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12 pages, 16415 KiB

Open AccessArticle

Additive Manufacturing of Resected Oral and Oropharyngeal Tissue: A Pilot Study

by Alexandria L. Irace, Anne Koivuholma, Eero Huotilainen, Jaana Hagström, Katri Aro, Mika Salmi, Antti Markkola, Heli Sistonen, Timo Atula and Antti A. Mäkitie

Int. J. Environ. Res. Public Health 2021, 18(3), 911; https://doi.org/10.3390/ijerph18030911 - 21 Jan 2021

Cited by 1 | Viewed by 2353

Abstract

Better visualization of tumor structure and orientation are needed in the postoperative setting. We aimed to assess the feasibility of a system in which oral and oropharyngeal tumors are resected, photographed, 3D modeled, and printed using additive manufacturing techniques. Three patients diagnosed with [...] Read more.

Better visualization of tumor structure and orientation are needed in the postoperative setting. We aimed to assess the feasibility of a system in which oral and oropharyngeal tumors are resected, photographed, 3D modeled, and printed using additive manufacturing techniques. Three patients diagnosed with oral/oropharyngeal cancer were included. All patients underwent preoperative magnetic resonance imaging followed by resection. In the operating room (OR), the resected tissue block was photographed using a smartphone. Digital photos were imported into Agisoft Photoscan to produce a digital 3D model of the resected tissue. Physical models were then printed using binder jetting techniques. The aforementioned process was applied in pilot cases including carcinomas of the tongue and larynx. The number of photographs taken for each case ranged from 63 to 195. The printing time for the physical models ranged from 2 to 9 h, costs ranging from 25 to 141 EUR (28 to 161 USD). Digital photography may be used to additively manufacture models of resected oral/oropharyngeal tumors in an easy, accessible and efficient fashion. The model may be used in interdisciplinary discussion regarding postoperative care to improve understanding and collaboration, but further investigation in prospective studies is required. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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12 pages, 3179 KiB

Open AccessArticle

The Effect of Perioral Scan and Artificial Skin Markers on the Accuracy of Virtual Dentofacial Integration: Stereophotogrammetry Versus Smartphone Three-Dimensional Face-Scanning

by Hang-Nga Mai and Du-Hyeong Lee

Int. J. Environ. Res. Public Health 2021, 18(1), 229; https://doi.org/10.3390/ijerph18010229 - 30 Dec 2020

Cited by 6 | Viewed by 3030

Abstract

This study evaluated the effects of different matching methods on the accuracy of dentofacial integration in stereophotogrammetry and smartphone face-scanning systems. The integration was done (N = 30) with different matching areas (n = 10), including teeth image only (TO), perioral area [...] Read more.

This study evaluated the effects of different matching methods on the accuracy of dentofacial integration in stereophotogrammetry and smartphone face-scanning systems. The integration was done (N = 30) with different matching areas (n = 10), including teeth image only (TO), perioral area without markers (PN) and with markers (PM). The positional accuracy of the integrated models was assessed by measuring the midline linear deviations and incisal line canting between the experimental groups and laser scanner-based reference standards. Kruskal–Wallis and Mann–Whitney U tests were used for statistical analyses (α = 0.05). The PM method exhibited the smallest linear deviations in both systems; while the highest deviations were found in the TO in stereophotogrammetry; and in PN in smartphone. For the incisal line canting; the canting degree was the lowest in the PM method; followed by that in the TO and the PN in both systems. Although stereophotogrammetry generally exhibited higher accuracy than the smartphone; the two systems demonstrated no significant difference when the perioral areas were used for matching. The use of perioral scans with markers enables accurate dentofacial image integration; however; cautions should be given on the accuracy of the perioral image obtained without the use of markers. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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15 pages, 3696 KiB

Open AccessArticle

Accuracy of Dynamic Navigation System Workflow for Implant Supported Full Arch Prosthesis: A Case Series

by Luigi V. Stefanelli, George A. Mandelaris, Alessio Franchina, Nicola Pranno, Michele Pagliarulo, Francesca Cera, Fabio Maltese, Francesca De Angelis and Stefano Di Carlo

Int. J. Environ. Res. Public Health 2020, 17(14), 5038; https://doi.org/10.3390/ijerph17145038 - 13 Jul 2020

Cited by 19 | Viewed by 2927

Abstract

A minimally invasive implant treatment approach for future full arch implant prosthetic rehabilitations of trophic jaws represents a challenge. An optimal implant planning is strongly related with an accurate merge of the prosthetic information and the radiographic data. To comply with that, most [...] Read more.

