Transitional Era: from analogical to digital workflow in oral rehabilitation: a case report / Era de transição: do fluxo de trabalho analógico para o digital em reabilitação oral: relato de caso

ABSTRACT Digital dentistry is a ubiquitous phenomenon nowadays but it requires access to technologies and learning curve. To aid digital workflow implementation, digital steps can be progressively incorporated in conventional workflows. We aimed to demonstrate a multidisciplinary oral rehabilitation performed mixing conventional procedures with digital open-source software programs and low-cost devices. A 46-year-old female patient had photographs, intraoral scans, and cone-beam computed tomography obtained and used in combination with conventional clinical exams to develop a treatment plan. Power point software was used for digital smile planing and Horos for digital implant planning. The digital dataset were used to guide conventional clinical procedures (scaling and root planning, gingivoplasty, in-office tooth bleaching, fiber-post restoration, implant and bone graft placement, teeth preparation, and protheses design and milling). The inclusion of digital steps in the conventional workflow enabled the performance of rehabilitation procedures with reduced clinical time and increased predictability, favoring the overall workflow and the communication among the different dental specialties. A mixed workflow can progressively lead to an exclusively digital workflow as technologies become accessible and learning curve is coped.

RESUMO Atualmente, a Odontologia digital é um fenômeno onipresente, contudo exige acesso à tecnologia e curva de aprendizado. Para auxiliar na implementação de fluxos de trabalho digitais, etapas digitais podem ser progressivamente incorporadas nos fluxos de trabalho convencionais. Nosso objetivo foi demonstrar uma reabilitação oral multidisciplinar realizada combinando procedimentos convencionais e ferramentas digitais de baixo custo e acesso aberto. Uma paciente de 46 anos teve fotografias, exames intraorais e tomografia computadorizada de feixe cônico obtidos e usados em combinação com exame clínico convencional para desenvolvimento de um plano de tratamento. O software Power Point foi utilizado para o planejamento digital do sorriso e o Horos para o planejamento digital dos implantes. O conjunto de dados digitais foi usado para orientar a execução dos procedimentos clínicos convencionais (raspagem e alisamento radicular, gengivoplastia, clareamento dental, restauração com pino de fibra de vidro, inserção de implantes e enxerto ósseo, preparos protéticos e design e fresagem protética). A inclusão de etapas digitais no fluxo de trabalho convencional permitiu redução do tempo clínico na realização da reabilitação aliado à maior previsibilidade, favorecendo o fluxo de trabalho e a comunicação entre as diferentes especialidades odontológicas. O fluxo de trabalho misto pode progressivamente levar a um fluxo de trabalho exclusivamente digital à medida que as tecnologias se tornem acessíveis e a curva de aprendizado superada.

[Understanding and thinking about the current development of digital prosthodontic technology in China].

Digital prosthodontic technology has brought great changes to the prosthodontic technology in China by improving the quality of prostheses, adding new types of restorations, changing the manufacturing methods of restorations from handmade to computer-aided manufacturing, bringing new operating models of dental laboratories, and promoting the academic status of the prosthodontic technology. Digital prosthodontic technology still has some problems, such as insufficient precision for some manufacturing methods and shortage of professionals. Technicians and administrators of prosthodontic technology should face up to the problems and seize the opportunities, to improve the level of prosthodontic technology and train the highly educated professionals. At the same time, attentions should be payed to the advantages of the traditional prosthodontic technology while grasping the development of the digital prosthodontic technology. The dentists and the dental technicians should learn together and enhance communication to each other, to promote the progress of digital prosthodontic technology in China.

Three-dimensional printed models versus conventional stone models: an accuracy analysis

Aim: To compare the accuracy (trueness and precision) of cost-accessible three-dimensional (3D) printed models. Methods: A maxillary typodont (MM) was scanned and printed 10 times in polylactic acid, resulting in 10 digital models (DMs). Polyvinylsiloxane impressions were made to obtain 10 conventional stone models (SMs). All models were scanned and imported to CloudCompare software. The total area and three locations of interest were evaluated (zenith to incisal [Z-I], canine to canine [C-C], and first molar to canine [1M-C] distances). Total area evaluations were performed by aligning the MM and experimental models using the best-fit algorithm and were compared using the Haussdorf distance. The distances between points of interest were measured using the point-picking tool at the same 3D coordinates. The mean volumetric deviations were considered for trueness analysis. Precision was set as the standard deviation. Statistical differences were evaluated using the Student's t-test. Results:Total area volumetric comparisons showed that DMs showed superior trueness and precision (-0.02 ± 0.03) compared to the SMs (0.37 ± 0.29) (P < 0.001). No differences between the models were observed for Z-I (P = .155); however, SMs showed fewer deviations for C-C (P = .035) and 1M-C (P = .001) than DMs. Conclusions: The DMs presented superior trueness and precision for total area compared to the SMs; however, the SMs were more accurate when points of interest were evaluated

