLA, and PolyJet techniques, 10 resin patterns were milled by using a 5-axis milling machine, 10 resin patterns were produced by using a NextDent 5100 3D Printer, and 10 wax patterns were printed by using a Solidscape 3D printer. The patterns were invested and cast in Ni-Cr alloy. Each coping was evaluated by using a digital microscope on 16 points around the finish line on the metal die at ×230 magnification. The mean marginal discrepancy was calculated. The mean differences among the groups were compared by using 1-way ANOVA, and post hoc analysis was used for pairwise comparison of the groups (α=.05). RESULTS: The mean value of marginal discrepancy was 93.1 ±25 µm in the milling, 71.1 ±25 µm in the SLA, and 41.3 ±6 µm in the PolyJet group. No statistically significant difference was found between the milling and SLA groups (P=.158), while the PolyJet group showed significantly lower mean marginal discrepancy than the 2 other groups (P<.05). CONCLUSIONS: The PolyJet method produces metal copings with better marginal fit than the SLA or milling techniques. However, the marginal fit was clinically acceptable in metal copings made with all the 3 methods.

Comparison of Bolton ratio in normal occlusion and different malocclusion groups in Iranian population.

OBJECTIVES: Bolton ratio is used as a method for diagnosis of tooth size discrepancy. Tooth size discrepancy has an important role in the stability of results of final orthodontic treatment. The aim of this study was to determine and compare Bolton ratio in normal occlusion and different malocclusion groups of Iranian population. MATERIALS AND METHODS: This descriptive-analytic study comprises 240 orthodontic patient casts (for every malocclusion group: class I, class II division 1, class II division 2, class III, 30 males and 30 females) which have fully erupted and complete permanent dentitions from first molar to first molar, and also 60 persons (30 male-30 female) with normal occlusion. The mesiodistal tooth sizes were measured using digital caliper two times with a 4-week interval. RESULTS: The average mesiodistal size of all teeth in the malocclusion group was significantly bigger than in the normal occlusion group. Although there was no relationship between anterior ratio and gender or malocclusion groups, but a significant relationship between total ratio in Class II division 1 and normal occlusion was seen. Furthermore, a significant difference between anterior and total ratios in the present study and original Bolton's values was found. CONCLUSIONS: In the normal occlusion group, the anterior and total ratios were bigger than those in Bolton's original study. Also, "class II division 1" showed the lowest values of Bolton ratio among the other normal occlusion and malocclusion groups. Therefore, the original Bolton's values should be used conservatively in Iranian population.

Smile attractiveness perception regarding buccal corridor size among different facial types.

BACKGROUND: The width of the buccal corridor (BC) is one of the factors affecting smile attractiveness. OBJECTIVES: The aim of this study was to determine the effects of the BC size on the smile attractiveness of individuals with short, normal and long faces from the viewpoint of laypersons, general dentists and orthodontists. MATERIAL AND METHODS: Smiling photographs of male and female subjects who met the inclusion criteria were digitally altered to create 3 BC sizes (narrow: 2%; normal: 15%; wide: 28%) and 3 facial types defined by the facial index (FI) (short face: FI ≤ 83.9; normal face: 84.0 ≤ FI ≤ 87.9; long face: FI ≥ 88.0). Nine different combinations were made and the evaluators rated the overall attractiveness and acceptability of each smile on a 10-millimeter visual analog scale (VAS). RESULTS: A total of 53 raters (22 laypersons, 16 general dentists and 15 orthodontists) participated in this study. The orthodontists and general dentists had similar viewpoints and they preferred narrow and normal BCs over the wide ones in all facial types. Laypersons preferred normal BC for normal faces, while they did not distinguish different BCs in short faces. CONCLUSIONS: Variations in the BC size affect smile attractiveness in different facial types and wide BCs are attributed to the least attractive smiles. Due to the different viewpoints of laypersons and professionals in this regard, there is no justification for expanding the maxillary arch to achieve more attractive smiles.

Comparison of Dental Panoramic Radiography and CBCT for Measuring Vertical Bone Height in Different Horizontal Locations of Posterior Mandibular Alveolar Process.

