Accuracy of implant placement with computer-aided static, dynamic, and robot-assisted surgery: a systematic review and meta-analysis of clinical trials.

This systematic review explores the accuracy of computerized guided implant placement including computer-aided static, dynamic, and robot-assisted surgery. An electronic search up to February 28, 2023, was conducted using the PubMed, Embase, and Scopus databases using the search terms "surgery", "computer-assisted", "dynamic computer-assisted", "robotic surgical procedures", and "dental implants". The outcome variables were discrepancies including the implant's 3D-coronal, -apical and -angular deviations. Articles were selectively retrieved according to the inclusion and exclusion criteria, and the data were quantitatively meta-analysed to verify the study outcomes. Sixty-seven articles were finally identified and included for analysis. The accuracy comparison revealed an overall mean deviation at the entry point of 1.11 mm (95% CI: 1.02-1.19), and 1.40 mm (95% CI: 1.31-1.49) at the apex, and the angulation was 3.51˚ (95% CI: 3.27-3.75). Amongst computerized guided implant placements, the robotic system tended to show the lowest deviation (0.81 mm in coronal deviation, 0.77 mm in apical deviation, and 1.71˚ in angular deviation). No significant differences were found between the arch type and flap operation in cases of dynamic navigation. The fully-guided protocol demonstrated a significantly higher level of accuracy compared to the pilot-guided protocol, but did not show any significant difference when compared to the partially guided protocol. The use of computerized technology clinically affirms that operators can accurately place implants in three directions. Several studies agree that a fully guided protocol is the gold standard in clinical practice.

Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review.

Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.

Effect of the different debonding strength of metal and ceramic brackets on the degree of enamel microcrack healing.

OBJECTIVE: This study aims to determine shear debonding strength of metal and ceramic brackets, and the degree of enamel crack healing. MATERIAL AND METHODS: Extracted human maxillary premolars were flattened on the buccal surface, and randomly separated into five groups (n = 15). In control groups (groups 1 and 2), metal and ceramic brackets were bonded on flat polished enamel, while in experimental groups (groups 3 and 4), metal and ceramic brackets were bonded on the surface with boundary where corner cracks were created. Additionally, fifteen specimens (group 5) were also prepared for an indentation procedure with no bracket installation. The degree of crack healing was measured. All brackets were detached with a universal testing machine, and the adhesive remnant index (ARI) was also identified. Healing degree and apparent fracture toughness were then calculated. RESULTS: Between groups with similar bracket types, there was no statistically significant difference in debonding strength. Regarding bracket types, ceramic brackets provided significantly higher debonding strength than metal brackets. There was a significant difference in ARI scores between metal and ceramic brackets. The corner cracks showed signs of healing in both horizontal and vertical directions. No statistically significant difference in the healing rates among the groups was found and the apparent fracture toughness increased from the initial to the final measurement. CONCLUSIONS: Within the limitations of this study, even though ceramic brackets required significantly higher debonding force compared to metal brackets, debonding stress was limited to the bonding site and did not affect the surrounding cracks on enamel.

Effect of the different debonding strength of metal and ceramic brackets on the degree of enamel microcrack healing

ABSTRACT Objective: This study aims to determine shear debonding strength of metal and ceramic brackets, and the degree of enamel crack healing. Material and Methods: Extracted human maxillary premolars were flattened on the buccal surface, and randomly separated into five groups (n = 15). In control groups (groups 1 and 2), metal and ceramic brackets were bonded on flat polished enamel, while in experimental groups (groups 3 and 4), metal and ceramic brackets were bonded on the surface with boundary where corner cracks were created. Additionally, fifteen specimens (group 5) were also prepared for an indentation procedure with no bracket installation. The degree of crack healing was measured. All brackets were detached with a universal testing machine, and the adhesive remnant index (ARI) was also identified. Healing degree and apparent fracture toughness were then calculated. Results: Between groups with similar bracket types, there was no statistically significant difference in debonding strength. Regarding bracket types, ceramic brackets provided significantly higher debonding strength than metal brackets. There was a significant difference in ARI scores between metal and ceramic brackets. The corner cracks showed signs of healing in both horizontal and vertical directions. No statistically significant difference in the healing rates among the groups was found and the apparent fracture toughness increased from the initial to the final measurement. Conclusions: Within the limitations of this study, even though ceramic brackets required significantly higher debonding force compared to metal brackets, debonding stress was limited to the bonding site and did not affect the surrounding cracks on enamel.

