CAD-CAM and analog occlusal splints comparison based on the amount of occlusal adjustments. 3D analysis of the volumetric changes: A pilot study.

OBJECTIVE: To evaluate the volumetric changes on occlusal surface of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal devices fabricated following a fully digital workflow after occlusal adjustment, compared to those fabricated with an analog workflow. MATERIALS AND METHODS: Eight participants were included in this clinical pilot study, receiving two different occlusal devices fabricated with two different workflows, fully analog and fully digital. Every occlusal device was scanned before and after the occlusal adjustments to compare the volumetric changes using a reverse engineering software program. Moreover, three independent evaluators assessed a semi-quantitative and qualitative comparison using visual analog scale and dichotomous evaluation. The Shapiro-Wilk test was performed to validate normal distribution assumption, and a dependent t-Student test for paired variables was used to determine statistically significant differences (p-value < 0.05). RESULTS: The root mean square value was extracted from the 3-Dimensional (3D) analysis of the occlusal devices. The average values of the root mean square were higher for the analogic technique (0.23 ± 0.10 mm) than the digital technique (0.14 ± 0.07 mm) but the differences were not statistically significant (paired t-Student test; p = 0.106) between the two fabrication techniques. The semiquantitative visual analog scale values between the impression for the digital (5.08 ± 2.4 cm) and analog (3.80 ± 3.3 cm) technique were significant (p < 0.001), and statistically significant differences values were assessed for evaluator 3 compared to the other evaluators (p < 0.05). However, the three evaluators agreed on the qualitative dichotomous evaluation in 62% of the cases, and at least two evaluators agreed in 100% of the evaluations. CONCLUSIONS: Occlusal devices fabricated following a fully digital workflow resulted in fewer occlusal adjustments, as they could be a valid alternative to those fabricated following an analog workflow. CLINICAL SIGNIFICANCE: Fabricated occlusal devices following a fully digital workflow could have some advantages over analog workflow such reduce occlusal adjustments at delivery appointment, which can result in reduced chair time and therefore increased comfort for the patient and clinician.

Comparison accuracy of digital and analog method using milled occlusal splints.

OBJECTIVE: This clinical trial aims to compare the accuracy of interocclusal registration in centric relation taken with polyvinyl siloxane and intraoral scanner (IOS) with the fabrication of occlusal devices. METHODS: Thirty-one participants were included in the trial registered at ClinicalTrials.gov (NCT05317182) receiving two different occlusal devices from two different workflows. One workflow was performed using polyvinyl siloxane impression material and the other with IOS. Every splint was scanned before and after the occlusal adjustments to compare the volumetric changes using the Root Mean Square deviation (RMS). Furthermore, three evaluators assessed the 3D comparison using color maps in a Visual Analog Scale (VAS). RESULTS: The average values of RMS were higher for the analog approach (0.01 ± 0.067) than the digital approach (0.065 ± 0.035). However, the differences were not statistically significant (p < 0.063) between the two impression techniques. For the semiquantitative analysis performed by blinded evaluators, differences in VAS values between the impression for the digital (2.08 ± 2.4) and analog (3.80 ± 3.3) technique were statistically significant. The three evaluators agreed in more than 90% of the qualitative dichotomous evaluation. CONCLUSION: Digital impressions did not show inferior accuracy compared to conventional impressions when assessed using quantitative measurements. CLINICAL SIGNIFICANCE: This clinical trial provided evidence on registering interocclusal relationship at increased vertical dimension with fully digital workflow for complete arch prosthesis.

A fully digital protocol to provide a fixed interim complete denture for immediate loading for a completely edentulous patient: A dental technique.

Complete arch immediate-loading implant-supported prostheses can represent a major challenge for the patient and the dental team. Obtaining stable references and an accurate occlusal record after implant placement to provide an interim prosthesis is a difficult task and can deviate from the initial treatment plan. The described technique presents a fully digital protocol to provide an immediate complete arch implant-supported fixed interim prosthesis for edentulous patients by making postoperative cone beam computed tomography and intraoral digital scans that correlate with the previous plan.

The PGO concept: Prosthetically guided orthodontics concept.

