Personalized subperiosteal implant­supported obturator for the rehabilitation of rhino­orbit­cerebral mucormycosis sequela: A case report.

Severe atrophy of the maxilla occasionally renders it impossible to place standard endosseous implants to replace absent teeth. For such cases, personalized subperiosteal implants (PSI) are presented as a treatment alternative. Due to novel design and manufacturing technologies, PSIs are fitted closely to the bone structure of the patient, after defining the anchorage areas where the bone is of higher quality and allowing a passive dental prosthesis to be attached to restore function and aesthetics to the patient. The present case report documents a patient with severe bone defects as a sequela of rhino-orbit-cerebral mucormycosis. After a failed microvascular fibula flap reconstruction, the patient was treated with a removable implant-supported prosthesis attached to a PSI, which provided occlusion with the mandible of the patient and closed the oronasal-antral communication defect. At 18 months after treatment, the patient felt well, with no biological complications and the prosthesis was well adjusted and with good function. Consequently, we consider that in some cases such as this, a customized solution of this type can avoid complex reconstruction treatments.

Influence of impression method and shoulder design on the marginal adaptation of CAD/CAM nanoceramic resin onlay restorations.

Objective: This in-vitro study investigates the influence of two different impression techniques and two shoulder designs on the marginal adaptation of computer-aided design/computer-aided manufacturing restorations. Methods: Forty mandibular first premolars were cast into dental arch models for this in vitro study. Fragile cusps and concavities on the mesial-buccal-occlusal surfaces were treated, with 2 mm of the occlusal surface removed. Teeth were categorised into two groups based on shoulder preparation. Digital scanning using a 3Shape 3D scanner identified them further for allocation into conventional and digital impression subgroups. The restorations were created from nanoceramic resin blocks using prescribed guidelines. Microscopic evaluation assessed the restoration's marginal adaptation, with data analysed using SPSS 27.0. The level of significance was set at p ≤ 0.05. Results: Digital intraoral scanning consistently demonstrated smaller marginal gaps than the traditional impression method, regardless of shoulder preparation, with the differences being statistically significant (p < 0.05). Furthermore, shoulder preparation significantly reduced the marginal gaps in both the digital and traditional impression groups (p < 0.05). Conclusions: The onlay preparation design with a shoulder led to restorations with improved marginal adaptation compared with the design with no shoulder. Direct digital impression techniques produced restorations within a better marginal discrepancy than traditional impressions.

PSI: Planner-specific, physician-specific, or patient-specific implant for orbital reconstruction?

This study aimed to identify and quantify the variations in PSI designs intended for an identical patient. Records from 10 patients with an orbital fracture involving two walls, for which a primary orbital reconstruction was indicated, were retrospectively included. Clinical engineers from two centers independently generated proposal designs for all patients. Following web meeting(s) with the surgeon from the same institute, the PSI designs were finalized by the engineer. A cross-over of the engineer with the surgeon of the other center created two new design teams. In total, 20 proposal and 40 final PSI designs were produced. A three-dimensional comparison between different PSI designs for the same patient was performed by computing a difference score. Initially, the design proposals of the two engineers showed a median difference score of 37%, which was significantly reduced to a median difference score of 26% for the final designs with different engineers. The median difference score of 22% between surgeons demonstrated that both parties introduced notable user variations to the final designs. Evidence supporting the advantages of an experienced design team was found, with significantly fewer modifications, fewer meetings, and less time required to complete the design (up to 40% time reduction). The findings of the study underline the dependency of PSI design on the surgeon and engineer, and support the need for a more evidence-based protocol for PSI design.

Impact of Channel Thickness and Doping Concentration for Normally-Off Operation in Sn-Doped ß-Ga2O3 Phototransistors.