A minimally invasive implant treatment approach for future full arch implant prosthetic rehabilitations of trophic jaws represents a challenge. An optimal implant planning is strongly related with an accurate merge of the prosthetic information and the radiographic data. To comply with that, most computer aided implantology (CAI) systems require additional steps, as radiographic stents or fiducial markers to overlap digital jaw scans to cone beam computed tomography (CBCT) data. Using dynamic CAI, residual teeth (up to three) make it possible for the merge to avoid new radiographic scans. An additional challenge is the treatment involving immediate implants compared with delayed implants placed into healed bone. As for other static CAI systems, the operator’s experience and the quality of the CBCT data make the planning affordable and secure the entire implants placement procedure. The literature reports accuracies in terms of comparison between placed implants and planned implants, following a double CBCT approach, based on radiographic volume overlapping. Thirteen consecutive future totally edentulous patients (77 implants), divided into two groups (group A: 3–4 teeth traced; group B: 5–6 teeth traced) requiring a full arch implant prosthetic rehabilitation were included in the reported case series. A dynamic CAI was used to plan and to place all implants following all the recommended digital steps. The software used provided a tool (Trace and Place) that made the merge between X-ray views of the residual teeth and their own positions possible. This method definitely registered that teeth positions comply with the required accuracy live check. After implants placement, a post-operative CBCT was taken in order to evaluate the deviations of the achieved implants at coronal, apical, and depth level as well as angular deviations. Statistically significant radiological mean difference between the two groups was found in the coronal position of implants (0.26 mm, p < 0.001), in the apical position of implants (0.29 mm, p < 0.001), in the depth of implants (0.16 mm, p = 0.022), and in the angular deviation (0.7, p = 0.004). The use of the TaP technology for the treatment of the patients with at least three stable teeth that need to be removed for a totally implant prosthetic treatment is a promising technique. The performed accuracy analysis demonstrated that this digital protocol can be used without a loss of accuracy of the achieved implants compared to planned ones. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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16 pages, 1500 KiB

Open AccessArticle

Integrated 3D Information for Custom-Made Bone Grafts: Focus on Biphasic Calcium Phosphate Bone Substitute Biomaterials

by Alessandra Giuliani, Maria Laura Gatto, Luigi Gobbi, Francesco Guido Mangano and Carlo Mangano

Int. J. Environ. Res. Public Health 2020, 17(14), 4931; https://doi.org/10.3390/ijerph17144931 - 08 Jul 2020

Cited by 2 | Viewed by 2382

Abstract

Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca₃(PO₄)₂, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate [...] Read more.

Purpose: Several studies showed that the sintering temperature of 1250 °C could affect the formation of α-Ca₃(PO₄)₂, which is responsible for the reduction of the hardness value of biphasic calcium phosphate biocomposites, but they did not evaluate the inference of the sintering time at peak temperature on transition of β-Ca₃(PO₄)₂ to α-Ca₃(PO₄)₂. This analysis explored, in an innovative way, inferences and correlations between volumetric microstructure, mechanical properties, sintering temperature, and time at peak temperature in order to find the best sintering conditions for biphasic calcium phosphate composites grafted in severe alveolar bone defects. Methods: Sintered biphasic calcium phosphates (30%-hydroxyapatite/70%-tricalcium phosphate) were tested by microCT imaging for the 3D morphometric analysis, by compressive loading to find their mechanical parameters, and by X-ray diffraction to quantify the phases via Rietveld refinement for different sintering temperatures and times at the peak temperature. Data were analysed in terms of statistical inference using Pearson’s correlation coefficients. Results: All the studied scaffolds closely mimicked the alveolar organization of the jawbone, independently on the sintering temperatures and times; however, mechanical testing revealed that the group with peak temperature, which lasted for 2 hours at 1250 °C, showed the highest strength both at the ultimate point and at fracture point. Conclusion: The good mechanical performances of the group with peak temperature, which lasted for 2 hours at 1250 °C, is most likely due to the absence of the α-Ca₃(PO₄)₂ phase, as revealed by X-ray diffraction. However, we detected its presence after sintering at the same peak temperature for longer times, showing the time-dependence, combined with the temperature-dependence, of the β-Ca₃(PO₄)₂ to α-Ca₃(PO₄)₂ transition. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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12 pages, 6852 KiB

Open AccessArticle

Digital versus Conventional Impression Taking Focusing on Interdental Areas: A Clinical Trial

by Maximiliane Amelie Schlenz, Victoria Schubert, Alexander Schmidt, Bernd Wöstmann, Sabine Ruf and Katharina Klaus

Int. J. Environ. Res. Public Health 2020, 17(13), 4725; https://doi.org/10.3390/ijerph17134725 - 30 Jun 2020

Cited by 21 | Viewed by 3661

Abstract

Due to the high prevalence of periodontitis, dentists have to face a larger group of patients with periodontally compromised dentitions (PCDs) characterized by pathologic tooth migration and malocclusion. Impression taking in these patients is challenging due to several undercuts and extensive interdental areas [...] Read more.

