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STATEMENT OF PROBLEM: Minimally invasive treatments have gained popularity in recent years. However, research comparing the fracture resistance of lithium disilicate partial coverage veneer restorations with that of ceramic crowns is lacking. PURPOSE: The purpose of this in vitro study was to evaluate and compare the fracture resistance of lithium disilicate restorations fabricated for preparations of various designs. The designs included veneer preparations with finish lines in the upper, middle, and lower third of the facial surface and ceramic crown preparations with margins in the lower third of the facial surface. All restorations were designed and fabricated using a chairside digital workflow. MATERIAL AND METHODS: Four maxillary right central incisor typodont teeth were prepared for partial coverage veneer preparation with the margin in the upper middle third of the facial surface (PU1/3); partial coverage veneer preparation with margin in lower middle third of the facial surface (PL1/3); complete coverage veneer preparation (CV) with margin in the cervical region; and ceramic crown (CC) preparation. Each preparation was scanned, and 15 casts were 3D printed from each scan. A total of 60 lithium disilicate restorations were fabricated (n=15 per group) using a chairside computer-aided design and computer-aided manufacturing (CAD-CAM) system (Primescan and MCXL). The different restorations were cemented to the 3D printed testing dies with a photopolymerizable resin cement. The specimens were artificially aged with 10 000 thermal cycles between 5 and 55 °C with a dwell time of 30 seconds and were loaded to failure using a universal testing machine. The maximum load to fracture was analyzed using a 1-way ANOVA and post hoc Tukey honestly significant difference (HSD) test (α=.05). Additionally, the fracture patterns of the specimens were evaluated with a stereomicroscope for descriptive purposes. RESULTS: The mean fracture resistance of the chairside CAD-CAM lithium disilicate veneers and ceramic crowns was statistically different depending on the design of the restoration (P<.05). Group CC demonstrated the highest fracture resistance values (1440.66 N), followed by CV (929.8 N) and PU1/3 (756.13 N). The lowest value was for PL1/3 (532.4 N). CONCLUSIONS: The fracture resistance measured for the maxillary central incisor partial coverage veneers with margins in the middle third of the facial surface appear capable of resisting average occlusal forces. However, these veneers demonstrated lower fracture resistance values when compared with complete coverage veneers. Further, lithium disilicate crowns demonstrated higher fracture resistance than veneers, irrespective of their design.
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Cerâmica , Coroas , Porcelana Dentária , Planejamento de Prótese Dentária , Facetas Dentárias , Incisivo , Humanos , Análise do Estresse Dentário , Falha de Restauração Dentária , Maxila , Desenho Assistido por Computador , Técnicas In VitroRESUMO
PURPOSE: The present study evaluated the effects of the root portion design, segment (middle vs. apical), and part (die vs. cast) on the trueness of three-dimensional (3D)-printed removable die-cast complex. MATERIAL AND METHODS: The trueness of apical and middle segments of the root portion of 45 3D-printed removable dies and casts with three different root portion designs (n = 15) was assessed using a metrology-grade computer program. The three removable dies and cast designs (root form [RF], conical [CON], and cylindric [CYL]) were created using professional computer-aided manufacturing computer programs (DentalCAD 3.1 Rijeka, and InLab CAD 22.0), and manufactured using stereolithographic 3D printer (Form3; FormLabs, Somerville, MA). Subsequently, the 3D-printed removable dies and casts were scanned by a single operator with an intraoral scanner (PrimeScan; Dentsply Sirona, Charlotte, NC), and their respective standard tessellation language files were aligned and compared to master reference files in a metrology-grade computer program (Geomagic Control X; 3D systems, Rock Hill, NC). The root mean square (RMS) values of the middle and apical segments for each removable die and cast were calculated and analyzed using a mixed model including a repeated measure 3-way analysis of variance (ANOVA) and post-hoc stepdown Bonferroni-corrected pairwise comparisons (α = 0.05). RESULTS: A statistically significant 3-way interaction between factors was detected, suggesting that the part (removable die or alveolar cast) and their design affected the RMS values of their apical and middle root portion segment. (p = 0.045). The post-hoc analysis identified significant differences between RMS values of the apical segments of the CON and CYL removable dies (p = 0.005). Significant differences were observed between the middle and apical segments of the CON (p < 0.001) and RF removable die designs (p = 0.004). No statistically significant differences were noticed between the RMS of the different alveolar cast designs (p > 0.05). Significant differences were detected between the apical and middle segments of the same alveolar cast design (p < 0.05). CONCLUSIONS: For the manufacturing trinomial and 3D printing strategy used in the present study, the interaction of the part, design, and segment affected the trueness of removable dies and alveolar casts. The trueness was higher on the middle segment on removable dies and alveolar casts in all designs used, except for CYL removable dies, where the trueness difference between segments was small. Higher trueness values may be achieved with designs with simple apical segment geometries.