Clinical relevance of Digital Dentistry during COVID-19 outbreak: a scoped review

Aim: To perform a scoped literature review on advantages of digital workflows in dentistry that could be widely adopted to address safety issues raised during the coronavirus (COVID-19) pandemic. Methods: Recent studies on any advantages of digital dentistry ­ as compared to conventional methods ­ that could help addressing the new safety demands for dental treatments that emerged due to the current pandemic were included. PUBMED, Embase, and Web of Knowledge databases were searched for eligible articles published in the last five years. The guidelines of PRISMA statement were followed during data extraction and evaluation. Results: The present search strategy yielded 181 publications. After application of exclusion criteria, a total of 34 studies were finally considered eligible to be discussed. Among the most important advantages of digital dentistry that contribute to safety during the current pandemic are: reduced number of clinical appointments required, shorter chairside time, less invasive surgeries and safer procedures. Conclusion: Within the limitations of this study, the findings observed herein suggest that the use of digital workflows in dentistry could lead to increased safety and reduced transmission of COVID-19 during the current pandemic

Descrição de um método digital utilizado na montagem do aparelho na técnica lingual simplificada / Description of a digital method used to mount the device in the simplified lingual technique

Resumo A Ortodontia lingual é uma técnica ortodôntica estética onde os bráquetes são posicionados na face lingual dos dentes, que respeita os princípios de biomecânica e que preconiza que a montagem do aparelho siga alguns protocolos. A montagem dos bráquetes pode ser feita por meio da confecção prévia de um modelo de set up ortodôntico e/ou auxilio de máquina e posteriormente deve ser feita a transferência do aparelho para a boca do paciente a fim de se realizar a colagem propriamente dita. Outra forma de montagem do aparelho lingual é a simplificada, isto é, com a colagem direta na superfície lingual do esmalte, porém demanda maior habilidade do profissional ou também no modelo de má oclusão, sem a confecção de set up. O objetivo deste artigo foi demonstrar, através de um relato de caso, como facilitar a técnica utilizando recursos tecnológicos e virtualmente, por meio de um software e um scanner e substituir alguns passos tradicionais da montagem do aparelho lingual. O primeiro passo seria realizar a digitalização intraoral por meio de um scanner, onde são obtidos os modelos em arquivos STL que posteriormente serão manipulados no software e depois prototipados por meio de impressoras digitais. Também o set up e a montagem dos bráquetes, assim como a guia para construção da moldeira de transferência são feitas virtualmente. Ao final, é possível realizar toda a montagem do aparelho lingual pré-fabricado com excelência por meios digitais (AU)

Abstract Lingual orthodontics is an aesthetic orthodontic technique, where brackets are positioned on the teeth lingual surface, respecting the principles of biomechanics and recommends that device mounting follow some protocols. The brackets can be mounted by means of the previous preparation of an orthodontic set up model and/or machine aid and subsequently the device must be transferred to the patient's mouth in order to perform the bonding itself. Another form for mounting the lingual device is the simplified method, which consist in direct bonding on the lingual surface of the enamel, but demands greater professional skills or also in malocclusion models, without set up preparation. The purpose of this case report is to show how to simplify the technique using virtual and technological resources, through a software and a scanner, replacing the traditional steps for lingual mounting technique. The first step would be to replace dental impression by intra-oral scanning performed through an intra-oral scanner where models are obtained in STL files that will be subsequently manipulated in the software and then prototyped through digital printers. Also the set up and the bracket mounting, as well as the guide for construction of the transfer tray are made virtually.It is possible to perform with excellence the lingual mounting technique by digital means.(AU)

Escaneamento digital e prototipagem 3d para confecção de laminados cerâmicos: relato de caso clínico / Digital Scanning and 3D Prototyping for Ceramic Laminate Confection: Clinical Case