Due to the high prevalence of periodontitis, dentists have to face a larger group of patients with periodontally compromised dentitions (PCDs) characterized by pathologic tooth migration and malocclusion. Impression taking in these patients is challenging due to several undercuts and extensive interdental areas (IAs). The aim of this clinical trial was to analyze the ability of analog and digital impression techniques to display the IAs in PCDs. The upper and the lower jaws of 30 patients (n = 60, age: 48–87 years) were investigated with one conventional impression (CVI) using polyvinyl siloxane and four digital impressions with intraoral scanners (IOSs), namely True Definition (TRU), Primescan (PRI), CS 3600 (CAR), and TRIOS 3 (TIO). The gypsum models of the CVIs were digitalized using a laboratory scanner. Subsequently, the percentage of the displayed IAs in relation to the absolute IAs was calculated for the five impression techniques in a three-dimensional measuring software. Significant differences were observed among the impression techniques (except between PRI and CAR, p-value < 0.05). TRU displayed the highest percentage of IAs, followed by PRI, CAR, TIO, and CVI. The results indicated that the IOSs are superior to CVI regarding the ability to display the IAs in PCDs. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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8 pages, 2217 KiB

Open AccessArticle

Repeatability of Freehand Implantations Supported with Universal Plastic Sleeves—In Vitro Study

by Łukasz Zadrożny, Marta Czajkowska, Eitan Mijiritsky and Leopold Wagner

Int. J. Environ. Res. Public Health 2020, 17(12), 4453; https://doi.org/10.3390/ijerph17124453 - 21 Jun 2020

Cited by 6 | Viewed by 2909

Abstract

Repeatability and precision are major factors which have an influence on final implant treatment results. The aim of this study was to evaluate the repeatability of freehand implant procedures assisted with special plastic sleeves which are placed on the drill to guarantee the [...] Read more.

Repeatability and precision are major factors which have an influence on final implant treatment results. The aim of this study was to evaluate the repeatability of freehand implant procedures assisted with special plastic sleeves which are placed on the drill to guarantee the proper mesiodistal distance from the landmark’s surface. Patient data required for implant treatment, including images of mandibles from CBCT scans and virtual models of soft tissues and teeth, were used to prepare complete virtual models of patient clinical conditions. The models were saved as STL files and 3D printed in five copies. Drilling procedures were done at positions 37, 46 and 47. Each model was scanned with pins in the osteotomies and compared using digital aligning of the models’ surfaces. The average deviation was −1.38 ± 1.4 mm. Average deviations on guide pins placed at position 37 were −0.46 ± 0.59 mm, at position 46 were −1.46 ± 0.88 mm (landmark’s surface of both: distal tooth’s surface), and at position 47 were the highest: −2.69 ± 1.62 mm (landmark’s surface: surface of plastic sleeve). The following conclusion was drawn: Using universal plastic sleeves could improve implant procedure precision especially in the case of partially edentulous patients. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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13 pages, 3345 KiB

Open AccessArticle

Artificial Intelligence (AI)-Driven Molar Angulation Measurements to Predict Third Molar Eruption on Panoramic Radiographs

by Myrthel Vranckx, Adriaan Van Gerven, Holger Willems, Arne Vandemeulebroucke, André Ferreira Leite, Constantinus Politis and Reinhilde Jacobs

Int. J. Environ. Res. Public Health 2020, 17(10), 3716; https://doi.org/10.3390/ijerph17103716 - 25 May 2020

Cited by 27 | Viewed by 4711

Abstract

The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n [...] Read more.

The purpose of the presented Artificial Intelligence (AI)-tool was to automatically segment the mandibular molars on panoramic radiographs and extract the molar orientations in order to predict the third molars’ eruption potential. In total, 838 panoramic radiographs were used for training (n = 588) and validation (n = 250) of the network. A fully convolutional neural network with ResNet-101 backbone jointly predicted the molar segmentation maps and an estimate of the orientation lines, which was then iteratively refined by regression on the mesial and distal sides of the segmentation contours. Accuracy was quantified as the fraction of correct angulations (with predefined error intervals) compared to human reference measurements. Performance differences between the network and reference measurements were visually assessed using Bland−Altman plots. The quantitative analysis for automatic molar segmentation resulted in mean IoUs approximating 90%. Mean Hausdorff distances were lowest for first and second molars. The network angulation measurements reached accuracies of 79.7% [−2.5°; 2.5°] and 98.1% [−5°; 5°], combined with a clinically significant reduction in user-time of >53%. In conclusion, this study validated a new and unique AI-driven tool for fast, accurate, and consistent automated measurement of molar angulations on panoramic radiographs. Complementing the dental practitioner with accurate AI-tools will facilitate and optimize dental care and synergistically lead to ever-increasing diagnostic accuracies. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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18 pages, 1024 KiB

Open AccessArticle

Patient-Reported Outcome Measures (PROMs) for Two Implant Placement Techniques in Sinus Region (Bone Graft versus Computer-Aided Implant Surgery): A Randomized Prospective Trial

by Ghazwan Almahrous, Sandra David-Tchouda, Aboubacar Sissoko, Nathalie Rancon, Jean-Luc Bosson and Thomas Fortin

Int. J. Environ. Res. Public Health 2020, 17(9), 2990; https://doi.org/10.3390/ijerph17092990 - 25 Apr 2020

Cited by 7 | Viewed by 2961

Abstract

Purpose: To assess patient-reported outcomes measures (PROMs) for two implant placement techniques in cases of sinus bone atrophy (bone graft surgery (BGS) versus computer-aided implant surgery (CAIS)), after surgery and one year later, and to evaluate the clinical success of both treatments. Methods: [...] Read more.