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Computer-aided design and computer-aided manufacturing systems enable digital designing and 3-dimensional (3D) printing of definitive casts with removable dies. However, the fit of the removable dies should be without interferences for their accurate positioning in the cast. Given that the accuracy of additive manufacturing depends on design- and manufacturing-related factors, verifying the accuracy of the position of 3D-printed removable dies in their cast is essential to fabricate positionally accurate definitive prostheses, which would enable minimal or no laboratory and clinical adjustments. This dental technique article presents a straightforward approach to verify the seating of a 3D-printed removable die by using verification matrices made of a polyvinylsiloxane interocclusal registration material.
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3D-printed shell complete dentures generated from a scan of the patient's existing prostheses can simplify and expedite the surgical planning and interim restoration design for complete arch rehabilitations. Three patients were rehabilitated with endosteal implants, and interim restorations were generated from the contours of the 3D-printed shell complete dentures used as diagnostic aids. This case series report presents the recommended protocol and its clinical progression, in addition to clinical and radiographic images of the treatment outcomes.
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Traditionally, artificial teeth arrangements or the definitive complete dentures are used to establish important prosthodontic parameters such as the occlusal plane orientation, vertical dimension, and the incisal edge position. The relationship of these elements with the underlying bony structures is commonly evaluated using advanced planning protocols such as the dual scan technique. This technique article presents an uncomplicated alternative approach to establish these parameters intraorally using a 3D-printed shell complete denture generated from a 3D scan of the patient's existing complete denture.
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OBJECTIVES: The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone. MATERIALS AND METHODS: An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool. RESULTS: A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004). CONCLUSIONS: Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.
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Implantes Dentários , Humanos , Seleção de Pacientes , Estética Dentária , Bases de Dados FactuaisRESUMO
OBJECTIVES: The aim of this study was to assess the following PIO question: In adult patients treated with an indication for single tooth extraction in the maxillary esthetic zone (15-25), what is the influence of an immediate implant placement and immediate loading protocol on the clinical performance (primary aim) and esthetic outcomes (secondary aim) focusing on investigations published after 2010. MATERIAL AND METHODS: An electronic search in Medline (PubMed), the Cochrane Central Register of Controlled Trials, and EMBASE databases up to April 2022 was performed to identify clinical studies investigating the outcome of single implants subjected to immediate placement with immediate restoration/loading (Type 1A). RESULTS: Sixty-three studies (10 randomized controlled trials, 28 prospective and 25 retrospective cohort studies) were included with a follow-up ranging from 12 to 96 months. One thousand nine hundred sixty-one implants reported survival rates of 99.2 (98.6-99.5) % at 1 year, 97.5 (95.9-98.4) % after 3 years, and 95.8 (93.3-97.4) % after 5 years; 1064 immediately loaded restorations presented survival rates of 98.9 (97.8-99.5) % after 1 year, 96.8 (93.6-98.4) % after 2 years, and 94.8 (89.6-97.4) % after 5 years. Comparing baseline to 12-month data using the Hedges' g effect size (95% CI), papilla height presented an overall effect size of -0.71 (-1.25, -0.1) mm, midfacial recession change of -0.15 (-0.66, 0.36) mm, and a 0.82 (0.37, 1.28) gain in PES. CONCLUSIONS: Immediate implant placement and immediate loading can be considered a predictable and safe treatment option for single maxillary anterior restorations with adequate survival rates and favorable esthetics outcomes for up to 5 years.
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Implantes Dentários , Adulto , Humanos , Estudos Prospectivos , Estudos Retrospectivos , Estética Dentária , Bases de Dados FactuaisRESUMO
OBJECTIVES: Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval. MATERIALS AND METHODS: Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary. RESULTS: Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research. CONCLUSIONS: Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur.