OBJECTIVE: The aim of this case report is to present a novel digital approach of guiding orthodontics and periodontal surgery by creating interim restorations that represent the final shape of the teeth before starting the treatment. CLINICAL CONSIDERATIONS: The patient presented with worn dentition, super-erupted maxillary and mandibular anterior teeth, and altered passive eruption, all this creating a gummy smile. Following a digital wax-up design, a digital orthodontic set-up, and the digital bracket bonding, temporary restorations, and bracket indirect bonding trays were fabricated. Restorations' cementation, bracket bonding, and periodontal surgery were performed the same day. After 14 months of orthodontic treatment, teeth were restored with final ceramic restorations. One year and 6 months was the total treatment duration. CONCLUSION: Prosthetically guided orthodontic concept allows the use of digital technology to simulate the final outcome of the patient treatment before starting dental therapy. This technique not only improves the communication between specialists, it also reduces treatment time and increases precision and predictability. CLINICAL SIGNIFICANCE: The prosthetically guided orthodontics (PGO) concept has the goal to start interdisciplinary therapy with a simulation of the final outcome. Giving the worn teeth their proper size through interim restorations prior to orthodontic therapy will guide the orthodontist from the beginning of the treatment and will improve communications between all the specialists. Through a digital approach, a digital wax-up and an orthodontic digital set-up the objectives of treatment can be established early on.

The digital alveolar cast: A revised approach to an old concept.

An alveolar cast is recommended for the fabrication of specific fixed dental prostheses. The analog workflow for such casts is labor-intensive, time-consuming, and highly skill dependent. Advancements in digital technologies are bringing new, efficient, and streamlined protocols for dental practice. This article presents a digital workflow for the fabrication of an alveolar cast by using computer-aided design and computer-aided manufacturing (CAD-CAM)technologies.

Stone verification device for verifying the definitive cast of an implant-supported restoration: A dental technique.

To reduce the risk of implant and prosthetic complications, implant-supported prostheses should be passive. A verification device is used to verify the abutment analog position on the definitive cast, and hence its accuracy. This article describes the fabrication of a Type IV stone implant verification device for verifying the accuracy of the definitive cast.

Digital scanning under rubber dam: An innovative method for making definitive impressions in fixed prosthodontics.

OBJECTIVE: To provide a comprehensive protocol for final impressions making under rubber dam isolation by using an intraoral scanner. CLINICAL CONSIDERATION: Impression making after tooth preparation with rubber dam isolation are impossible with conventional physical impressions, which are not with intraoral scanners. Digital technologies have disrupted dentistry in the last decades, bringing new, straightforward, and more time-efficient protocols for dental practice. CONCLUSIONS: Taking in consideration the beneficial properties of scanning under rubber dam this protocol can be highly recommended for everyday use for making definitive intraoral scans for tooth-supported restorations. CLINICAL SIGNIFICANCE: The described protocol offers the possibility to make a final impression in a stress-free environment, without blood or saliva, to obtain a better visualization and scanning of the finish line, and the potential of save time on definitive impression making.

Manejo quirúrgico-endodóncico de una reabsorción cervical invasiva clase III empleando composite / Endo-surgical management of a class III invasive cervical resorption using composite

La reabsorción cervical invasiva (RCI) es un tipo de reabsorción radicular insidiosa y agresiva que se origina en la superficie radicular externa. Típicamente, suele pasar inadvertida puesto que en la mayoría de los casos es asintomática. El uso de la tomografía computarizada con haz cónico (CBCT) mejora el diagnóstico y la planificación y la utilización dental mejora la realización del tratamiento. El objetivo principal de un tratamiento óptimo de ICR es la eliminación e inactivación del proceso de reabsorción y la reconstrucción del defecto. Entre los materiales empleados en la literatura para el sellado del defecto, el composite parece ser una opción válida. En el presente caso clínico se describe el tratamiento combinado quirúrgico-endodóncico de una reabsorción cervical invasiva clase III de Heithersay sellada con composite. Después de un año de seguimiento, el paciente se mostraba asintomático y la rarefacción ósea peri radicular ha disminuido significativamente no existiendo recidiva de la reabsorción

Invasive cervical resorption (ICR) is an aggressive type of radicular resorption that originates in the external radicular surface. It can typically go unnoticed since it is often asymptomatic. The use of cone beam computed tomography (CBCT) increases in a greater diagnostic and planning and a dental microscope increases the proper execution of the treatment. The main objective of an optimal treatment of ICR is the elimination and inactivation of the resorptive process, and the reconstruction of the defect. Among the dental material used in the literature for sealing the defect, composite seems to be a valid option. The present case-report describes a combined surgical and endodontic treatment of a Heithersay class III invasive cervical resorption sealed with dental composite. A one-year follow-up shows the patient to be asymptomatic, and the bone rarefaction to have decreased significantly, with no evidence of a resorption recurrence