Purpose: To assess patient-reported outcomes measures (PROMs) for two implant placement techniques in cases of sinus bone atrophy (bone graft surgery (BGS) versus computer-aided implant surgery (CAIS)), after surgery and one year later, and to evaluate the clinical success of both treatments. Methods: Sixty patients with bone atrophy in the posterior maxilla and in need of implant placement were randomly assigned to two groups, and in accordance with the case report form (CRF), 30 were treated with BGS and 30 with CAIS. Immediately after treatment and one year later, PROMs were assessed, and the clinical success of both treatments was evaluated. Results: No significant differences were found between BGS and CAIS with regard to the following: loss of implants (p = 492); patient recommendation (p = 210); duration of surgery (p = 987); pain on the intervention day (p = 512); pain in the week after intervention (p = 299); and complications in the stage of surgery (p = 1.00). Similarly, at one year, no differences were found with regard to the following: pain around implant (p = 481); infection of implants (p = 491); abnormal radiographic imaging (p = 226); occurrence of undesirable events (p = 1.00); loss of one of the implants (p = 1.00); plaque detection (p = 1.00); bleeding on probing (p = 236); and presence of keratinized mucosa (p = 226). However, a significant difference was found among BGS and CAIS with regard to the number of consultations (p = 0001); number of implants placed (p = 033); and treatment difficulty (p = 0369). Significant differences were found for peri-implantitis (p = 0481) and radiology of craterization (p = 020) in clinical examination at the first year. Conclusion: Treatment difficulty and number of consultations were higher for BGS than for CAIS, as well as peri-implantitis and bone craterization at one year, indicating significant differences between the two treatments. However, there were no statistically significant differences between BGS and CAIS regarding the other PROMs, at placement and after one year. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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11 pages, 1682 KiB

Open AccessArticle

The Innovative and Sustainable Use of Dental Panoramic Radiographs for the Detection of Osteoporosis

by Andy Wai Kan Yeung and Ioana Mozos

Int. J. Environ. Res. Public Health 2020, 17(7), 2449; https://doi.org/10.3390/ijerph17072449 - 03 Apr 2020

Cited by 32 | Viewed by 3229

Abstract

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and [...] Read more.

This bibliometric study evaluated the scientific impact of papers dealing with osteoporosis detected by dental panoramic radiographs by performing citation analysis and cited reference analysis. Retrospective data was extracted from the Web of Science Core Collection database and imported into VOSviewer, CRExplorer, and CitNetExplorer for analyzing semantic contents, cited references, and temporal citation network. The 280 relevant papers identified were cited 4874 times, having an h-index of 38 and 17.4 citations per paper. The top five major contributing countries were Japan (n = 54, 19.3%), USA (n = 43, 15.4%), Brazil (n = 38, 13.6%), Turkey (n = 38, 13.6%), and the UK (n = 32, 11.4%). Citation per paper correlated with publication count among the authors and institutions. Mandibular cortical width was the most frequently used and most cited measurement index. References published during the 1970s and 1980s have built the foundation for the development of research that investigates the potential associations between osteoporosis and radiographic measurements on panoramic radiographs. Osteoporosis detection by dental panoramic radiographs is a perennially investigated research topic with global contributions. Panoramic radiographs are considered early detection and screening tools for osteoporosis by worldwide research. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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12 pages, 2215 KiB

Open AccessArticle

New Intraoral Scanner-Based Chairside Measurement Method to Investigate the Internal Fit of Crowns: A Clinical Trial

by Maximiliane Amelie Schlenz, Jonas Vogler, Alexander Schmidt, Peter Rehmann and Bernd Wöstmann

Int. J. Environ. Res. Public Health 2020, 17(7), 2182; https://doi.org/10.3390/ijerph17072182 - 25 Mar 2020

Cited by 9 | Viewed by 3031

Abstract

To measure the internal fit of the computer-aided designed/computer-aided manufactured (CAD/CAM) crowns, a new scanner-based chairside approach was investigated in patients, and the results were compared to the established silicone replica technique and a digital laboratory replica method. Thirty full-coverage crown preparations were [...] Read more.