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Implantes Dentários , Perda de Dente , Humanos , Consenso , Guias de Prática Clínica como Assunto , Revisões Sistemáticas como AssuntoRESUMO
PURPOSE: To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints. MATERIALS AND METHODS: The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 - Milling (Wax), Group 2 - Heat-polymerizing, Group 3 - Milling (M series), Group 4 - Milling (DWX-51/52D), Group 5 - 3D-printing (Cares P30), and Group 6 - 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests. RESULTS: The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 - Milling (Wax) (0.03 ± 0.02 mm), Group 3 - Milling (M series) (0.04 ± 0.01 mm), and Group 4 - Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 - Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 - Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 - 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 - Heat-polymerizing and Group 5 - 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 - Milling (Wax) showed the best and most uniform surface matching with the most area in green. CONCLUSION: The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.
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Desenho Assistido por Computador , Placas Oclusais , Impressão Tridimensional , SoftwareRESUMO
PURPOSE: To evaluate the effects of 5 manufacturing technologies and 2 finish line designs on the trueness and dimensional stability of 3D-printed definitive dies at finish line regions under different storage conditions and time. MATERIAL AND METHODS: Preparation of light chamfer and round shoulder finish lines were adopted individually on two mandibular first molar typodont teeth and digitalized as standard tessellation language (STL) files. A total of 240 samples (192 AM definitive dies and 48 definitive conventional stone dies) in 20 groups (n = 12) were manufactured based on 2 finishing line designs (chamfer and shoulder), 5 manufacturing technologies (4 additively manufactured technologies and conventional stone die), and 2 storage conditions (light exposure and dark). The 4 additively manufactured (AM) technologies include a DLP 3D-printer, an economic LED 3D-printer, a CLIP 3D-printer, and an SLA 3D-printer. All the study samples were distributed into two storage conditions. Subsequently, samples were digitalized to STL files at 3 different time points (within 36 hours, 1-month, and 3-months). A surface matching software was used to superimpose the sample STL files onto the corresponding original STL files with the best-fit alignment function. The trueness of each printed and stone definitive dies and their dimensional stabilities were measured by the root mean square (RMS, in mm). A linear mixed-effects model was used to test the effects of the finish line design, manufacturing technology, storage condition, and storage time on RMS values (α = 0.05). RESULTS: While finish line designs had no significant effects [F(1, 220) = 0.85, p < 0.358], the manufacturing technologies [F(3, 220) = 33.02, p < 0.001], storage condition [F(1, 220) = 4.11, p = 0.044], and storage time F(2, 440) = 10.37, p < 0.001] affected the trueness and dimensional stability of 3D-printed dies at finish line regions. No significant interactions were found among the 4 factors. For the manufacturing technologies, Type IV stone groups and LCD 3D-printer groups had significantly higher RMS values than the other 3 printers (p < 0.001) with no significant differences between Type IV stone and LCD 3D-printer groups (p = 0.577). DLP 3D-printer groups had higher RMS values than both SLA 3D-printer groups and CLIP 3D-printer groups (p < 0.001). There were no significant differences between SLA 3D-printer groups and CLIP 3D-printer groups, p = 0.671. For the effects of storage conditions, RMS values were significantly higher in the groups stored with the direct light exposure than the ones stored in the dark, p = 0.044. In terms of the effects of storage time, the RMS values were significantly higher after 1-month storage, p = 0.002; and 3-month storage, p < 0.001, than the ones at the immediate postmanufacturing stage. However, the RMS values after 1-month and 3-month storage were not significantly different from each other (p = 0.169). CONCLUSIONS: Manufacturing technologies, storage conditions, and storage time significantly affected the trueness and dimensional stability of 3D-printed dies at finish line regions, while finish line designs had no significant effects. Among the AM technologies tested, all have produced either comparable or truer 3D-printed dies than the Type IV dental stone dies, and the CLIP and SLA 3D-printers produced the best outcomes. 3D-printed dies showed significant distortion after 1-month and 3-months storage, especially under light exposure storage conditions. These findings may negate the clinical need to preserve 3D-printed dies, and digital data should be preserved instead.
