Trends in computer-aided manufacturing in prosthodontics: a review of the available streams.

In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses

Accuracy of casts produced from conventional and digital workflows: A qualitative and quantitative analyses

PURPOSE: Comparing the accuracy of casts produced from digital workflow to that of casts produced from conventional techniques. MATERIALS AND METHODS: Whole arch alginate (ALG) and polyvinyl siloxane (PVS) impressions were taken with stock trays and custom trays, respectively. The ALG impressions were poured with type III dental stone, while the PVS impressions were poured with type IV dental stone. For the digital workflow, IOS impressions were taken and physical casts were produced by 3D printing. In addition, 3D printed casts were produced from images obtained from a laboratory scanner (LS). For each technique, a total of 10 casts were produced. The accuracies of the whole arch and separated teeth were virtually quantified. RESULTS: Whole arch cast accuracy was more superior for PVS followed by LS, ALG, and IOS. The PVS and ALG groups were inferior in the areas more susceptible to impression material distortion, such as fossae and undercut regions. The LS casts appeared to have generalized errors of minor magnitude influencing primarily the posterior teeth. The IOS casts were considerably more affected at the posterior region. On the contrary, the IOS and LS casts were more superior for single tooth accuracy followed by PVS and ALG. CONCLUSION: For whole arch accuracy, casts produced from IOS were inferior to those produced from PVS and ALG. The inferior outcome of IOS appears to be related to the span of scanning. For single tooth accuracy, IOS showed superior accuracy compared to conventional impressions

Morphological Symmetry of Maxillary Anterior Teeth before and after Prosthodontic Planning: Comparison between Conventional and Digital Diagnostic Wax-Ups

OBJECTIVE: The aim of this study was to evaluate the impact of different prosthodontic planning methods on the morphological symmetry of maxillary anterior teeth. MATERIALS AND METHODS: In 13 patients receiving fixed prosthodontic treatment, dental models were obtained from the Oral Health Centre of Western Australia. Two forms of diagnostic prosthodontic planning were executed: conventional wax-up and digital wax-up. The asymmetry was evaluated at two levels: tooth morphological asymmetry (TMA) and anterior segment morphological asymmetry (ASMA). For the TMA, the labial surface of each anterior tooth was superimposed on a mirror image of the contralateral tooth. The ASMA involved superimposition of the combined labial surface of all the anterior teeth on one side on the mirror image of the combined labial surface of the contralateral side. For each asymmetry, the discrepancies in the form of 3D Euclidean distances were calculated and statistically evaluated by the Kruskal-Wallis test (p = 0.05). RESULTS: At the TMA level, the digital wax-up models had significantly less asymmetry (p 0.05). CONCLUSION: In this study, the single tooth symmetry had improved after the digital wax-up. However, the conventional wax-up had a minimal impact on single tooth symmetry. ASMA was minimally affected by the two wax-ups

Longevity of ceramic onlays: A systematic review

OBJECTIVE: This systematic review aimed to evaluate the longevity of ceramic onlays and identify the factors that influence their survival. MATERIALS AND METHODS: An electronic search was conducted through PubMed (MEDLINE), Google Scholar and Cochrane Library, up to August 2017. The literature search aimed to retrieve all the clinical studies on the longevity of ceramic onlays. Ceramic onlay was defined as any partial ceramic restoration that covers at least one cusp. RESULTS: A total of 21 studies met the selection criteria and were deemed suitable for this review. The medium‐term studies (2–5 years) indicated a survival rate of 91‐100%, and the long term studies (more than 5 years) showed a survival rate of 71–98.5%. The most common reason of failure was fracture, followed by debonding and caries. The most common patterns of deterioration were loss of margin integrity and discoloration. Onlay longevity can be enhanced if the preparation allows for at least 2 mm occlusal ceramic thickness and incorporates additional retentive features. Restoring teeth that are nonvital, teeth in a more posterior region, or teeth for patients with parafunctional habits appears to be associated with greater ceramic failure. Fabrication materials and methods, and adhesive bonding system did not seem to influence onlay longevity. CONCLUSIONS: The clinical performance of the ceramic onlay appears acceptable regardless of the follow‐up duration. Fracture of the ceramic onlay is the predominant cause of failure, and the most observed form of deterioration was associated with the restoration margin. CLINICAL SIGNIFICANCE: Ceramic onlay appears to be a reliable option to restore posterior teeth. The most common pattern of failure is fracture of the ceramic material. The risk of ceramic onlay failure seems to increase if the restored tooth is nonvital and the patient demonstrates parafunctional habits

Effect of different lateral occlusion schemes on peri-implant strain: A laboratory study