To measure the internal fit of the computer-aided designed/computer-aided manufactured (CAD/CAM) crowns, a new scanner-based chairside approach was investigated in patients, and the results were compared to the established silicone replica technique and a digital laboratory replica method. Thirty full-coverage crown preparations were included. Based on a digital impression with an intraoral scanner (IOS, Trios 3), three CAD/CAM measurement copings (‘COM’, resin composite; ‘ZIR’, zirconium dioxide; ‘NPA’, non-precious alloy) were fabricated for each tooth preparation. The internal fit of the measurement copings was analyzed with three different evaluation methods: IOS-based digital approach (D-IOS), digital replica method with laboratory software (D-GOM), and conventional silicone replica technique (CV-SR). The congruence between the determined target parameter of the 80-µm cement space and the actual measured internal gap was investigated. Statistical analysis was performed by ANOVA (p-value < 0.05). No significant difference was determined between the three evaluation methods. However, significant differences were observed for the three coping materials (p-value < 0.05), the single measurement position (marginal, axial, and occlusal fit) (p-value < 0.05), and the interaction between the coping material and the measurement position (p-value < 0.05). COM revealed the smallest internal gap, followed by ZIR and NPA. Regardless of the coping material, the occlusal gap was higher than the axial and marginal gaps. Furthermore, only the internal gaps of the marginal area almost matched the target parameter of 80-µm for the cement space. D-IOS is effective for measuring internal fit of single crowns in different clinical settings. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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16 pages, 3976 KiB

Open AccessArticle

Histologic, Histomorphometric, and Clinical Analysis of the Effects of Growth Factors in a Fibrin Network Used in Maxillary Sinus Augmentation

by Ihsan Caglar Cinar, Bahattin Alper Gultekin, Alper Saglanmak, Serdar Yalcin, Vakur Olgac and Eitan Mijiritsky

Int. J. Environ. Res. Public Health 2020, 17(6), 1918; https://doi.org/10.3390/ijerph17061918 - 15 Mar 2020

Cited by 6 | Viewed by 2866

Abstract

This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either [...] Read more.

This randomized controlled clinical trial evaluated the effect of mineralized plasmatic matrix (MPM), comprised of synthetic graft and platelet concentrates, on new bone formation and volume stability over time in maxillary sinus lifting (MSL). Unilateral MSL was performed in 20 patients with either beta-tricalcium phosphate (β-TCP) or MPM grafts (10 sinuses each). Six months postsurgery, specimens were obtained with a trephine bur prior to implant placement in 39 cases. Volumetric changes in sinus augmentation were analyzed between 1 week (T-I) and 6 months (T-II) postsurgery. Histomorphometric and histological analyses of biopsy samples revealed mean new bone percentages of 35.40% ± 9.09% and 26.92% ± 7.26% and residual graft particle areas of 23.13% ± 6.16% and 32.25% ± 8.48% in the MPM and β-TCP groups, respectively (p < 0.05). The mean soft-tissue areas in the MPM and β-TCP groups were 41.48% ± 8.41% and 40.83% ± 8.86%, respectively (p > 0.05). Graft reductions between baseline and 6-months postprocedure in the β-TCP and MPM groups were 17.12% ± 13.55% and 14.41% ± 12.87%, respectively, with significant graft volume reduction observed in both groups (p < 0.05) while there is no significant difference between MPM and β-TCP groups (p > 0.05). Thus, MPM, representing growth factors in a fibrin network, increases new bone formation and has acceptable volume stability in MSL procedures Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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10 pages, 3018 KiB

Open AccessArticle

Perceptions of Dentists and Non-Professionals on Some Dental Factors Affecting Smile Aesthetics: A Study from Vietnam

by Vo Truong Nhu Ngoc, Dang-Khoa Tran, Truong Manh Dung, Nguyen Viet Anh, Vu Thi Nga, Le Quynh Anh, Nguyen Thi Thuy Hanh, Nguyen Phuong Linh, Hoang Ngoc Quynh and Dinh Toi Chu

Int. J. Environ. Res. Public Health 2020, 17(5), 1638; https://doi.org/10.3390/ijerph17051638 - 03 Mar 2020

Cited by 10 | Viewed by 6637

Abstract

Aim: It is important to meet the aesthetic expectation regarding the smile concept of both dentists and non-professionals after treatment is complete. Therefore, the study aims to evaluate the effects of altered displays in incisors, gingival margin, and other smile-related-factors on dentists’ [...] Read more.

Aim: It is important to meet the aesthetic expectation regarding the smile concept of both dentists and non-professionals after treatment is complete. Therefore, the study aims to evaluate the effects of altered displays in incisors, gingival margin, and other smile-related-factors on dentists’ vs. non-professionals’ aesthetics perceptions. Materials and method: We altered the features of 42 digital smile photographs to generate the changed displays in incisors, gingival margin, and other smile-related-factors. Then, these altered photographs were presented to 51 dentists and 51 non-professionals, and each picture was rated by each participant with a visual analog scale ranging from 0 (very ugly) to 100 (very beautiful). Results: We found that the alterations in incisors, gingival margin, and other factors affected studied groups’ aesthetic perception of smile. The ugly smile threshold rated by both groups for crown length of maxillary central incisors was 2.0 mm. This threshold was 2.5 mm for dentists, with moving the gingival margin of maxillary lateral incisors to the incisal ridge. The ugly thresholds for other smile-related-factors were different between studied groups; for example, the ugly thresholds for gingival exposure levels were 3 and 4mm for dentists and non-professionals, respectively. Thus, our data indicate that altered displays in incisors, gingival margin, and other smile-related-factors affected perceptions of both studied groups on smile aesthetics, but dentists tended to feel more refined than non-professionals. Dentists and non-professionals had significantly different aesthetic perceptions of the alteration of the gingival exposure level. Conclusion: Both dentists and non-professionals’ perceptions should be fully considered during orthodontic and prosthodontic treatment to achieve optimum aesthetic results. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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9 pages, 3076 KiB