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Desenho Assistido por Computador , Impressão Tridimensional , Tecnologia , Software , Modelos DentáriosRESUMO
PURPOSE: To investigate the trueness of intraoral scanning in 8 commonly seen partially edentulous conditions. MATERIALS AND METHODS: A maxillary dentoform was modified into the 8 commonly seen partially edentulous conditions. Each modification was scanned with a laboratory desktop scanner. Each modification was then scanned 10 times (n = 10) with an intraoral scanner. All scans were exported as STL files and then imported into a surface matching software using the best-fit alignment method. The dimensional differences between the study STL files from the intraoral scanner were compared to the corresponding reference STL files. The measurements were calculated as the root mean square (RMS) and defined as the trueness of the intraoral scans. In addition to the RMS values, qualitative assessments were completed on the color maps. The color maps produced by the surface matching software were used to visualize the areas of deviation between scans from the intraoral scanner and their corresponding reference files. One-way analysis of variance (ANOVA), followed by pair-wise comparisons using Fisher's Protected Least Significant Difference were utilized to compare the differences between the groups in RMS values (α = 0.05). RESULTS: Partially edentulous condition significantly affected the trueness of the intraoral scans. Group 8 (Class IV) had significantly lower RMS (0.1878 ± 0.0455 mm) than all other groups (p < 0.001). Group 2 (Class II) and Group 7 (Class III modification I) are not significantly different from each other (Group 2: 0.5758 ± 0.0300 mm; Group 7: 0.5602 ± 0.0231 mm, p = 0.571), while they both had significantly higher RMS than all other groups (p < 0.001). The remaining groups showed the RMS values were within the range of 0.3001 ± 0.0891 mm (Group 6 - Class III with Long Edentulous Span) and 0.4541 ± 0.1039 mm (Group 1 - Class I). CONCLUSION: Different partially edentulous conditions affected the trueness of the scans generated from the selected intraoral scanner. Class IV edentulous condition had the highest intraoral scan trueness. It is unknown if RMS values are clinically significant, and the validity of using intraoral scans directly for PRDP fabrication will need further studies.
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Técnica de Moldagem Odontológica , Boca Edêntula , Humanos , Desenho Assistido por Computador , Imageamento Tridimensional , Modelos Dentários , Boca Edêntula/diagnóstico por imagemRESUMO
STATEMENT OF PROBLEM: Additively manufactured dental casts are gaining popularity as the digital workflow is adopted in dentistry. However, studies on their dimensional accuracy and stability under different storage conditions in the dental laboratory are lacking. PURPOSE: The purpose of this in vitro study was to compare the effects of different additive manufacturing processes and storage conditions on the dimensional accuracy and stability of 3D-printed dental casts. MATERIAL AND METHODS: A completely dentate maxillary typodont model was digitized 10 times with a dental laboratory laser scanner, and the standard tessellation language (STL) files were used to manufacture 3D-printed diagnostic casts with the digital light projection (DLP) 3D printer (Asiga MAX) and material jetting (MJ) 3D printer (ProJet 3510 DPPro). Twenty DLP-printed and 20 MJ-printed diagnostic casts were digitized within 24 hours of production. Subsequently, all 3D-printed diagnostic casts were stored for 3 months, either in closed laboratory boxes or in dental laboratory open-face plastic containers with direct exposure to full-spectrum balanced light. After 3-month storage, all 40 3D-printed casts were digitized again. All scanned files were compared with the corresponding STL files in a surface-matching software program. The dimensional accuracy was measured and compared by the root mean square (RMS, in µm). Repeated measures analysis of variance (ANOVA) was used to compare RMS values among the variables, and the Tukey honestly significant difference (HSD) test was used for post hoc multiple comparisons (α=.05). RESULTS: The casts produced from the DLP 3D printer had a significantly higher mean ±standard deviation RMS of 153.7 ±25.4 µm than those produced with the MJ 3D printer with RMS of 134.1 ±16.0 µm (P<.001). The storage condition (box storage versus light exposure) did not affect the accuracy of the DLP-printed casts (P=.615) or the MJ-printed casts (P=.999). When comparing all 3D-printed casts after 3-month storage, group DLP-3M-Lit had the highest mean ±standard deviation RMS of 163.0 ±26.5 µm, and group MJ-3M-Box had the lowest RMS of 132.8 ±16.9 µm. The DLP-printed casts stored under light exposure were significantly less accurate than the MJ-printed casts stored in the box (P=.048). DLP-printed casts stored under light exposure showed significant surface color change under visual inspection. CONCLUSIONS: The MJ 3D printer produced more accurate 3D-printed dental casts than the DLP 3D printer. After 3-month storage, the DLP-printed casts stored under light exposure were the least accurate, and the MJ-printed casts stored without light exposure were the most accurate. The surface color change of DLP-printed casts stored under light exposure after 3-month storage was evident.