We demonstrate a Sn-doped monoclinic gallium oxide (ß-Ga2O3)-based deep ultraviolet (DUV) phototransistor with high area coverage and manufacturing efficiency. The threshold voltage (VT) switches between negative and positive depending on the ß-Ga2O3 channel thickness and doping concentration. Channel depletion and Ga diffusion during manufacturing significantly influence device characteristics, as validated through computer-aided design (TCAD) simulations, which agree with the experimental results. We achieved enhancement-mode (e-mode) operation in <10 nm-thick channels, enabling a zero VG to achieve a low dark current (1.84 pA) in a fully depleted equilibrium. Quantum confinement in thin ß-Ga2O3 layers enhances UV detection (down to 210 nm) by widening the band gap. Compared with bulk materials, dimensionally constrained optical absorption reduces electron-phonon interactions and phonon scattering, leading to faster optical responses. Decreasing ß-Ga2O3 channel thickness reduces VT and VG, enhancing power efficiency, dark current, and the photo-to-dark current ratio under dark and illuminated conditions. These results can guide the fabrication of tailored Ga2O3-based DUV phototransistors.

Successful use of a 3D-printed surgical guide to facilitate transiliosacral fixation in a cat with bilateral sacroiliac luxation.

Case summary: A 7-year-old male castrated domestic shorthair cat was presented for treatment of a bilateral sacroiliac luxation (SIL). CT was performed and the data were extracted in a stereolithography (STL) file, after which a 3D-printed drill guide (3DPDG) was devised, using computer-aided design (CAD) software, and printed. Using an open surgical approach, the guide was used as an aid for drilling the sacrum. The ilial wings were drilled free-hand later and a transiliosacral pin (TP) was inserted to realign and stabilise the SIL. The cat exhibited an early return to normal limb function and a CT scan performed at the postoperative follow-up showed early signs of bone remodelling at the sacroiliac joint. Relevance and novel information: To the authors' knowledge, this is the first report using a 3DPDG for implant placement in the feline sacrum without intraoperative imaging.

The learning curve of a dynamic navigation system used in endodontic apical surgery.

Background/purpose: Quantitative in vitro research was conducted on the learning process of a dynamic navigation system. This study provides guidance for the promotion and application of dynamic navigation technology in the endodontic apical surgery field. Materials and methods: Standardized models were designed and 3D printed to form the approach operation of endodontic apical surgery. 6 clinicians with no experience in dynamic navigation performed the operation. The distance deviation tolerance was set as 0.6 mm, and the angle deviation tolerance was set as 5°. Fifteen mm deep approach operation was completed using dynamic navigation. Each operator performed 10 consecutive exercises on the models. The positioning deviation and operation time of each operator for each practice were recorded. Based on this, the learning curve of the dynamic navigation of every operator was mapped. The learning difficulty of dynamic navigation was evaluated. Results: The learning curves of all operators reached a stable level after the 7th practice, which can ensure that the distance and angle deviations are maintained within the deviation tolerances (0.6 mm, 5°). Conclusion: Operators with no experience in dynamic navigation technology need practice to master dynamic navigation operations. For this navigation system, operators with no operational experience can master dynamic navigation operations after 7 exercises.

Establishing complexity targets to enhance artificial reef designs.

Artificial reefs (AR), which are integral tools for fish management, ecological reconciliation and restoration efforts, require non-polluting materials and intricate designs that mimic natural habitats. Despite their three-dimensional complexity, current designs nowadays rely on empirical methods that lack standardised pre-immersion assessment. To improve ecosystem integration, we propose to evaluate 3-dimensional Computer-aided Design (3D CAD) models using a method inspired by functional ecology principles. Based on existing metrics, we assess geometric (C-convexity, P-packing, D-fractal dimension) and informational complexity (R-specific richness, H- diversity, J-evenness). Applying these metrics to different reefs constructed for habitat protection, biomass production and bio-mimicry purposes, we identify potential complexity target points (CTPs). This method provides a framework for improving the effectiveness of artificial reef design by allowing for the adjustment of structural properties. These CTPs represent the first step in enhancing AR designs. We can refine them by evaluating complexity metrics derived from 3D reconstructions of natural habitats to advance bio-mimicry efforts. In situ, post-immersion studies can help make the CTPs more specific for certain species of interest by exploring complexity-diversity or complexity-species distribution relationships at the artificial reef scale.

Digital technology implementation in prosthodontics postgraduate programs in Saudi Arabia: a multi-institutional survey of program directors.