RESUMO Objetivo: O presente estudo teve como objetivo determinar a resistência ao cisalhamento de braquetes metálicos e cerâmicos, e o grau de reparo de fraturas no esmalte. Métodos: Pré-molares superiores, extraídos de humanos, foram aplainados na face vestibular e aleatoriamente divididos em cinco grupos (n = 15). Nos grupos controle (Grupos 1 e 2), os braquetes metálicos e cerâmicos foram colados em esmalte liso e polido; enquanto nos grupos experimentais (Grupos 3 e 4), os braquetes metálicos e cerâmicos foram colados em superfície delimitada, em cujos cantos foram criadas fissuras. Adicionalmente, foram também preparados 15 espécimes (Grupo 5) para um teste com indentação, sem a instalação de braquetes. O grau de reparo das fraturas foi avaliado. Todos os braquetes foram descolados usando uma máquina universal de testes, e o índice de adesivo remanescente (ARI) também foi avaliado. O grau de reparo e a tenacidade à fratura aparente foram então calculados. Resultados: Entre os grupos com o mesmo tipo de braquetes, não houve diferença estatisticamente significativa na força de descolagem. Com relação aos tipos de braquetes, os cerâmicos apresentaram uma força de descolagem significativamente maior do que os metálicos. Houve uma diferença significativa nos escores ARI entre os braquetes metálicos e os cerâmicos. As fraturas de canto mostraram sinais de reparo nos sentidos horizontal e vertical. Não foi detectada diferença estatisticamente significativa no grau de reparo entre os grupos, e a tenacidade à fratura aparente aumentou da mensuração inicial para a final. Conclusão: Considerando-se as limitações desse estudo, apesar de os braquetes cerâmicos necessitarem de força de descolagem significativamente maior do que os braquetes metálicos, a tensão de descolagem foi limitada ao sítio de colagem, não afetando as fraturas de esmalte ao redor.

Effects of design parameters on fracture resistance of glass simulated dental crowns.

OBJECTIVE: This study aimed to individually quantify the effects of various design parameters, including margin thickness, convergence angle of abutment, and bonding conditions on fracture resistance of resin bonded glass dental crown systems (namely, glass simulated crown). MATERIALS AND METHODS: An in vitro experimental test and an in silico computational eXtended Finite Element Method (XFEM) were adopted to explore crack initiation and propagation in glass simulated crown models with the margin thickness ranging from 0.8 to 1.2mm, convergence angle from 6° to 12°, and three different bonding conditions, namely non-bonded (NB), partially bonded (PB), fully bonded (FB). RESULTS: The XFEM modeling results of cracking initiation loads and subsequent growth in the glass simulated crown models were correlated with the experimental results. It was found that the margin thickness has a more significant effect on the fracture resistance than the convergence angle. The adhesively bonded state has the highest fracture resistance among these three different bonding conditions. CONCLUSION: Crowns with thicker margins, smaller convergence angle and fully bonded are recommended for increasing fracture resistance of all-ceramic crowns. This numerical modeling study, supported by the experimental tests, provides more thorough mechanical insight into the role of margin design parameters, thereby forming a novel basis for clinical guidance as to preparation of tapered abutments for all-ceramic dental crowns.

Thermally induced fracture for core-veneered dental ceramic structures.

Effective and reliable clinical uses of dental ceramics necessitate an insightful analysis of the fracture behaviour under critical conditions. To better understand failure characteristics of porcelain veneered to zirconia core ceramic structures, thermally induced cracking during the cooling phase of fabrication is studied here by using the extended finite element method (XFEM). In this study, a transient thermal analysis of cooling is conducted first to determine the temperature distributions. The time-dependent temperature field is then imported to the XFEM model for viscoelastic thermomechanical analysis, which predicts thermally induced damage and cracking at different time steps. Temperature-dependent material properties are used in both transient thermal and thermomechanical analyses. Three typical ceramic structures are considered in this paper, namely bi-layered spheres, squat cylinders and dental crowns with thickness ratios of either 1:2 or 1:1. The XFEM fracture patterns exhibit good agreement with clinical observation and the in vitro experimental results obtained from scanning electron microscopy characterization. The study reveals that fast cooling can lead to thermal fracture of these different bi-layered ceramic structures, and cooling rate (in terms of heat transfer coefficient) plays a critical role in crack initiation and propagation. By exploring different cooling rates, the heat transfer coefficient thresholds of fracture are determined for different structures, which are of clear clinical implication.