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Desenho Assistido por Computador , Modelos Dentários , Impressão Tridimensional , Maxila , Fluxo de TrabalhoRESUMO
PURPOSE: To evaluate the color stability of 3D-printed interim restorations with different surface treatments while immersed in various staining solutions or beverages (artificial saliva, tea, coffee, and wine) for 6 months. MATERIAL AND METHODS: An acrylic tooth was prepared for an all-ceramic full-coverage restoration. A laboratory scanner was used to digitize the prepared abutment tooth. A virtual all-ceramic full-coverage restoration was designed on the digitized abutment tooth using a laboratory CAD/CAM software. Eighty abutment teeth and interim restorations were 3D-printed with tooth-colored photopolymerizing resin. The restorations were randomly allocated into two different groups: Polish and Optiglaze. For the Polish group, interim restorations were finished and polished with aluminum oxide finishers/polishers. For the Optiglaze group, one layer of nanofilled, light-polymerizing protective coating was then applied. The 80 printed interim crowns were divided into 4 different groups depending on where they would be immersed: Artificial saliva, coffee, wine, and tea. After the sample allocations, there were 8 experimental groups. Each group was allocated with 10 specimens. Color measurements were obtained using a digital spectrophotometer in conjunction with The CIE L*a*b* system before the immersion and 6 months after the immersion. Two-way analysis of variance (ANOVA) was used to test the effects of surface treatment, immersion liquid, and their interaction on ΔE at 6-month post-immersion. Fisher's protected least significant differences (LSD) was used as post hoc test to compare groups differences (α = .05). RESULTS: There were significant effects of surface treatment [F(1,72) = 13.39, p = 0.000], immersion liquid [F(3,72) = 74.18, p = 0.000], and their interaction [F(3,72) = 16.33, p = 0.000] on ΔE at 6-month post-immersion at the α = .05 level. The polish group showed significantly higher ΔE than the Optiglaze group when immersed in coffee (p < 0.001) and wine (p = 0.015). The Optiglaze group showed significantly higher ΔE than the polish group that was immersed in artificial saliva (p < 0.001). The wine group showed higher ΔE than all other immersion liquid groups for both polish and Optiglaze surface treatments (p < 0.001 for all comparisons). ΔL* showed a reduction that was significantly higher than the 2.0 acceptability threshold in the wine-polish (p < 0.001) and wine-Optiglaze (p < 0.001) groups. ΔE showed a color change that was significantly higher than the perceptibility and acceptability thresholds for all the groups under polish surface treatment (p < 0.001). ΔE also showed a color change that was significantly higher than the perceptibility and acceptability thresholds for artificial saliva, tea, and wine under Optiglaze surface treatment (p = 0.004). CONCLUSIONS: 3D-printed interim restorations showed significant discoloration after 6-months immersions in the artificial saliva and common beverages (including tea, coffee, and wine). Among all the chromogenic beverages, red wine caused the most significant discoloration on the interim restorations. When 3D-printed interim restorations are needed for extended intraoral service, nano-filled, light polymerizing protective coating can reduce the restoration discoloration caused by chromogenic beverages. The protective effect is most significant against coffee.
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Bebidas , Materiais Dentários , Café , Cor , Resinas Compostas , Teste de Materiais , Impressão Tridimensional , Propriedades de SuperfícieRESUMO
This technique report describes an alternative method to stabilize surgical templates throughout full-arch static computer-assisted implant surgery (FA s-CAIS). In FA s-CAIS, remaining teeth, mucosa, existing implants, custom occlusal device, bone, or any combination thereof, could be used as an initial positioning mechanism to position surgical templates. Different anchoring mechanisms are then used to stabilize the surgical templates during surgery. In this report, a novel design of surgical templates using remaining dentition and opposing occlusal surfaces as initial positioning mechanism followed by the combination of bone block fixation screw and stainless-steel beads as secondary anchoring mechanisms is described. The advantages, limitations, and comparisons with surgical templates using other anchoring mechanisms are also discussed.