OBJECTIVE: To assess the current status of digital technology (DT) implementation in prosthodontics post-graduate (PG) programs in Saudi Arabian dental institutions. METHODOLOGY: A 19-item survey was created using Google forms and the link was emailed to the 29 prosthodontics PG program directors (advanced clinical training and joint program) in Saudi Arabia. The questionnaire contained five Sect. 1) didactic training and DT usage in PG preclinical, clinical and laboratory training, 2) incorporation of DT in PG program, 3) utilization of DT and the types of cases treated by PG students during their course, 4) information on the faculties involved in prosthodontics PG education, and 5) potential challenges encountered and program directors' satisfaction of the PG program. Descriptive statistics was used to present the frequencies and proportions, and Chi square inferential test was used to compare the participants' response based on the type of PG programs (α = 0.05). RESULTS: Only 28 program directors responded to the survey, yielding a 95.5% response rate. Among the program directors, 24 (85.7%) and 4 (14.3%) directors supervised the advanced clinical training and joint programs, respectively. Among the DT, CAD/CAM was the most used technology (50-80%), followed by intra-oral scanning (28-96%). Digital technology implementation was largely limited by lack of resources or equipment (67%), cost (53%) and scarcity of PG teaching staff (46%). A significant difference was observed between the programs regarding the mandatory use of DT for their cases (p = 0.03). CONCLUSIONS: This multi-institutional survey of program directors revealed that DT is continuously implemented in the last few years. Saudi dental institutions must prioritize implementing and utilizing DT in PG training to graduate competent prosthodontists in this fast-paced digital era. While DT is pivotal in dental education, its implementation is limited in many institutions due to resources or equipment, cost, and lack of trained faculty.

Direct versus fully digital indirect bracket bonding: a split-mouth randomized clinical trial on accuracy.

OBJECTIVES: The primary aim is to assess differences in accuracy of orthodontic bracket positioning between fully digital indirect bracket bonding (IDB) and conventional direct bracket bonding (DBB). The secondary aims are to assess differences in bracket bonding failures, bracket repositioning need, clinician experience and patient satisfaction. MATERIALS AND METHODS: This prospective study was designed as a split-mouth randomized clinical trial. In total, 35 patients were analyzed with a six month follow-up period. Translational and orientational deviations from the planned bracket position were determined. Clinician experience and patient satisfaction were evaluated by means of a survey. RESULTS: The difference in translation was 0.34 mm (95% CI: 0.238-0.352, p = 0.017), the difference in orientation was 4.80˚ (95% CI: 3.858-5.727, p < 0.001), both in favour of IDB. IDB showed significantly more immediate (IDB: 3.9%, DBB: 0%) and late (IDB: 5.4%, DBB: 2.5%, p = 0.008) bonding failures. Clinicians and patients experienced a shorter clinical chair time with indirect bonding over direct bonding. CONCLUSIONS: IDB bracket positioning leads to significant smaller translation and orientation deviations from digital IDB planning, than DBB bracket positioning. However, IDB leads to more immediate bonding failures than DBB. The majority of patients preferred IDB over DBB, due to a shorter clinical chair time. CLINICAL RELEVANCE: This study adds to the knowledge of IDB in orthodontics and contributes to evidence on this technique. This evidence is applicable in everyday orthodontics, with respect to patient satisfaction and technical limits of IDB. The trial was registered in the Dutch Trial Register and the International Clinical Trials Registry Platform (ICTRP) of the World Health Organization (WHO), number NL9411.

Improved stability of open bite deformities: taking control of the transverse width using digital technology and robotic archwire bending.

Many factors need to be considered when selecting treatment protocol for surgical correction of skeletal open bite deformities. In order to achieve stable long-term results, it is essential to explore the origin of the open bite, including dysfunction of the temporomandibular joint, tongue and compromised nasal breathing, in addition to the skeletal deformity. Recurrence of skeletal open bite is associated with relapse of the expanded transverse width. Three-dimensional virtual planning allows different treatment options to be explored and final decisions to be made together with the orthodontist. This study presents a treatment protocol for predictable and stable widening of the maxillary transverse width over the long term, involving premolar extraction and rounding and shortening of the upper dental arch by advancing the molar segments. The stability of inter-canine, inter-premolar, and inter-molar distances, as well as overjet and overbite, were measured in 16 patients treated with this technique; measurements were obtained pre- and post-surgery, and the mean follow-up was 43 months. Orthodontic treatment was designed digitally and finished with robotically bent wires (SureSmile), which allowed exact planning of the overall treatment, thus making orthognathic surgery more predictable for the patient. The changes in transverse width were significant and stable over time.