Introdução:lentes de contato dentais podem ser uma excelente opção para correção de cor, forma, tamanho e posicionamento dental. Entretanto é umtratamentoque requer várias etapas laboratoriais com riscos de distorções nas etapas de moldagem e vazamento do modelo. Desta forma, desadaptações dos laminados em boca podem ser frequentes.Objetivo:relatar um caso clínico de nove laminados cerâmicos em que foi empregado o escaneamento digital, troquelização virtual e prototipagem do modelo em 3D.Método:paciente do gênero feminino, 59 anos, buscou atendimento odontológico queixando-se de desproporcionalidade dentária ao sorrir. Ao exame clínico foi observada uma inclinação maxilar que causava aquela desarmonia. Foi proposta a confecção de laminados cerâmicos para compensar a discrepância óssea bem como melhorar forma, contorno e cromia dentária. Após planejamento digital, confecção do enceramento diagnóstico, mock up, e aceita do planejamento por parte da paciente, iniciaram-se os preparos dentários. Finalizada esta etapa, os dentes foram escaneados (Trios 3Shape), troquelizados e prototipados em impressora 3D. O modelo foi encaminhado ao laboratório que confeccionou as peças protéticas em dissilicato de lítio de forma injetada e maquiada. Por fim, foram realizadas as provas secas, úmidas, ajustes necessários e cimentação dos laminados com cimento resinoso fotopolimerizável.Conclusão:a tecnologia empregada se mostrou eficiente na resolução do caso, sendo uma técnica rápida, que causou pouco desconforto à paciente e oportunizou uma boa adaptação dos laminados cerâmicos (AU).

Introduction:laminates veneers can be an excellent choice for color correction, shape, size and dental positioning. However, it is a technique that requires several laboratory steps with risks of distortion in the molding and casting steps of the model. Thus, maladjustments of laminatesin the mouth may be frequent.Objective:to report a clinical case of nine ceramic laminates through the digital scanning, virtual punching and 3D prototyping of the model.Methods:A 59 years old woman showed up to dental clinic searched dental care complaining of dental disproportionality when smiling. At the clinical examination, a maxillary inclination was observed that caused disharmony. It was proposed the making of ceramic laminates to compensate the bone discrepancy as well as improve shape, contour and dental color. After the digital planning, preparation diagnostic wax-up, mock up, and acceptance of patient planning, the dental preparations were started. After this step, the teeth were scanned (Trios 3Shape), punched and prototyped in a 3D printer. The model was sent to the laboratory to do the prosthetic parts in lithium disilicate in an injected and makeup manner. At last, it were made the tests dry, wet, required adjustments finally cementation of the ceramic laminates with photopolymerizable resin cement. Conclusions:the technology employed was efficient in solving this case, being a fast technique, which caused little discomfort to the patient and provided a good adaptation of the ceramic laminates (AU).

[Research and application of three-dimensional printed template in endodontics].

With the progress of technology, three-dimensional (3D) printing technology has become more and more widely used in stomatology. 3D printed template has played an irreplaceable role in oral implantation; at the same time, 3D printed template, which has been successfully applied to the calcified root canal negotiation, endodontic treatment of dental invaginatus, apical surgery and autotransplantation, has also provided a new concept and treatment mode for the diagnosis and therapy of endodontic diseases. This review, summarized the research and application of 3D printed template from the perspective of the treatment of endodontic deseases.

Research and application of three-dimensional printed template in endodontics / 中华口腔医学杂志

With the progress of technology, three-dimensional (3D) printing technology has become more and more widely used in stomatology. 3D printed template has played an irreplaceable role in oral implantation; at the same time, 3D printed template, which has been successfully applied to the calcified root canal negotiation, endodontic treatment of dental invaginatus, apical surgery and autotransplantation, has also provided a new concept and treatment mode for the diagnosis and therapy of endodontic diseases. This review, summarized the research and application of 3D printed template from the perspective of the treatment of endodontic deseases.

Cinco tópicos tecnológicos na ortodontia atual / Five technological topics in current orthodontics

O artigo explorou cinco tópicos de interesse na ortodontia na realidade clínica da especialidade. Muitas vezes com o apelo comercial, marketing, mídias sociais e até mesmo em eventos científicos, ortodontistas são instigados a absorverem novas tecnologias como se fossem indispensáveis para o sucesso clínico e que seriam vistos como retrógrados se não adotarem as novas práticas. O objetivo deste trabalho foi elucidar os temas mini-implantes ortodônticos, tomografia computadorizada de feixe cônico, bráquetes autoligados, scanner intraoral e alinhadores transparentes e mostrar que toda tecnologia deve ser vista com critério e estudada antes de ser adotada indiscriminadamente. A finalidade do tratamento ortodôntico deve ser pela melhor solução possível para a realidade do paciente, através de treinamento, discernimento e empenho do profissional. E isto só pode ser alcançado com estudo, educação e individualização de cada caso clínico.

