Digital Workflow for Double Complete Arch Zirconia Prostheses Utilizing a Novel Scan Body.

The purpose of this clinical report is to present a complete digital workflow for the fabrication of complete arch fixed zirconia implant restorations. An intraoral scanner was used to capture the implants' position at the abutment level and also the patient's existing interim prostheses with the double digital scanning technique. A novel scan body and impression pin were utilized throughout the scanning process which allowed for the accurate and reproducible superimposition of the generated Standard Tesselation Language (STL) files. Prosthesis prototypes were digitally designed and fabricated, tried in, and verified intraorally. The definitive zirconia prostheses were then fabricated and delivered to the patient. This technique can be utilized in both arches overcoming the absence of stable intraoral landmarks for superimposition of STL files.

Prosthodontics treatment considerations for methamphetamine-dependent patients.

Overt dental disease is a distinguishing comorbidity associated with methamphetamine abuse, necessitating the need for special management to maximize treatment benefits. As this highly addictive stimulant increases in popularity, it has become imperative that clinicians are equipped to thoughtfully provide comprehensive care for these patients. This article reviews the impact of methamphetamine to systemic and oral health and proposes a comprehensive treatment plan and sequence for the methamphetamine-dependent patient. A multidisciplinary approach is recommended. Destructive oral and psychological changes must be identified and controlled. A thorough risk assessment, caries control, and preventative plan should be established before initiating prosthodontic treatment. Patient motivation, support, and a timely recall schedule are integral for dental longevity.

Fracture toughness of yttria-stabilized zirconia sintered in conventional and microwave ovens.

STATEMENT OF PROBLEM: The fabrication of zirconium dioxide (ZrO2) dental prosthetic substructures requires an extended sintering process (8 to 10 hours) in a conventional oven. Microwave sintering is a shorter process (2 hours) than conventional sintering. PURPOSE: The purpose of this study was to compare the fracture toughness of 3 mol % Y2O3-stabilized ZrO2 sintered in a conventional or microwave oven. MATERIAL AND METHODS: Partially sintered ZrO2 specimens from 3 manufacturers, KaVo, Lava 3M, and Crystal HS were milled (KaVo Everest engine) and randomly divided into 2 groups: conventional sintering and microwave sintering (n=16 per group). The specimens were sintered according to the manufacturers' recommendations and stored in artificial saliva for 10 days. Fracture toughness was determined by using a 4-point bend test, and load to fracture was recorded. Mean fracture toughness for each material was calculated. A 2-way ANOVA followed by the Tukey HDS post hoc test was used to assess the significance of sintering and material effects on fracture toughness, including an interaction between the 2 factors (α=.05). RESULTS: The 2-way ANOVA suggested a significant main effect for ZrO2 manufacturer (P<.001). The post hoc Tukey HSD test indicated that mean fracture toughness for the KaVo ZrO2 (5.85 MPa·m(1/2) ±1.29) was significantly higher than for Lava 3M (5.19 MPa·m(1/2) ±0.47) and Crystal HS (4.94 MPa·m(1/2) ±0.66) (P<.05) and no significant difference was observed between Lava 3M and Crystal HS (P>.05). The main effect of the sintering process (Conventional [5.30 MPa·m(1/2) ±1.00] or Microwave [5.36 MPa·m(1/2) ±0.92]) was not significant (P=.76), and there was no interaction between sintering and ZrO2 manufacturer (P=.91). CONCLUSIONS: Based on the results of this study, no statistically significant difference was observed in the fracture toughness of ZrO2 sintered in microwave or conventional ovens.

Loss of natural dentition: multi-level effects among a geriatric population.