Fracture resistance of CAD/CAM tooth-colored versus cast metal post-and-core restorations in root filled teeth: An in vitro study.

Purpose: This study investigated the fracture resistance and failure modes of custom-fabricated post- and core dental restorations using various CAD/CAM materials. Materials and Methods: Seventy-five mandibular second premolars were allocated to five groups (n = 15) and prepared for standardized post and core restorations. The groups included a control group comprising cast metal and four CAD/CAM materials: Vita Enamic, Shofu HC, Trilor, and PEKK. Fracture resistance was assessed using a compressive force at a crosshead speed of 1 mm/min until failure occurred. Data were analyzed using one-way analysis of variance (ANOVA) and chi-square tests. Results: The metal group had the highest fracture resistance (244.41 ± 75.20 N), with a significant variance compared to that in the CAD/CAM groups (p < 0.001). No significant differences were observed among the non-metallic groups. Conclusions: While several CAD/CAM materials displayed satisfactory flexural properties, cast metal posts showed superior fracture resistance in endodontically treated teeth but were mostly associated with catastrophic failure. The clinical application of CAD/CAM materials for post-core restorations presents a viable alternative to traditional metal posts, potentially reducing the risk of unfavorable fractures.

Material properties and finite element analysis of adhesive cements used for zirconia crowns on dental implants.

This study aimed to evaluate the material properties of four dental cements, analyze the stress distribution on the cement layer under various loading conditions, and perform failure analysis on the fractured specimens retrieved from mechanical tests. Microhardness indentation testing is used to measure material hardness microscopically with a diamond indenter. The hardness and elastic moduli of three self-adhesive resin cements (SARC), namely, DEN CEM (DENTEX, Changchun, China), Denali (Glidewell Laboratories, CA, USA), and Glidewell Experimental SARC (GES-Glidewell Laboratories, CA, USA), and a resin-modified glass ionomer (RMGI-Glidewell Laboratories, CA, USA) cement, were measured using microhardness indentation. These values were used in the subsequent Finite Element Analysis (FEA) to analyze the von Mises stress distribution on the cement layer of a 3D implant model constructed in SOLIDWORKS under different mechanical forces. Failure analysis was performed on the fractured specimens retrieved from prior mechanical tests. All the cements, except Denali, had elastic moduli comparable to dentin (8-15 GPa). RMGI with primer and GES cements exhibited the lowest von Mises stresses under tensile and compressive loads. Stress distribution under tensile and compressive loads correlated well with experimental tests, unlike oblique loads. Failure analysis revealed that damages on the abutment and screw vary significantly with loading direction. GES and RMGI cement with primer (Glidewell Laboratories, CA, USA) may be suitable options for cement-retained zirconia crowns on titanium abutments. Adding fillets to the screw thread crests can potentially reduce the extent of the damage under load.

A 48-month clinical performance of hybrid ceramic fragment restorations manufactured in CAD/CAM in non-carious cervical lesions: case report.

From the restorative perspective, various methods are available to prevent the progression of non-carious cervical lesions. Direct, semi-direct, and indirect composite resin techniques and indirect ceramic restorations are commonly recommended. In this context, semi-direct and indirect restoration approaches are increasingly favored, particularly as digital dentistry becomes more prevalent. To illustrate this, we present a case report demonstrating the efficacy of hybrid ceramic fragments fabricated using computer-aided design (CAD)/computer-aided manufacturing (CAM) technology and cemented with resin cement in treating non-carious cervical lesions over a 48-month follow-up period. A 24-year-old male patient sought treatment for aesthetic concerns and dentin hypersensitivity in the cervical region of the lower premolar teeth. Clinical examination confirmed the presence of two non-carious cervical lesions in the buccal region of teeth #44 and #45. The treatment plan involved indirect restoration using CAD/CAM-fabricated hybrid ceramic fragments as a restorative material. After 48 months, the hybrid ceramic material exhibited excellent adaptation and durability provided by the CAD/CAM system. This case underscores the effectiveness of hybrid ceramic fragments in restoring non-carious cervical lesions, highlighting their long-term stability and clinical success.