PURPOSE: This study aims to investigate the effects of four different lateral occlusion schemes and different excursions on peri-implant strains of a maxillary canine implant. MATERIALS AND METHODS: Four metal crowns with different occlusion schemes were attached to an implant in the maxillary canine region of a resin model. The included schemes were canine-guided (CG) occlusion, group function (GF) occlusion, long centric (LC) occlusion, and implant-protected (IP) occlusion. Each crown was loaded in three sites that correspond to maximal intercuspation (MI), 1 mm excursion, and 2 mm excursion. A load of 140 N was applied on each site and was repeated 10 times. The peri-implant strain was recorded by a rosette strain gauge that was attached on the resin model buccal to the implant. For each loading condition, the maximum shear strain value was calculated. RESULTS: The different schemes and excursive positions had impact on the peri-implant strains. At MI and 1 mm positions, the GF had the least strains, followed by IP, CG, and LC. At 2 mm, the least strains were associated with GF, followed by CG, LC, and IP. However, regardless of the occlusion scheme, as the excursion increases, a linear increase of peri-implant strains was detected. CONCLUSION: The peri-implant strain is susceptible to occlusal factors. The eccentric location appears to be more influential on peri-implant strains than the occlusion scheme. Therefore, adopting an occlusion scheme that can reduce the occurrence of occlusal contacts laterally may be beneficial in reducing peri-implant strains

Accuracy of Intraoral Scanners for Recording the Denture Bearing Areas: A Systematic Review

PURPOSE: To systematically review clinical and laboratory studies that investigated the accuracy of intraoral scanners in recording denture bearing areas. MATERIALS AND METHODS: Electronic and manual searches were conducted to identify all the available clinical and laboratory studies reporting the accuracy of digital impressions for recording denture related soft tissues. After the application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed to meet the objective of this study. RESULTS: The inclusion criteria were met by 18 studies out of which 8 were clinical and the rest were laboratory investigations. The eligible studies assessed the accuracy of intraoral scanners in recording both the denture supporting structures and the peripheral mobile tissues. The accuracy results were different among the various intraoral scanners. Likewise, the effect of several influencing factors, such as artificial markers, scanner head size, scanning strategy, and the operator's experience, were evaluated. CONCLUSION: While the accuracy of intraoral scanners was comparable to the conventional techniques in recording bony structures with attached mucosa, they were not capable of accurately registering the mobile tissues. In addition, factors such as presence of a marker, larger scanner head size and specific scanning techniques appeared to improve the accuracy of the digital impression. This article is protected by copyright. All rights reserved

Effect of prosthodontic planning on lateral occlusion scheme: a comparison between conventional and digital planning

UNLABELLED: Recently, digital wax-up is proposed as a tool to aid prosthodontic planning. However, there are no data about the effect of prosthodontic planning on lateral occlusion scheme. OBJECTIVE: This study aims to evaluate the impact of conventional and digital prosthodontic planning on lateral occlusion scheme. MATERIAL AND METHODS: Dental models of 10 patients were collected. All models had Angle Class I occlusion and were undergoing prosthodontic treatment that would influence the lateral occlusion scheme. Each set of models had received both conventional wax-up and digital wax-up. In relation to the lateral occlusion scheme, the following variables were evaluated: the prevalence of the different lateral occlusion scheme, number of contacting teeth and percentage of each contacting tooth. Four excursive positions on the working side were included: 0.5, 1.0, 2.0 and 3.0 mm from the maximal intercuspation position. RESULTS: The lateral occlusion scheme of the two wax-up models was subjected to alterations following excursion. There was a tendency for the prevalence of canine-guided occlusion to increase and for the prevalence of group function occlusion to decrease with increasing excursion. The number of contacting teeth was decreasing with the increasing magnitude of excursion. For the 0.5 mm and 1.0 mm positions, the two wax-ups had significantly greater contacts than the pre-treatment models, while at the 2.0 mm and 3.0 mm positions, all the models were similar. For all models, canines were the most commonly contacting teeth, followed by the teeth adjacent to them. No difference was observed between the two wax-ups in relation to the number of contacting teeth. CONCLUSION: Although the prosthodontic planning had influenced the pattern of the lateral occlusion scheme and contacts, there was no difference between the conventional and digital prosthodontic planning

Effect of modified tray design on accuracy of different impression techniques for parallel and divergent implants

This study evaluated the effect of a modified tray design on the accuracy of implant impressions in comparison with the non-splinted and splinted impression techniques. Two titanium frameworks were produced to fit two parallel implants and two divergent implants with a 15o angle. According to the frameworks employed, two acrylic resin master models were fabricated. For each model, 10 impressions were taken with every technique. The maximum framework principal strain was calculated for every generated cast. For the parallel implant model, the strains of the non-splinted (118.4 με), splinted (89.0 με), and modified tray design impression (49.4 με) techniques were statistically similar (P = 0.16). For the divergent implant model, all the impression techniques showed a considerably higher strain than the parallel implant model. The splinted (287.0 με) and the modified (262.9 με) tray design impression techniques showed similar strains for the divergent implant model, which were significantly less than the strains for the non-splinted impression (518.0 με) technique (P < 0.05). Therefore, for two parallel implants, all the impression techniques exhibited similar accuracy. When angulation existed between the implants, the splinted and the modified tray design impression techniques were more accurate than the non-splinted impression technique