The article explored five topics of interest in orthodontics into the clinical reality. Often commercial appeal, marketing, social media and even scientific events, encourages orthodontists to absorb new technologies as if an indispensable feature to clinical success. The lack of adoption of such techniques could drive the professional to the career obsolescence. The objective of this work was to elucidate about orthodontic miniscrews, cone beam computed tomography, self-ligating brackets, intraoral scanner and clear aligners, showing that all technology must be viewed with precaution and deeply investigated before being widely adopted. It is reinforced that the purpose of orthodontic treatment should be hardly tied to the patient's reality, through training, discernment and professional commitment. And this can only be achieved with education and individualization of each clinical case.

Vantagens da utilização do protocolo dentogengival total em zircônia / Advantages of using the full-contour zirconia dentogingival protocol

A reabilitação protética por meio de implantes tem se confi gurado como o padrão-ouro para a devolução da função previamente perdida pelo paciente, podendo ser realizada com próteses removíveis ou fixas sobre os implantes osseointegrados. As próteses fixas do tipo protocolo proporcionam maior estabilidade durante as atividades cotidianas, como falar e comer, além de alta performance estética, quando bem indicada. Vislumbrando uma maior resistência das próteses, melhor harmonização do sorriso e adequada adaptação, as infraestruturas em zircônia vêm sendo altamente difundidas na literatura. Confeccionadas pelo método CAD/CAM, as próteses em zircônia dispensam as etapas de solda, o que elimina possíveis distorções de grandes estruturas, além de serem produzidas mais rapidamente e com uma estética maior, caracterizando-se como a melhor opção para pacientes que buscam a mimetização do sorriso natural.

The prosthetic rehabilitation using dental implants has been featured as the gold standard for retrieving patient's lost function, and may be performed by implant-supported removable or fixed dental prostheses. The implant-supported fixed prosthesis provides greater stability during daily activities, such as talking and eating, and high aesthetic performance, when properly indicated. In order to obtain higher resistance, superior smile esthetics and adequate prosthesis fit, the zirconia infrastructure have been highly disseminated in the literature. The CAD/CAM zirconia prosthesis avoids welding/soldering, which eliminates possible distortions of large structures. In addition, it is produced faster and with greater aesthetic, being nowadays characterized as the best option for patients who seek to emulate the natural smile.

Emergence Profile Index Implant Surgical Guide.

INTRODUCTION: This case series presents an innovative approach to fabricating an implant surgical guide to facilitate ideal implant placement. CASE SERIES: Three healthy, non-smoking patients with a partially edentulous ridge presented to a private practice. Informed consent for dental implant placement was attained from patients. Sequential three-dimensional (3D) surgical guides were fabricated before implant surgery using light-polymerizing material. These guides provided information to the surgeons on implant position in the bucco-lingual, mesio-distal, and apico-coronal directions. CONCLUSION: With assistance of the proposed surgical guide, ideal 3D implant placement can be achieved so that future peri-implant complications can be minimized.

The effect of three different investing materials on complete denture flasking deformation / 中国基层医药

Objective To investigate the effect of different investing materials on the complete denture flasking deformation.Methods The denture wax casts were invested by plaster,dental stone,and dental stone together with silicone,respectively.8 trial dentures were randomly chosen from above each group,and 4 reference points were selected in the cast.The conventional water bath polymerization system was used for the process.The distance between reference points were measured before and after thermally processing the Acrylic base.F test and Kruskal-Wallis H test were applied for statistical analysis.Results The distance between A and B (F =3.768,P =0.040) and the mean of total distance among O,A,B and C(F =4.830,P =0.019) had statistically significant differences among the three groups.The deformation variance of Group 1 (a conventional plaster) between 175μm and 267μm was maximum.The deformation values of Group2 (a dental stone) was appropriate with Group3 (a dental stone + a silicone).Smoothness (x2 =17.575,P ＜ 0.01) was statistically different among the three groups.Conclusion The flaskingprocess with the plaster had the maximum movement.The process with dental stone showed the minimal toothmovement,the process with the dental stone along with with thesilicone caused a similar movement as from the single dental stone but resulted in a smoother denture surface.