Reinforcement of 3D-printed resins for denture base by adding aramid fibers: Effect on mechanical, surface, and optical properties.

PURPOSE: The present study evaluated the mechanical, surface, and optical properties of 3D-printed resins for removable prostheses reinforced by the addition of aramid fibers. MATERIALS AND METHODS: According to ISO 20795-1:2013 standards, specimens were printed using a digital light processing 3D printer and divided into two groups (n = 06/group): 3D-printed resin for denture base as the control group, and a group with the same 3D-printed resin in addition of 5% aramid fibers as the experimental group. Red aramid fibers were chosen for aesthetic characterization. The specimens were evaluated for their mechanical properties, such as elastic modulus (GPa), flexural strength (MPa), and superficial properties by their surface microhardness (KHN), surface roughness (µm), and surface free energy (mJ/m2). Optical properties were evaluated by the color difference (∆E00) between groups. The statistical test chosen after the exploratory analysis of the data was One-way ANOVA followed by Tukey's HSD (α = 0.05). RESULTS: The results showed statistical differences in elastic modulus (p < 0.0001), flexural strength (p < 0.0001), surface free energy polar variable (p = 0.0322), total surface free energy (p = 0.0344), with higher values for the experimental. Surface hardness and surface roughness showed no statistical difference (p ≥ 0.05). The color difference (∆E00) obtained through the CIEDE2000 calculus was below the perceptibility threshold (≤1.1). CONCLUSION: Adding aramid fibers to 3D-printed resin for denture bases resulted in better mechanical properties, without major alterations in surface properties. In addition, it is an easy-to-apply choice for mechanical reinforcement and aesthetic characterization, with the expression of small blood vessels in the 3D-printed resin for removable denture bases.

Digital Simulation and Designing of a Novel Osteotomy Guide for Autotransplantation in the Anterior Region.

Autotransplantation of teeth (ATT) is a viable treatment option for replacing teeth lost due to various reasons. Periodontal ligament (PDL) on the donor tooth is one of the most crucial factors determining the success of ATT. To preserve the PDL during surgery and improve the success rate of ATT, digital dentistry has been applied to ATT. In this article, a digital workflow including surgical simulation, a three-dimensional (3D) replica fabrication, and a novel osteotomy guide design is introduced. Digital simulation of ATT on a patient's integrated model enables visualization of anatomical structures and the 3D position of the donor tooth prior to the actual surgery. The 3D-printed osteotomy guide allows the transfer of the direction and depth of the planned osteotomy into the intraoral environment. The 3D replica helps prepare the recipient site before the actual transplantation, which minimizes the extra-alveolar time of the donor tooth and decreases trauma during the try-in process. The proposed virtual planning and the use of the guide and the 3D replica can facilitate the surgical procedures while minimizing complications.

Rapid transformation of nanobodies affinity based on AlphaFold2's high-accuracy predictions and interaction analysis for enrofloxacin detection in coastal fish.

High-affinity antibodies are crucial in biosensors, disease diagnostics, therapeutic drug development, and immunological analysis, making the enhancement of antibody affinity a key research focus within the field. Computer-aided design is recognized as a time-saving and labor-efficient method for nanobodies in vitro affinity maturation. Compared to experimental mutagenesis techniques, it is advantageous due to the elimination of the need for laborious library construction and screening processes. However, these approaches are constrained by structural prediction since inaccuracy in structure could readily result in maturation failures. Herein, a novel nanobodies modification method for in vitro affinity maturation, utilizing the high accuracy prediction of AlphaFold2, was employed to rapidly transform a low affinity nanobody against enrofloxacin (ENR) into one with high affinity. The molecular docking results revealed a 1.5- to 2.5-fold increase in the number of noncovalent interactions of modified nanobodies, accompanied by a reduction in binding free energy ranging from 14.1 to 62.6%. The evaluation results from ELISA and BLI indicated that the affinity of the modified nanobodies had been enhanced by 6.2-91.6 times compared to the template nanobody. Furthermore, the modified nanobodies were employed for the detection of ENR-spiked coastal fish samples. In summary, this research proposed a nanobodies modification method from a new perspective, endowing its great application potential in biosensors, food safety, and environmental monitoring.