The effect of margin thickness, degree of convergence and bonding interlayer on the marginal failure of glass-simulated all-ceramic crowns.

The objectives of this study were to identify the effect of design parameters, namely marginal thickness, degree of convergence and the different interfacial conditions, on the initial failure load that induces cracking from the margin in glass-simulated dental crowns. Crown-like glass cylinders were prepared to simulate posterior all-ceramic crowns with two different marginal thicknesses (0.8 or 1.2mm) and degrees of convergence (6° or 12°). A three-step bonding system was used complementarily with a silane coupling agent to adhesively bond the specimens to resin dies. The crowns were subjected to an axial applied load to generate hoop tensile stress at the crown margin. The entire loading and fracture processes were recorded by video camera. The loading data were compared with the other two interfacial treatments (Vaseline grease and directly poured uncured resin on glass). The Weibull distribution was used to statistically analyze the characteristic failure load and the mean values. The fracture surfaces were fractographically analyzed along with the load-displacement curves, and the degrees of crack stability for each parameter were also identified. It was found that there is no difference in the initial failure load between the different marginal thicknesses in all interfacial conditions. The bonded crowns present more resistance to crack propagation. The higher convergence crown preparation can reduce the initial failure load at the crowns' margin, which can be resisted by a strongly bonded interface. Clear interactions between margin design parameters and their effects on the stress development and crack propagation are necessary to develop an appropriate design of all-ceramic crowns.

Occlusal geometrical considerations in all-ceramic pre-molar crown failure testing.

OBJECTIVES: To evaluate the influence of occlusal geometry of all-ceramic pre-molars, namely cusp angle and associated notch radius, on the scatter of load to failure tests. METHODS: Forty-five all-ceramic upper pre-molar crowns with three zirconia core thicknesses (0.4, 0.6 and 0.8 mm) were broken on dental implant abutments oriented in three angulations (0°, 15°, and 30°). The crowns were loaded using a 4 mm diameter steel cylindrical bar placed along the midline fissure at a crosshead speed of 1 mm min(-1). The scatter of the failure load was evaluated using Weibull analysis. The cusp angle of each crown was critically evaluated to determine the cusp angle and effective radius of the fissure notch root. The relationship between failure load and cusp angle was compared with that between failure load and effective radius as well as notch induced stress concentration by considering R(2) values of fitted trend lines with these relationships. RESULTS: The fracture load differences either between abutment angulations or zirconia thicknesses were not clearly revealed in this study. Except for the group of 30° abutment angulation, the crowns present high scatter of failure loads with low Weibull modulus. However, a simple dependence between fracture load and effective cusp angle was observed. SIGNIFICANCE: Occlusal geometry is an important issue that affects the degree of stress concentration and should be understood by both technician and clinician for appropriate design and material selection of all-ceramic crowns.

Influence of occlusal geometry on ceramic crown fracture; role of cusp angle and fissure radius.

OBJECTIVES: To develop an approximate analytical model that identifies the influence of both cusp angle and notch radius on the failure load of all-ceramic premolar crowns. METHODS: The scatter of failure loads in a crown fracture resistance test was analyzed based on the stress intensity and stress concentration factors from mechanics models developed for simple compact tension to more sophisticated blunt V-notch specimens. Based on the same loading conditions and dimensions, the predicted loads were systematically compared with fracture loads of laboratory-tested crowns to identify the most relevant model. Finally, based upon these models a safe range of cusp angles and notch radii were identified for posterior all-ceramic crowns with various veneering materials' fracture toughness values as the selection criteria. RESULTS: The failure loads of the crowns were distributed in the range between the classical compact tension (lower bound) and blunt V-notch model (upper bound). Additionally, when considering the effect of different materials, the predicted trend of failure loads moves to higher loads well above typical occlusal forces when the fracture toughness of veneering porcelain is increased. The effects of notch radius on the failure load are still inconclusive due to the relatively complex shape of occlusal surfaces. Further studies on crowns with a range of material properties are required to substantiate the model. SIGNIFICANCE: Cusp angle is a key factor that controls the stress generated at the crown fissure. This study provides the rationale for evaluating such effects and clinical guidelines for occlusal design are proposed.