Fatigue damage analysis of porcelain in all-ceramic crowns / 北京大学学报(医学版)

Objective:To investigate the fatigue damage mechanism of porcelain,and its relation with the microscopic defects in clinically failed all-ceramic crowns.Methods: Collecting the bilayered all-ceramic crowns failed in vivo.The fractured surfaces and occlusial surfaces of failed crowns were examined by an optical microscope followed by detailed fractography investigations using a field emission scanning electron microscope.When chemical impurities were of concern,energy-dispersive X-ray spectroscopy analysis was performed to examine chemical composition.A standard practice for fractography failure analysis of advanced ceramics is applied to disclose the fracture mode,and damage character.Results: Three types of fracture features are defined as breakdown of the entire crown,and porcelain chipping-off/delamination.Alumina crowns were usually characterized by breakdown of the entire crown,while zirconia crowns by porcelain chipping-off and delamination.The fatigue damage of porcelain was classified into surface wear,cone crack,and porcelain delamination.The observed microscopic defects in this study included air bubbles and impurity particles.Conclusion: The multi-point occlusial contacts were recommended in all-ceramic restorations clinically.The thickness of porcelain is important for the anti-fatigue ability of porcelain.Cautions have to be taken to avoid contaminations during the veneering processes.

Alveolitis: Revisión de la literatura y actualización

La alveolitis es la complicación más frecuente de la extracción dentaria. Su frecuencia varía del 1 al 4 % y puede llegar del 20 al 30 % en extracciones de terceros molares mandibulares. Se describen algunos factores de riesgo que aumentan su incidencia, aunque se habla de un origen multifactorial. La clínica y los síntomas subjetivos nos permiten su diagnóstico y clasificación. Para tratar las alveolitis se han utilizado localmente distintos productos para inducir la formación del coágulo: antibióticos, anestésicos, analgésicos y antiinflamatorios, asociados o no con corticoides, analgésicos y antibióticos sistémicos. También la medicina natural y tradicional ocupa un lugar importante en el tratamiento de esta urgencia estomatológica, y se destacan terapéuticas como: la apiterapia, la acupuntura y la ozonoterapia, además tecnologías de avanzada como los soft láser.

Alveolitis is the most frequent complication of tooth extraction. Its frequency varies from 1 to 4 % and may reach 20 to 30 % in extractions of mandibular third molars. Some risk factors increasing its incidence are described, although reference is made to a multifactorial origin. The clinic and the subjective symptoms allow us to make its diagnosis and to classify it. Different products have been used in the treatment of alveolitis to induce clot formation: antibiotics, anesthesics, analgesics and anti-inflammatories associated or not with corticoids, analgesics and systemic antibiotics. Natural and traditional medicine also play an important role in the treatment of this stomatological emergency and therepeutics such as the apiotherapy, the acupuncture, the ozone therapy and state-of-the art technologies as the soft laser are stressed.

Autotrasplante dentario

Se realizó una revisión bibliográfica sobre el autotrasplante y el homotrasplante dentario con el objetivo de actualizar los aspectos fundamentales sobre este tema. Se destacan los factores esenciales para el éxito de éstos, como son: revascularización posoperatoria, reinserción del ligamento al hueso y al cemento, y la importancia de la integridad del ligamento parodontal. Se analizaron las indicaciones y contraindicaciones de los trasplantes dentarios, así cmo la técnica quirúrgica, entre otros aspectos. Se concluye que los dientes para ser trasplantados deben tener formado por lo menos el tercio cervical de su raíz, los dientes trasplantados tienen que fijarse en infraoclusión durante 4 a 6 semanas y el traumatismo sobre el saco folicular y los tejidos parodontales del diente interfieren en la evolución de los trasplantes.

A bibliographic review on dental autologous transplantation and homologous transplantation was made in order to bring up to date the fundamental aspects about this topic. The factors necessary for the success of these transplantations are stressed: postoperative revascularization, reinsertion of the ligament to the bone and cement, and the importance of the integrity of the periodontal ligament. The indications and contraindications of dental transplantations, as well as the surgical technique, among other things, were analyzed. It is concluded that to transplant a tooth at least the cervical third of its root must be formed. Transplanted teeth should be fixed in infraocclusion from 4 to 6 weeks. The traumatism of the follicular sac and the periodontal tissues of the tooth interfere the evolution of transplantations.