Accuracy of the surgical execution of virtually planned deep circumflex iliac artery flaps and their appropriateness for masticatory rehabilitation.

BACKGROUND: Tumorous diseases of the jaw demand effective treatments, often involving continuity resection of the jaw. Reconstruction via microvascular bone flaps, like deep circumflex iliac artery flaps (DCIA), is standard. Computer aided planning (CAD) enhances accuracy in reconstruction using patient-specific CT images to create three-dimensional (3D) models. Data on the accuracy of CAD-planned DCIA flaps is scarce. Moreover, the data on accuracy should be combined with data on the exact positioning of the implants for well-fitting dental prosthetics. This study focuses on CAD-planned DCIA flaps accuracy and proper positioning for prosthetic rehabilitation. METHODS: Patients post-mandible resection with CAD-planned DCIA flap reconstruction were evaluated. Postoperative radiograph-derived 3D models were aligned with 3D models from the CAD plans for osteotomy position, angle, and flap volume comparison. To evaluate the DCIA flap's suitability for prosthetic dental rehabilitation, a plane was created in the support zone and crestal in the middle of the DCIA flap. The lower jaw was rotated to close the mouth and the distance between the two planes was measured. RESULTS: 20 patients (12 males, 8 females) were included. Mean defect size was 73.28 ± 4.87 mm; 11 L defects, 9 LC defects. Planned vs. actual DCIA transplant volume difference was 3.814 ± 3.856 cm³ (p = 0.2223). The deviation from the planned angle was significantly larger at the dorsal osteotomy than at the ventral (p = 0.035). Linear differences between the planned DCIA transplant and the actual DCIA transplant were 1.294 ± 1.197 mm for the ventral osteotomy and 2.680 ± 3.449 mm for the dorsal (p = 0.1078). The difference between the dental axis and the middle of the DCIA transplant ranged from 0.2 mm to 14.8 mm. The mean lateral difference was 2.695 ± 3.667 mm in the region of the first premolar. CONCLUSION: The CAD-planned DCIA flap is a solution for reconstructing the mandible. CAD planning results in an accurate reconstruction enabling dental implant placement and dental prosthetics.

A new guide for enhancing dental implant placement: an in vitro assessment of accuracy.

This study aimed to design a new surgical guide for controlling the mesiodistal distance between implant osteotomies and adjacent teeth as well as the osteotomy depth in partially edentulous patients. The guide kit was designed with design software and milled with a CNC (computer numerical control) router. The guide consisted of 2 components-stoppers and crown guides-for determining the drilling depth and mesiodistal position, respectively. The stoppers were designed in 7.5-, 9.5-, and 11.5-mm lengths, and the crown guides were fabricated with outer diameters of 5.0, 6.0, 7.0, and 8.0 mm. The accuracy of the guide was assessed by preparing a total of 20 implant osteotomies in 4 partially edentulous models and comparing the dimensions of the actual osteotomies to the values that were predicted to occur with the use of the surgical guides. Osteotomies were prepared using the 7.5-mm stopper with either the 7.0- or 8.0-mm crown guide. Cone beam computed tomography (CBCT) was used to obtain images for analysis of osteotomy-tooth mesiodistal distances, which were predicted to be 3.0 or 5.5 mm, depending on position; interosteotomy mesiodistal distances, which were predicted to be 3.0 mm; and osteotomy depth, which was predicted to be 11.5 mm. A 1-sample t test was used to determine if there were significant differences between the predicted values and the measurements of the guided osteotomies on the CBCT images of the mandibular models, and an independent t test was conducted to compare the results of 3.0- and 5.5-mm osteotomy-tooth distances (α = 0.05). Differences between the predicted and actual values of the interosteotomy mesiodistal distance (P = 0.516) and osteotomy depth (P = 0.847) were not statistically significant. The actual osteotomy-tooth mesiodistal distances were significantly different from the predicted values of 3.0 (P = 0.000) and 5.5 mm (P = 0.001), with higher mean differences of 0.46 and 0.60 mm, respectively. The designed guide had a high accuracy in achieving optimal linear interosteotomy mesiodistal distances and osteotomy depths, and the obtained mean values were clinically acceptable.