OBJECTIVE: To quantify the impact of edentulousness on residual ridge volume, denture stomatitis (DS), as well as oral health behaviours among geriatric denture-wearers. BACKGROUND: Residual ridge resorption (RRR) is the primary intraoral complication of complete edentulism, but individual variation among geriatric patients has been observed. MATERIALS AND METHODS: Data collection relied upon a 10-year retrospective chart review of all complete denture-wearing geriatric patients presenting at the Removable Prosthodontics Clinic, Dental School of Athens, between 1993 and 2002. Analyses relied on descriptive, bivariate, and multivariate methods based on ordinal logistic regression. RESULTS: A total of 873 records of geriatric patients (age mean = 72; median = 70; range = 65-95) comprised our analytical sample. Subjects' mean (SD) time since edentulation was 7.7 (10.2) years. Eleven percent were diagnosed with temporomandibular disorder (TMD). While 28% of patients reported cleaning their dentures at least daily, 6% presented with denture stomatitis (DS). Each added year of edentulism increased the odds of mandibular RRR: OR (95% CI) = 1.05 (1.03, 1.07). Nightly denture wear was the strongest risk factor for DS. Finally, independent of age and sex, each year of being edentulous increased the odds of presenting with TMD: OR (95% CI) = 1.03 (1.01, 1.05). CONCLUSION: Time since edentulation was strongly associated with mandibular but not maxillary RRR, as well as TMD development.

Retrospective Analysis of Implant Overdenture Treatment in the Advanced Prosthodontic Clinic at the University of Illinois at Chicago.

The aim of the present retrospective study was to evaluate the clinical outcomes of implant-supported overdenture treatment provided by prosthodontic specialty residents. Twenty-three patients with 25 implant-supported overdentures (IODs) participated in the study. Seventy-four implants were placed by periodontic, prosthodontics, or oral and maxillofacial surgery students. All prostheses were fabricated in the advanced prosthodontics clinic at University of Illinois at Chicago. The condition of the peri-implant soft tissue, implants, and prostheses were evaluated. Complications and any maintenance were documented. Patients completed an oral health impact profile-14 and semantic differential scale questionnaires. Statistical analyses were performed using SPSS statistical software. Twenty mandibular and 5 maxillary IODs were evaluated. Ninety-seven percent of the attachments were locators (Zest Anchors) and 3% ball attachments. None of the implants had lost osseointegration, but 14 implants (19%) had developed marginal bone loss in one-third of the implant length or more. Fourteen (19%) implants had developed dehiscence, which ranged from 1 to 4 mm. A variation in the width of the keratinized tissue, gingival, plaque, and calculus index was observed. There was a statistically significant relationship between the presence of plaque and the bleeding on probing on the buccal aspect of implants (P = .012). The incidence of dehiscence was significantly higher on the midfacial when the keratinized tissue was less than 2 mm (P < .0001). The majority of the complications were prosthetic in nature, such as broken denture teeth (74%) and worn or loose matrices (35%). Debris was observed in 19% of the locator abutments, and 36% of the overdentures were not stable in application of anterior force. Patients were compliant with oral hygiene protocols and their chewing ability was high (mean = 8.0). The overall experience was pleasant (mean = 7.5); the treatment provided good esthetics (mean = 8.3) and great satisfaction (mean = 8.5). From an educational and clinical perspective, IOD therapy has been documented to be a predictable and successful treatment option. Patients should be informed of the required maintenance and the possible complications related to IOD therapy.

Current status of patient recall in U.S. predoctoral dental school clinics.

The Commission on Dental Accreditation (CODA)'s revised standard 2-23, which went into effect in July 2013, requires U.S. dental graduates to be competent in "evaluation of the outcomes of treatment, recall strategies, and prognosis." To assess the way dental schools are implementing this revised recommendation, a survey was conducted to assess the existence of recall systems in the schools' clinics and factors enhancing or hindering the formation of an effective recall system. Surveys were returned from thirty-five dental schools (54.7 percent response rate). Results showed that most institutions had active recall systems and the respondents believed that program effectiveness can be further improved. Suggested improvements included patient education and tracking patient recall appointments. The results indicate that recall systems exist in predoctoral dental education programs, have high student involvement, and vary among schools.

Patients' profiles and perceptions of complete dentures in a university dental clinic.

This study investigated factors associated with perceptions of complete dentures (CDs) among patients presenting at a university dental clinic. A retrospective chart review of all new edentulous patients presenting at the Athens University School of Dentistry Removable Prosthodontics Clinic between 1993 and 2002 (n = 2,526) was completed. More than half of CD-wearing patients were dissatisfied with their dentures at the initial visit. Dissatisfaction was correlated with current use of denture adhesives and less time spent edentulous and was more prevalent among females. Factors affecting patients? adaptation to and satisfaction with CDs should be considered at CD fabrication and follow-up.