Open AccessArticle

Comparative Analysis of the Reproduction Accuracy of Main Methods for Finding the Mandible Position in the Centric Relation Using Digital Research Method. Comparison between Analog-to-Digital and Digital Methods: A Preliminary Report

by Andrey Stafeev, Aleksandr Ryakhovsky, Pavel Petrov, Sergey Chikunov, Aleksandr Khizhuk, Marina Bykova and Nataliya Vuraki

Int. J. Environ. Res. Public Health 2020, 17(3), 933; https://doi.org/10.3390/ijerph17030933 - 03 Feb 2020

Cited by 4 | Viewed by 3514

Abstract

Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording [...] Read more.

Purpose: To compare the aspect of the reproduction accuracy in studied methods of determination of the (CR) of jaws using the digital research methods. The methods used were bilateral manipulation by P.E. Dawson, frontal deprogrammer, leaf gauge, and intraoral device for recording of Gothic arch angle. Methods: To determine the reproduction accuracy of the centric relation of jaws, we examined 5 patients with intact dentition in a prosthetic dentistry clinic (first class in Angle’s system). For each method, 20 registrations of the centric jaw relation were carried out by one operator. The breaks between definitions were 30 minutes. A total of 400 CR recording operations were carried out (400 records of CR). In order to study the reproducibility of CR determination methods, 200 recorded mandible positions were analyzed by means of an analog-to-digital method (a macro kit Canon 650D, Canon 60 mm macro IS USM f2.8, Canon macro ring MR-14 EX and the computer program Adobe Photoshop) to assess the first occlusal contact obtained in the CR of jaws, while the other 200 were analyzed by means of a digital method (the computer program Avantis for 3D modeling, Prime as a laboratory 3D scanner (DOF), and Trios as an intraoral scanner (3Shape)) to assess the spatial position of the mandible in the CR. Statistical analysis was carried out using STATISTICA-10. In all statistical analysis procedures, the critical significance level p was assumed to be 0.05. Results: In the study of the data by means of the computer program Avanti 3D, the reproducibility of the mandible position in the CR reached 0.119 ± 0.012 mm for frontal deprogrammer, 0.225 ± 0.028, p ≤ 0.05 for bilateral manipulation by Dawson P.E., 0.207 ± 0.02, p ≤ 0.05 for leaf gauge, and 0.120 ± 0,013, p ≤ 0.05 using an intraoral device for recording the Gothic arch angle. The analog-to-digital method showed an identical tendency for reproduction of the mandible position. Conclusions: The digital analysis we made using the Avantis 3D program showed, with high confidence, that the maximum reproducibility of the CR position was reached by using our own design frontal deprogrammer and the device for recording Gothic arch angle. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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16 pages, 7290 KiB

Open AccessArticle

An Experimental Strategy for Capturing the Margins of Prepared Single Teeth with an Intraoral Scanner: A Prospective Clinical Study on 30 Patients

by Francesco Guido Mangano, Bidzina Margiani, Ivan Solop, Nadezhda Latuta and Oleg Admakin

Int. J. Environ. Res. Public Health 2020, 17(2), 392; https://doi.org/10.3390/ijerph17020392 - 07 Jan 2020

Cited by 5 | Viewed by 4226

Abstract

Purpose: To present an experimental strategy for successfully capturing the margins of prepared single teeth with an intraoral scanner (IOS). Methods: The protocol was as follows: (1) an intraoral impression was captured with an IOS, without taking care of the visibility [...] Read more.

Purpose: To present an experimental strategy for successfully capturing the margins of prepared single teeth with an intraoral scanner (IOS). Methods: The protocol was as follows: (1) an intraoral impression was captured with an IOS, without taking care of the visibility of the margins; (2) a partial analog impression was taken by means of a 3D-printed custom tray filled with polyvinylsiloxane light, after the removal of a retraction cord; (3) the hollow portion of the analog impression, with the preparation margins clearly visible, was scanned extraorally with the same IOS; (4) the scan of the analog impression was imported into computer-assisted-design (CAD) software, where its normals were inverted; (5) the scan with inverted normals was registered on the first intraoral scan, and replaced it; (6) the technician designed the final restoration, which was fabricated and delivered for application. The study outcomes were: (1) the marginal adaptation of the final crown; (2) the quality of interproximal contacts; and (3) the quality of occlusal contacts. Results: Thirty patients (18 males, 12 females; mean age 51.3 ± 11.6 years) were selected for this study. All these patients were restored with a monolithic translucent zirconia crown, fabricated following the aforementioned protocol. The clinical precision and the marginal adaptation of the crowns were optimal, interproximal contact points were perfect, and the only necessary adaptations were occlusal, with some minor precontacts that had to be polished. Conclusions: The present protocol seems to be compatible with the fabrication of clinically precise zirconia crowns. Further studies are needed to confirm these results. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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15 pages, 3062 KiB

