The 4D virtual patient: A proof of concept in digital dentistry.

This dental technique article updates the 3-dimensional (3D) virtual patient digital workflow by introducing the space-time information acquired with jaw tracking motion. The direct digital procedure involved scanning the interim prostheses, creating virtual casts, and transferring the digital facebow, virtual articulation, and jaw-tracking motion. All 3D files and records from the intraoral scanner, cone beam computed tomography, extraoral scanner, and jaw tracking motion were superimposed using existing teeth as the connecting link in all data sets and adopting the best-fit alignment. The main advantages of the technique were creating a 4-dimensional virtual patient and standardizing the introduction of clinical space-time information (the fourth dimension) beyond the static condition.

Influence of Calcified Canals Localization on the Accuracy of Guided Endodontic Therapy: A Case Series Study.

This study aimed to evaluate the precision of the guided endodontic technique applied to calcified canals in anterior teeth in relation to demographic and dental variables. The present observational study was conducted during the period 2020-2021. The patients were consecutive referrals at the Department of Endodontics and Conservative Dentistry of the University Hospital of Siena. The guided endodontics protocol was applied using 0.75 mm diameter burs for the lower teeth and 0.90 mm for the upper teeth. The inclusion criteria were as follows: (i) teeth with pulp canal obliteration (PCO) associated with a periapical lesion (periapical index (PAI) ≥ 2); (ii) teeth with PCO that require the placement of a root canal post for the execution of a prosthetic treatment; (iii) teeth in which surgical treatment was not justified. Socio-demographic characteristics of the patients were recorded and related to the drill path accuracy through the guide in the calcified endodontic canal, evaluated through a radiographic analysis, and classified as optimal (in the center of the root canal) and acceptable (deviated peripherally/tangentially). A logistic regression model was built to predict the factors that influence the poor precision of the technique. Seventeen patients (mean age 48 years) with eighteen calcified single-rooted teeth were enrolled. All teeth were associated with periapical lesions with PAI scores from 2 to 5 (mean PAI: 3.055). From the model, it is evident that the presence of a calcification affecting the apical area of the root increases the probability of being off-center with the bur by about 15 times. In addition, a previous attempt at endodontic treatment and the position in the lower arch increases the probability of non-centrality of the drill, although in a non-statistically significant way. In any of the analyzed cases, the guided endodontic technique applied to PCO did not determine the presence of iatrogenic errors, such as perforations. However, the apical localization of the obliteration increases the probability of being off-center with the drill during the instrumentation phase by about 15 times.

Computer-guided implant surgery for immediate implanting and loading: The STIL technique.

A method is described for minimizing errors in positioning a surgical template during the insertion of implants immediately after extraction and the placement of interim prostheses with immediate loading. The technique, called sequential template immediate loading (STIL), uses modular templates to fix pins before extracting the teeth, thus giving a reliable position for the subsequent templates for inserting the implant and placing the interim prosthesis.

Incorporating a facial scanner into the digital workflow: A dental technique.

The transfer of extraoral and intraoral clinical information into the virtual environment is necessary to optimize prosthetic treatment planning. The purpose of this article was to describe a digital workflow designed to superimpose the different 3D files obtained with an intraoral scanner, a cone bean computed tomography (CBCT) device, and a facial scanner and their clinical application with the Digital bite device.

Computer-aided flapless implant surgery and immediate loading. A technical note.

PURPOSE: The aim of the present technical note was to describe a prosthetic technique developed to increase the predictability of immediately loaded implants supporting a fixed prosthesis after computer-aided template-guided flapless implant placement. METHODS: During a 2-year period, eight patients presenting partial edentulism underwent computer-aided template-guided implant placement. The presented technique was used during the prosthetic procedures to directly transfer the data obtained with the facebow to the surgical environment, allowing for accurate repositioning of the temporary prosthesis on the implants as previously planned with the digital software. RESULTS: A total of 78 dental implants were immediately loaded with an implant-supported fixed prosthesis after flapless template-guided implant placement. A survival and success rate of 100 % was reported after a mean follow-up of 1 year from the prosthetic loading. Neither major complications nor dropouts were observed during the healing time. From both clinical and radiological evaluations, implants appeared stable with no signs of soft tissue inflammation or infection and no evidence of pathological peri-implant bone resorption. CONCLUSIONS: The proposed technique associated with computer-aided implant placement and immediate loading protocol provided a high implant and prosthetic survival and success rate. No complications were reported during the recalls, suggesting predictability and reliability of the present technique over a short-term period.