STATEMENT OF THE PROBLEM: Accurate measurement of the available bone height is an essential step in the pre-surgical phase of dental implantation. Panoramic radiography is a unique technique in the pre-surgical phase of dental implantations because of its low cost, relatively low-dose, and availability. PURPOSE: This article aimed to assess the reliability of dental panoramic radiographs in the accurate measurement of the vertical bone height with respect to the horizontal location of the alveolar crest. MATERIALS AND METHOD: 132 cone-beam computed tomography (CBCT) of the edentulous mandibular molar area and dental panoramic radiograph of 508 patients were selected. Exclusion criteria were bone abnormalities and detectable ideal information on each modality. The alveolar ridge morphology was categorized into 7 types according to the relative horizontal location of the alveolar crest to the mandibular canal based on CBCT findings. The available bone height (ABH) was defined as the distance between the upper border of the mandibular canal and alveolar crest. One oral radiologist and one oral surgeon measured the available bone height twice on each modality with a 7-dayinterval. RESULTS: We found a significant correlation between dental panoramic radiographs and cone-beam computed tomography values (ICC=0.992, p< 0.001). A positive correlation between the horizontal distance of the alveolar crest to the mandibular canal and measured differences between two radiographic modalities had been found (r=0.755, p< 0.001). For each single unit of increase in the horizontal distance of the alveolar crest to the mandibular canal, dental panoramic radiographs showed 0.87 unit of overestimation (p< 0.001). CONCLUSION: Dental panoramic radiographs can be employed safely in the pre-surgical phase of dental implantation in posterior alveolus of mandible, especially in routine and simple cases.

Factors Affecting Dental Caries of Preschool Children in Shiraz, 2014.

STATEMENT OF THE PROBLEM: Dental caries, the most common infectious disease, can lead to several consequences, including inflammation and bleeding of the gum, abscess formation, tooth loss, and subsequently loss of available space in the arch. PURPOSE: This study was designed to determine dental caries status of Shiraz preschool children and its related factors. MATERIALS AND METHOD: This cross-sectional study was conducted on the children registered in Shiraz kindergartens in 2014. The study recruited 453 children by randomized cluster sampling. We evaluated the children's demographic and oral hygiene factors, and their dental caries status using decayed, missed, and filled tooth (dmft) index and prevalence of the children with untreated dental caries. Relationship between the children's characteristics and their dental caries status was evaluated. RESULTS: Only 119 children (30.1%) were caries-free. The children's mean dmft index was 3.88(±3.9). After controlling the effect of confounding factors, the children's dental caries status was significantly associated with variables indicating their socioeconomic status such as fathers' job, mothers' education, and number of children in the family. Furthermore, there was a significant association between the children's dental caries status and their oral hygiene habits such as frequency of tooth brushing. CONCLUSION: The dental caries status of the studied preschool children was not desirable which could be indicative of the inadequacy of the current preventive programs. To improve this issue, interventional preventive programs such as tooth brushing are recommended. The programs are more necessary for the children of low socioeconomic families and those with poor oral hygiene habits.

Is Mandibular Fossa Morphology and Articular Eminence Inclination Associated with Temporomandibular Dysfunction?

STATEMENT OF THE PROBLEM: Finding a significant relationship between temporomandibular joint (TMJ) morphology and the incidence of temporomandibular dysfunction (TMD) may help early prediction and prevention of these problems. PURPOSE: The purpose of the present study was to determine the morphology of mandibular fossa and the articular eminence inclination in patients with TMD and in control group using cone beam computed tomography (CBCT). MATERIALS AND METHOD: The CBCT data of bilateral TMJs of 40 patients with TMD and 23 symptom-free cases were evaluated. The articular eminence inclination, as well as the glenoid fossa depth and width of the mandibular fossa were measured. The paired t-test was used to compare these values between two groups. RESULTS: The articular eminence inclination and glenoid fossa width and depth were significantly higher in patients with TMD than in the control group (p < 0.05). CONCLUSION: The articular eminence inclination was steeper in patients with TMD than in the control group. Glenoid fossa width and depth were higher in patients with TMD than that in the control group. This information may shed light on the relationship between TMJ morphology and the incidence of TMD.