Open AccessEditor’s ChoiceArticle

Reliability of a Virtual Prosthodontic Project Realized through a 2D and 3D Photographic Acquisition: An Experimental Study on the Accuracy of Different Digital Systems

by Luca Lavorgna, Gabriele Cervino, Luca Fiorillo, Giovanni Di Leo, Giuseppe Troiano, Marco Ortensi, Luigi Galantucci and Marco Cicciù

Int. J. Environ. Res. Public Health 2019, 16(24), 5139; https://doi.org/10.3390/ijerph16245139 - 16 Dec 2019

Cited by 54 | Viewed by 3929

Abstract

Aims: The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors [...] Read more.

Aims: The study aims to assess the accuracy of digital planning in dentistry, evaluating the characteristics of different intraoral 3D scanners and comparing it with traditional imaging 2D recording methods. Specifically, using computer aided design (CAD) software and measuring inside CAD software, authors want to verify the reliability of different models obtained with different techniques and machines. Methods: 12 patients that needed aesthetic restorative treatment were enrolled in the study. All the patients underwent recording data of the height and width dental elements 1.1, 1.2, and 1.3 size using different technologies and comparing 2D with 3D methods. A T test was then applied in order to verify whether there was a statistically significant difference between the measurements obtained, comparing the different tools data (Emerald, TRIOS, Photogrammetry and DSS (Digital Smile System)) with the reference values. Results: No significant differences emerged in the measurements made with the different scanners (Trios 3Shape ^®, Planmeca Emerald ^®) and photogrammetry. Therefore, what should be underlined regarding the 2D measurements is the speed and simplicity compared to all 3D techniques, so this work can help to better define the field of application and the limits connected to 2D techniques, giving a good window of the technique. Conclusions: The low number of patients is not sufficient to provide statistically significant results, but the digital planning future prospects seem to be promising. This study results highlighted how a photogrammetric scanner for dental arches would only have a much smaller shooting field size and greater accuracy. Despite these considerations, the photogrammetric facial scanner provided excellent results for the measurement of individual teeth, showing a great versatility of use. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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13 pages, 7794 KiB

Open AccessCase Report

Full-Digital Workflow for Fabricating a Custom-Made Direct Metal Laser Sintering (DMLS) Mandibular Implant: A Case Report

by Francesco Grecchi, Piero Antonio Zecca, Aldo Macchi, Alessandro Mangano, Federica Riva, Emma Grecchi and Carlo Mangano

Int. J. Environ. Res. Public Health 2020, 17(8), 2693; https://doi.org/10.3390/ijerph17082693 - 14 Apr 2020

Cited by 10 | Viewed by 2995

Abstract

Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top [...] Read more.

Direct Laser Metal Sintering (DLMS) is an additive manufacturing (AM) technique that is capable of manufacturing metal parts according to a three-dimensional (3D) design made using computer-assisted-design (CAD) software, thanks to a powerful laser beam that melts selectively micro-powder layers, one on top of the other, until the desired object is generated. With DMLS, it is now possible to fabricate custom-made titanium implants for oral and maxillofacial applications. We present the case of a 67-year-old woman diagnosed with a squamous cell carcinoma of the mandible. The patient underwent subtotal mandibular resection; conventional reconstruction procedures failed to rehabilitate the function of the mandible. A prosthesis replacing the resected mandible was designed and fabricated using a digital workflow. The extensive bone defect was rehabilitated with a prosthesis replacing the mandibular bone and supporting a morse-taper dental prosthesis. The masticatory function was reestablished. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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11 pages, 1224 KiB

Open AccessProtocol

An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 2: The Restoration of Molar Incisor Hypomineralization in Children

by Esti Davidovich, Shlomi Dagon, Israel Tamari, Michael Etinger and Eitan Mijiritsky

Int. J. Environ. Res. Public Health 2020, 17(5), 1499; https://doi.org/10.3390/ijerph17051499 - 26 Feb 2020

Cited by 16 | Viewed by 4970

Abstract

Until recently, the treatment for molar incisor hypomineralization (MIH) mainly included interim restorations such as resin restorations and stainless-steel crowns. These require replacement after adolescence. The use of intraoral scanners (IOS) has opened a new venue for restoring MIH teeth, by reducing the [...] Read more.