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Implantes Dentários , Cirurgia Assistida por Computador , Implantação Dentária Endóssea/métodos , Cirurgia Assistida por Computador/métodos , Computadores , Aço , Desenho Assistido por Computador , Prótese Dentária Fixada por ImplanteRESUMO
A fractured implant is considered a catastrophic failure that leads to the loss of the implant and the prosthesis. Available methods of implant removal include the reverse screw technique, use of trephines, or osteotomies around the implant. In case of a fractured implant, the access hole for the reverse screw technique is impossible, leading to the need for an osteotomy. When the apical part of the fractured implant is embedded in bone, finding the piece may lead to a more ample osteotomy and significant bone loss, complicating future implant placement. This technique presented utilized a CAD-CAM surgical template that was designed with the purpose of improving accuracy in finding the fractured part with minimal osteotomy, allowing for simultaneous placement of a new implant in the same site, with additional bone graft, utilizing the same template.
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Implantes Dentários , Parafusos Ósseos , Transplante Ósseo , Desenho Assistido por Computador , Implantação Dentária Endóssea/métodos , Osteotomia/métodosRESUMO
PURPOSE: To compare the intaglio surface trueness of obturator prosthesis bases manufactured by traditional compression molding, injection molding, and 3D printing techniques. MATERIALS AND METHODS: A complete edentulous master cast with Aramany Class I maxillary defect was selected for this in vitro study. Four study groups (n = 10/group) were included in this study, Group A: Compression Molding, Group B: Injection Molding, and Group C: Cara Print 3D DLP Printer, and Group D: Carbon 3D DLS Printer. All obturator prostheses' intaglio surfaces were scanned with a laboratory scanner (E4; 3Shape Inc, New Providence, NJ) and the dimensional differences between study samples and their corresponding casts were calculated as the root mean square (measured in mm, absolute value) using a surface matching software (Geomagic design X; 3D Systems, Rock Hill, SC). One-way Analysis of variance (ANOVA) and Fisher's least significant difference (LSD) test were used to compare groups differences in RMS (α = 0.05). RESULTS: There was a significant effect of manufacturing technique on the RMS values for the 4 conditions [F(3,36) = 5.743, p = 0.003]. Injection Molding (0.070 mm) and Compression Molding groups (0.076 mm) had a lower interquartile range, and the Cara Print 3D-Printer group (0.427 mm) and Carbon 3D-Printer (0.149 mm) groups had a higher interquartile range. The Injection Molding group showed the best and uniform surface matching with the most area in green in the color maps. The Injection Molding group (0.139 ± 0.049 mm) had significantly lower RMS than all other groups (p < 0.001 for all comparisons). Compression Molding (0.269 ± 0.057 mm), Cara Print 3D-Printer (0.409 ± 0.270 mm), and Carbon 3D-Printer (0.291 ± 0.082 mm) groups were not significantly different from each other (Compression Molding versus Carbon 3D-Printer, p = 0.59; Compression Molding versus Cara Print 3D-Printer, p = 0.25; Cara Print 3D-Printer versus Carbon 3D-Printer, p = 0.40). CONCLUSION: Obturator prosthesis bases manufactured with injection molding technique showed better intaglio surface trueness than ones made by the compression molding technique and 3D printers. Although obturator prosthesis bases manufactured from different 3D printers showed similar trueness, a DLP 3D printer produced less consistent outcome than a DLS 3D printer.