Until recently, the treatment for molar incisor hypomineralization (MIH) mainly included interim restorations such as resin restorations and stainless-steel crowns. These require replacement after adolescence. The use of intraoral scanners (IOS) has opened a new venue for restoring MIH teeth, by reducing the challenge of dealing with uncooperative children’s behavior and enabling tooth structure preservation and long-lasting restoration. We present an innovative treatment approach for children with MIH, using a digital workflow with IOS and CAD-CAM (computer-aided design and computer-aided manufacturing) fabrication of the restoration. The overall protocol involves a thorough diagnostic phase throughout treatment planning, which takes into consideration the child’s behavior and the parent’s cooperation and compliance. Initial preparation consists of inhalation sedation if needed, an effective local anesthesia, and the use of a rubber dam. Removal of all areas of enamel and dentin porosity is essential, and the tooth/teeth must be appropriately prepared to accommodate inlays or onlays for molars and labial veneers for incisors. IOS impressions are taken, including scanning of the prepared tooth and its antagonist, scanning of the bite, and CAD-CAM preparation of the restoration. Next is restoration, cementation, and follow up. Digital workflow provides definitive restorations in young patients due to the high accuracy of the scanning. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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10 pages, 2940 KiB

Open AccessProtocol

An Innovative Treatment Approach Using Digital Workflow and CAD-CAM Part 1: The Restoration of Endodontically Treated Molars in Children

by Esti Davidovich, Boaz Shay, Eyal Nuni and Eitan Mijiritsky

Int. J. Environ. Res. Public Health 2020, 17(4), 1364; https://doi.org/10.3390/ijerph17041364 - 20 Feb 2020

Cited by 11 | Viewed by 4316

Abstract

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) [...] Read more.

Stainless steel crowns are the most popular restoration technique for young permanent first molars treated endodontically. However, these restorations are not aesthetically appealing and need to be replaced. Endocrowns constitute a reliable approach for restoring severely damaged molars and premolars. Intraoral scanners (IOSs) are well tolerated by children and are easily and quickly implemented. We present an innovative treatment approach for endodontically treated teeth in children, using a digital workflow with IOS and computer-aided design/computer-assisted manufacturing (CAD/CAM) fabrication of the restoration. The protocol involves a thorough diagnostic phase and comprehensive treatment planning. Among the factors to be considered are the child’s behavior, the parents’ cooperation and compliance, and initial preparation including inhalation sedation, effective local anaesthesia and the use of a rubber dam. Full attention should be given to 1–2 mm of ferruling by the endocrown, which should be appropriately prepared to accommodate endocrowns for molars. IOSs include scanning of the prepared tooth and its antagonist, and scanning of the bite. CAD-CAM preparation of the restoration is followed by restoration bonding and follow up. Digital workflow should be considered in the treatment of endodontically treated molars since the high accuracy of the scanning enables definitive restoration in young patients. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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13 pages, 11141 KiB

Open AccessCase Report

Full Digital Workflow for the Treatment of an Edentulous Patient with Guided Surgery, Immediate Loading and 3D-Printed Hybrid Prosthesis: The BARI Technique 2.0. A Case Report

by Pietro Venezia, Ferruccio Torsello, Vincenzo Santomauro, Vittorio Dibello and Raffaele Cavalcanti

Int. J. Environ. Res. Public Health 2019, 16(24), 5160; https://doi.org/10.3390/ijerph16245160 - 17 Dec 2019

Cited by 27 | Viewed by 9139

Abstract

Purpose: To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an implant-supported 3D-printed hybrid prosthesis (an acrylic resin complete fixed dental prosthesis supported by implants). Methods: In edentulous cases, [...] Read more.

Purpose: To describe a technique intended to transfer of the intermaxillary and occlusal relationships in a fully digital environment from a complete denture to an implant-supported 3D-printed hybrid prosthesis (an acrylic resin complete fixed dental prosthesis supported by implants). Methods: In edentulous cases, the physiological mandibular position should be determined before the immediate loading procedures. In some cases, the use of interim removable prostheses for a few weeks could be useful to test the new occlusion in centric relation and to verify the prosthetic project. When the correct intermaxillary relationships are achieved, it is difficult to transfer them from the provisional to the final prostheses, as impressions or scans of edentulous arches do not have reference points for intermaxillary records. This paper presents a complex case and the technique used to transfer information from a complete denture to an implant-supported prosthesis with a digital workflow. A prosthetic stent has been used to scan the edentulous mandibular arch and to record the intermaxillary relation. Results: The delivery of the hybrid implant-supported prostheses was carried out with no problems and minimal occlusal adjustments. The patient was extremely satisfied with the treatment and the situation remained stable at the 1-year follow up. Conclusions: The approach described in the present article predictably maintains prosthetic information and allows the delivery of a final implant-supported restoration with the same occlusal relationship as the one tested with the provisional diagnostic dentures. Full article

(This article belongs to the Special Issue Digital Dentistry for Oral Health)

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