Assuntos
Desenho Assistido por Computador , Implantes Dentários , Prótese Total , Maxila , Impressão TridimensionalRESUMO
PURPOSE: To evaluate the fracture resistance behaviors of titanium-zirconium, one-piece zirconia, and two-piece zirconia implants restored by zirconia crowns and different combinations of abutment materials (zirconia and titanium) and retention modes (cement-retained and screw-retained zirconia crowns). MATERIAL AND METHODS: Three research groups (n=12) were evaluated according to combinations of abutment material, retention mode, and implant type. In the control group (TTC), titanium-zirconium implants (∅ 4.1 mm RN, 12 mm, Roxolid; Straumann USA, Andover, MA) and prefabricated titanium abutments (RN synOcta Cementable Abutment, H 5.5 mm; Straumann USA) were used to support cement-retained zirconia crowns. In the second group (ZZC), one-piece zirconia implants (PURE Ceramic Implant Monotype, ∅ 4.1 mm RD, 12 mm, AH 5.5 mm; Straumann USA) were used to support cement-retained zirconia crowns. In the third group (ZTS), two-piece zirconia implants (PURE Ceramic Implant, ∅ 4.1 mm RD, 12 mm) and prefabricated titanium abutments (CI RD PUREbase Abutment, H 5.5 mm) were used to support screw-retained zirconia crowns. All zirconia crowns were manufactured in the same anatomic contour with a 5-axis dental mill and blended 3 and 5 mol% yttria-stabilized zirconia (LayZir A2). Implants were inserted into specimen holders made of epoxy resin-glass fiber composite. All specimens were then subject to artificial aging in an incubator at 37°C for 90 days. Fracture resistance of specimen assemblies was tested under static compression load using the universal testing machine based on ISO14801 specification. The peak fracture loads were recorded. All specimens were examined at the end of the test microscopically at 5× and 10× magnification to detect any catastrophic failures. Comparisons between groups for differences in peak fracture load were made using Wilcoxon Rank Sum tests and Weibull and Kaplan-Meier survival analyses (α = 0.05). RESULTS: The TTC group (942 ± 241 N) showed significantly higher peak fracture loads than the ZZC (645 ± 165 N) and ZTS (650 ± 124 N) groups (p < 0.001), while there was no significant difference between ZZC and ZTS groups (p = 0.940). The survival probability based on the Weibull and Kaplan-Meier models demonstrated different failure molds between titanium-zirconium and zirconia implants, in which the TTC group remained in the plastic strain zone for a longer period before fracture when compared to ZZC and ZTS groups. Catastrophic failures, with implant fractures at the embedding level or slightly below, were only observed in the ZZC and ZTS groups. CONCLUSIONS: Cement-retained zirconia crowns supported by titanium-zirconium implants and prefabricated titanium abutments showed superior peak fracture loads and better survival probability behavior. One-piece zirconia implants with cement-retained zirconia crowns and two-piece zirconia implants with screw-retained zirconia crowns on prefabricated titanium abutment showed similar peak fracture loads and survival probability behavior. Titanium-zirconium and zirconia implants could withstand average intraoral mastication loads in the incisor region. This study was conducted under static load, room temperature (21.7°C), and dry condition, and full impacts of intraoral hydrothermal aging and dynamic loading conditions on the zirconia implants should be considered and studied further.
Assuntos
Implantes Dentários , Zircônio , Coroas , Dente Suporte , Projeto do Implante Dentário-Pivô , Materiais Dentários , Falha de Restauração Dentária , Análise do Estresse Dentário , Teste de Materiais , TitânioRESUMO
This technique describes a workflow to align the maxillary and mandibular edentulous intraoral scans in the computer-aided design and computer-aided manufacturing (CAD-CAM) software program for the fabrication of CAD-CAM implant-retained overdentures. Using the patient's existing and clinically satisfactory interim complete dentures as an aid for the interocclusal record, this technique provides a convenient option for aligning edentulous intraoral scans without the need for an additional clinical appointment, record base, or maxillomandibular tracing device.
Assuntos
Implantes Dentários , Boca Edêntula , Desenho Assistido por Computador , Planejamento de Dentadura , Prótese Total , Revestimento de Dentadura , Humanos , Boca Edêntula/diagnóstico por imagemRESUMO
This technical report describes a digital process to design and fabricate a verification device directly from an intraoral scan for nonsegmental implant-supported dental prostheses. By using an open source computer-aided design software program, this technique provides an economical option for dentists and dental laboratory technicians to fabricate a computer-aided design and computer-aided manufacturing (CAD-CAM) verification device. This technique is particularly beneficial for a long scanning span and large edentulous space with multiple scan bodies, and a verification device can be used to confirm the accuracy of a CAD-CAM implant definitive cast.
Assuntos
Implantes Dentários , Boca Edêntula , Desenho Assistido por Computador , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , HumanosRESUMO
The increased precision and design of surgical templates for static computer-aided implant surgery has led to concerns of excessive heat generation from the friction between the twist drills, metal sleeves in the surgical template, and guide handles during osteotomy preparation. In addition, the presence of a surgical template can prevent proper cooling of the twist drill as it enters the osteotomy site, leading to greater heat generation. This excessive heat may result in bone necrosis and failure of osseointegration to the implant surface. This article describes a straightforward technique of incorporating an existing design feature in many virtual implant planning software programs to add an irrigation channel to the implant surgical template for effective cooling during osteotomy preparation.